Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.

PubMed

Mansfield, Haley E; Canar, W Jeffrey; Gerard, Carter S; O'Toole, John E

2014-11-01

Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

Current treatment of gram-positive infections: focus on efficacy, safety, and cost minimalization analysis of teicoplanin.

PubMed

Crane, V S; Garabedian-Ruffalo, S M

1992-12-01

The current health care environment has had a significant impact on hospital Pharmacy and Therapeutics Committee formulary decisions. In evaluating a new therapy for formulary inclusion, a cost savings along with equivalent or an improvement in patient care and safety is optimal. Teicoplanin is an investigational glycopeptide antimicrobial agent with a spectrum of activity similar to vancomycin. Unlike vancomycin, however, teicoplanin has a long elimination half-life permitting administration once daily, and is well tolerated when given intramuscularly. In addition, teicoplanin is associated with a favorable safety profile. Red man syndrome does not appear to be a significant clinical problem. Results of our cost minimalization analysis using the average acquisition costs of vancomycin revealed that teicoplanin (400 mg), at an average acquisition cost of less than $28.46 when administered intravenously and $30.93 when administered intramuscularly, offers a clinically efficacious, safe, and less expensive alternative to vancomycin therapy.

Quasi-Optimal Elimination Trees for 2D Grids with Singularities

DOE PAGES

Paszyńska, A.; Paszyński, M.; Jopek, K.; ...

2015-01-01

We consmore » truct quasi-optimal elimination trees for 2D finite element meshes with singularities. These trees minimize the complexity of the solution of the discrete system. The computational cost estimates of the elimination process model the execution of the multifrontal algorithms in serial and in parallel shared-memory executions. Since the meshes considered are a subspace of all possible mesh partitions, we call these minimizers quasi-optimal. We minimize the cost functionals using dynamic programming. Finding these minimizers is more computationally expensive than solving the original algebraic system. Nevertheless, from the insights provided by the analysis of the dynamic programming minima, we propose a heuristic construction of the elimination trees that has cost O N e log ⁡ N e , where N e is the number of elements in the mesh. We show that this heuristic ordering has similar computational cost to the quasi-optimal elimination trees found with dynamic programming and outperforms state-of-the-art alternatives in our numerical experiments.« less

Quasi-Optimal Elimination Trees for 2D Grids with Singularities

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

Paszyńska, A.; Paszyński, M.; Jopek, K.

We consmore » truct quasi-optimal elimination trees for 2D finite element meshes with singularities. These trees minimize the complexity of the solution of the discrete system. The computational cost estimates of the elimination process model the execution of the multifrontal algorithms in serial and in parallel shared-memory executions. Since the meshes considered are a subspace of all possible mesh partitions, we call these minimizers quasi-optimal. We minimize the cost functionals using dynamic programming. Finding these minimizers is more computationally expensive than solving the original algebraic system. Nevertheless, from the insights provided by the analysis of the dynamic programming minima, we propose a heuristic construction of the elimination trees that has cost O N e log ⁡ N e , where N e is the number of elements in the mesh. We show that this heuristic ordering has similar computational cost to the quasi-optimal elimination trees found with dynamic programming and outperforms state-of-the-art alternatives in our numerical experiments.« less

Economic Analysis of Panitumumab Compared With Cetuximab in Patients With Wild-type KRAS Metastatic Colorectal Cancer That Progressed After Standard Chemotherapy.

PubMed

Graham, Christopher N; Maglinte, Gregory A; Schwartzberg, Lee S; Price, Timothy J; Knox, Hediyyih N; Hechmati, Guy; Hjelmgren, Jonas; Barber, Beth; Fakih, Marwan G

2016-06-01

In this analysis, we compared costs and explored the cost-effectiveness of subsequent-line treatment with cetuximab or panitumumab in patients with wild-type KRAS (exon 2) metastatic colorectal cancer (mCRC) after previous chemotherapy treatment failure. Data were used from ASPECCT (A Study of Panitumumab Efficacy and Safety Compared to Cetuximab in Patients With KRAS Wild-Type Metastatic Colorectal Cancer), a Phase III, head-to-head randomized noninferiority study comparing the efficacy and safety of panitumumab and cetuximab in this population. A decision-analytic model was developed to perform a cost-minimization analysis and a semi-Markov model was created to evaluate the cost-effectiveness of panitumumab monotherapy versus cetuximab monotherapy in chemotherapy-resistant wild-type KRAS (exon 2) mCRC. The cost-minimization model assumed equivalent efficacy (progression-free survival) based on data from ASPECCT. The cost-effectiveness analysis was conducted with the full information (uncertainty) from ASPECCT. Both analyses were conducted from a US third-party payer perspective and calculated average anti-epidermal growth factor receptor doses from ASPECCT. Costs associated with drug acquisition, treatment administration (every 2 weeks for panitumumab, weekly for cetuximab), and incidence of infusion reactions were estimated in both models. The cost-effectiveness model also included physician visits, disease progression monitoring, best supportive care, and end-of-life costs and utility weights estimated from EuroQol 5-Dimension questionnaire responses from ASPECCT. The cost-minimization model results demonstrated lower projected costs for patients who received panitumumab versus cetuximab, with a projected cost savings of $9468 (16.5%) per panitumumab-treated patient. In the cost-effectiveness model, the incremental cost per quality-adjusted life-year gained revealed panitumumab to be less costly, with marginally better outcomes than cetuximab. These economic analyses comparing panitumumab and cetuximab in chemorefractory wild-type KRAS (exon 2) mCRC suggest benefits in favor of panitumumab. ClinicalTrials.gov identifier: NCT01001377. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Cost minimization analysis of a store-and-forward teledermatology consult system.

PubMed

Pak, Hon S; Datta, Santanu K; Triplett, Crystal A; Lindquist, Jennifer H; Grambow, Steven C; Whited, John D

2009-03-01

The aim of this study was to perform a cost minimization analysis of store-and-forward teledermatology compared to a conventional dermatology referral process (usual care). In a Department of Defense (DoD) setting, subjects were randomized to either a teledermatology consult or usual care. Accrued healthcare utilization recorded over a 4-month period included clinic visits, teledermatology visits, laboratories, preparations, procedures, radiological tests, and medications. Direct medical care costs were estimated by combining utilization data with Medicare reimbursement rates and wholesale drug prices. The indirect cost of productivity loss for seeking treatment was also included in the analysis using an average labor rate. Total and average costs were compared between groups. Teledermatology patients incurred $103,043 in total direct costs ($294 average), while usual-care patients incurred $98,365 ($283 average). However, teledermatology patients only incurred $16,359 ($47 average) in lost productivity cost while usual-care patients incurred $30,768 ($89 average). In total, teledermatology patients incurred $119,402 ($340 average) and usual-care patients incurred $129,133 ($372 average) in costs. From the economic perspective of the DoD, store-and-forward teledermatology was a cost-saving strategy for delivering dermatology care compared to conventional consultation methods when productivity loss cost is taken into consideration.

Quasi-static ensemble variational data assimilation: a theoretical and numerical study with the iterative ensemble Kalman smoother

NASA Astrophysics Data System (ADS)

Fillion, Anthony; Bocquet, Marc; Gratton, Serge

2018-04-01

The analysis in nonlinear variational data assimilation is the solution of a non-quadratic minimization. Thus, the analysis efficiency relies on its ability to locate a global minimum of the cost function. If this minimization uses a Gauss-Newton (GN) method, it is critical for the starting point to be in the attraction basin of a global minimum. Otherwise the method may converge to a local extremum, which degrades the analysis. With chaotic models, the number of local extrema often increases with the temporal extent of the data assimilation window, making the former condition harder to satisfy. This is unfortunate because the assimilation performance also increases with this temporal extent. However, a quasi-static (QS) minimization may overcome these local extrema. It accomplishes this by gradually injecting the observations in the cost function. This method was introduced by Pires et al. (1996) in a 4D-Var context. We generalize this approach to four-dimensional strong-constraint nonlinear ensemble variational (EnVar) methods, which are based on both a nonlinear variational analysis and the propagation of dynamical error statistics via an ensemble. This forces one to consider the cost function minimizations in the broader context of cycled data assimilation algorithms. We adapt this QS approach to the iterative ensemble Kalman smoother (IEnKS), an exemplar of nonlinear deterministic four-dimensional EnVar methods. Using low-order models, we quantify the positive impact of the QS approach on the IEnKS, especially for long data assimilation windows. We also examine the computational cost of QS implementations and suggest cheaper algorithms.

Economic Implications of Widespread Expansion of Frozen Section Margin Analysis to Guide Surgical Resection in Women With Breast Cancer Undergoing Breast-Conserving Surgery.

PubMed

Boughey, Judy C; Keeney, Gary L; Radensky, Paul; Song, Christine P; Habermann, Elizabeth B

2016-04-01

In the current health care environment, cost effectiveness is critically important in policy setting and care of patients. This study performed a health economic analysis to assess the implications to providers and payers of expanding the use of frozen section margin analysis to minimize reoperations for patients undergoing breast cancer lumpectomy. A health care economic impact model was built to assess annual costs associated with breast lumpectomy procedures with and without frozen section margin analysis to avoid reoperation. If frozen section margin analysis is used in 20% of breast lumpectomies and under a baseline assumption that 35% of initial lumpectomies without frozen section analysis result in reoperations, the potential annual cost savings are $18.2 million to payers and $0.4 million to providers. Under the same baseline assumption, if 100% of all health care facilities adopted the use of frozen section margin analysis for breast lumpectomy procedures, the potential annual cost savings are $90.9 million to payers and $1.8 million to providers. On the basis of 10,000 simulations, use of intraoperative frozen section margin analysis yields cost saving for payers and is cost neutral to slightly cost saving for providers. This economic analysis indicates that widespread use of frozen section margin evaluation intraoperatively to guide surgical resection in breast lumpectomy cases and minimize reoperations would be beneficial to cost savings not only for the patient but also for payers and, in most cases, for providers. Copyright © 2016 by American Society of Clinical Oncology.

First-line trastuzumab plus taxane-based chemotherapy for metastatic breast cancer: cost-minimization analysis.

PubMed

Nerich, Virginie; Chelly, Jennifer; Montcuquet, Philippe; Chaigneau, Loïc; Villanueva, Cristian; Fiteni, Frédéric; Meneveau, Nathalie; Perrin, Sophie; Voidey, Aline; Monnot, Tess; Pivot, Xavier; Limat, Samuel

2014-10-01

To carry out a cost-minimization analysis including a comparison of the costs arising from first-line treatment by trastuzumab plus docetaxel versus trastuzumab plus paclitaxel in patients with metastatic breast cancer. All consecutive patients with human epidermal growth receptor 2-postive metastatic breast cancer who were treated at Besançon University Hospital and Saint Vincent private hospital between 2001 and 2010 by first-line therapy containing trastuzumab plus taxane were retrospectively studied. Economic analysis took into account costs related to drugs, hospitalization, and healthcare travel. Progression-free survival difference between the two treatments was not significant (p = 0.65). First-line treatment by trastuzumab plus taxane was estimated at approximately €68,000 (p = 0.74). The drug costs represented around 70-75% of the total cost, mainly related to the use of trastuzumab. Our economic analysis shows that although the costs of the two trastuzumab plus taxane regimens are similar, they may contribute to the on-going debate about the availability and use of innovative chemotherapy drugs, in particular in human epidermal growth factor receptor 2-positive metastatic breast cancer with new therapies such as trastuzumab-DM1 and pertuzumab. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose or oral iron as preoperative treatment in patients with colon cancer and iron deficiency anaemia.

PubMed

Calvet, Xavier; Gené, Emili; ÀngelRuíz, Miquel; Figuerola, Ariadna; Villoria, Albert; Cucala, Mercedes; Mearin, Fermín; Delgado, Salvadora; Calleja, Jose Luis

2016-01-01

Ferric Carboxymaltose (FCM), Iron Sucrose (IS) and Oral Iron (OI) are alternative treatments for preoperative anaemia. To compare the cost implications, using a cost-minimization analysis, of three alternatives: FCM vs. IS vs. OI for treating iron-deficient anaemia before surgery in patients with colon cancer. Data from 282 patients with colorectal cancer and anaemia were obtained from a previous study. One hundred and eleven received FCS, 16 IS and 155 OI. Costs of intravenous iron drugs were obtained from the Spanish Regulatory Agency. Direct and indirect costs were obtained from the analytical accounting unit of the Hospital. In the base case mean costs per patient were calculated. Sensitivity analysis and probabilistic Monte Carlo simulation were performed. Total costs per patient were 1827® in the FCM group, 2312® in the IS group and 2101® in the OI group. Cost savings per patient for FCM treatment were 485® compared to IS and 274® compared to OI. A Monte Carlo simulation favoured the use of FCM in 84.7% and 84.4% of simulations when compared to IS and OI, respectively. FCM infusion before surgery reduced costs in patients with colon cancer and iron-deficiency anaemia when compared with OI and IS.

Cost-minimization analysis in the treatment of spasticity in children with cerebral palsy with botulinum toxin type A: an observational, longitudinal, retrospective study.

PubMed

Tapias, Gloria; García-Romero, Mar; Crespo, Carlos; Cuesta, Maribel; Forné, Carles; Pascual-Pascual, Samuel Ignacio

2016-09-01

Cost-minimization analysis of onabotulinumtoxinA and abobotulinumtoxinA, taking into account the real dose administered to children with spasticity associated with dynamic equinus foot deformity due to cerebral palsy. A single centre, observational, longitudinal, and retrospective study which included spastic paediatric patients aged 2-to-18-years and treated with onabotulinumtoxinA or abobotulinumtoxinA from December 1995 to October 2012, in the Paediatric Neurology Unit of a first-level Spanish hospital. A longitudinal analysis of spasticity severity was made to confirm the similar efficacy of both treatments. Cost minimization was analyzed using the dose administered and the direct costs (pharmacological and medical visits costs) from the perspective of the National Health System (in euros from 2016). We analyzed 895 patients with paediatric spasticity: 543 were treated only with onabotulinumtoxinA, 292 only with abobotulinumtoxinA, and 60 with both treatments. The mean doses administered were 5.44 U/kg (SD = 2.17) for onabotulinumtoxinA, and 14.73 U/kg (5.26) for abobotulinumto xinA. The total annual direct cost (pharmacological and medical visits) was € 839.56 for onabotulinumtoxinA and € 631.23 for abobotulinumtoxinA, which represents a difference of € 208.34 per year in favour of treatment with abobotulinumtoxinA. It has been demonstrated that in real clinical practice, the cost per patient and year for treatment of paediatric spasticity was lower when abobotulinumtoxinA was used. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis.

PubMed

Elliott, Christopher S; Hsieh, Michael H; Sokol, Eric R; Comiter, Craig V; Payne, Christopher K; Chen, Bertha

2012-02-01

Abdominal sacrocolpopexy is considered a standard of care operation for apical vaginal vault prolapse repair. Using outcomes at our center we evaluated whether the robotic approach to sacrocolpopexy is as cost-effective as the open approach. After obtaining institutional review board approval we performed cost-minimization analysis in a retrospective cohort of patients who underwent sacrocolpopexy at our institution between 2006 and 2010. Threshold values, that is model variable values at which the most cost effective approach crosses over to an alternative approach, were determined by testing model variables over realistic ranges using sensitivity analysis. Hospital billing data were also evaluated to confirm our findings. Operative time was similar for robotic and open surgery (226 vs 221 minutes) but postoperative length of stay differed significantly (1.0 vs 3.3 days, p <0.001). Base case analysis revealed an overall 10% cost savings for robot-assisted vs open sacrocolpopexy ($10,178 vs $11,307). Tornado analysis suggested that the number of institutional robotic cases done annually, length of stay and cost per hospitalization day in the postoperative period were the largest drivers of cost. Analysis of our hospital billing data showed a similar trend with robotic surgery costing 4.2% less than open surgery. A robot-assisted approach to sacrocolpopexy can be equally or less costly than an open approach. This depends on a sufficient institutional robotic case volume and a shorter postoperative stay for patients who undergo the robot-assisted procedure. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Life cycle optimization model for integrated cogeneration and energy systems applications in buildings

NASA Astrophysics Data System (ADS)

Osman, Ayat E.

Energy use in commercial buildings constitutes a major proportion of the energy consumption and anthropogenic emissions in the USA. Cogeneration systems offer an opportunity to meet a building's electrical and thermal demands from a single energy source. To answer the question of what is the most beneficial and cost effective energy source(s) that can be used to meet the energy demands of the building, optimizations techniques have been implemented in some studies to find the optimum energy system based on reducing cost and maximizing revenues. Due to the significant environmental impacts that can result from meeting the energy demands in buildings, building design should incorporate environmental criteria in the decision making criteria. The objective of this research is to develop a framework and model to optimize a building's operation by integrating congregation systems and utility systems in order to meet the electrical, heating, and cooling demand by considering the potential life cycle environmental impact that might result from meeting those demands as well as the economical implications. Two LCA Optimization models have been developed within a framework that uses hourly building energy data, life cycle assessment (LCA), and mixed-integer linear programming (MILP). The objective functions that are used in the formulation of the problems include: (1) Minimizing life cycle primary energy consumption, (2) Minimizing global warming potential, (3) Minimizing tropospheric ozone precursor potential, (4) Minimizing acidification potential, (5) Minimizing NOx, SO 2 and CO2, and (6) Minimizing life cycle costs, considering a study period of ten years and the lifetime of equipment. The two LCA optimization models can be used for: (a) long term planning and operational analysis in buildings by analyzing the hourly energy use of a building during a day and (b) design and quick analysis of building operation based on periodic analysis of energy use of a building in a year. A Pareto-optimal frontier is also derived, which defines the minimum cost required to achieve any level of environmental emission or primary energy usage value or inversely the minimum environmental indicator and primary energy usage value that can be achieved and the cost required to achieve that value.

Wavelength routing beyond the standard graph coloring approach

NASA Astrophysics Data System (ADS)

Blankenhorn, Thomas

2004-04-01

When lightpaths are routed in the planning stage of transparent optical networks, the textbook approach is to use algorithms that try to minimize the overall number of wavelengths used in the . We demonstrate that this method cannot be expected to minimize actual costs when the marginal cost of instlling more wavelengths is a declining function of the number of wavelengths already installed, as is frequently the case. We further demonstrate how cost optimization can theoretically be improved with algorithms based on Prim"s algorithm. Finally, we test this theory with simulaion on a series of actual network topologies, which confirm the theoretical analysis.

What difference a decade? The costs of psychosis in Australia in 2000 and 2010: comparative results from the first and second Australian national surveys of psychosis.

PubMed

Neil, Amanda L; Carr, Vaughan J; Mihalopoulos, Cathrine; Mackinnon, Andrew; Lewin, Terry J; Morgan, Vera A

2014-03-01

To assess differences in costs of psychosis between the first and second Australian national surveys of psychosis and examine them in light of policy developments. Cost differences due to changes in resource use and/or real price rises were assessed by minimizing differences in recruitment and costing methodologies between the two surveys. For each survey, average annual societal costs of persons recruited through public specialized mental health services in the census month were assessed through prevalence-based, bottom-up cost-of-illness analyses. The first survey costing methodology was employed as the reference approach. Unit costs were specific to each time period (2000, 2010) and expressed in 2010 Australian dollars. There was minimal change in the average annual costs of psychosis between the surveys, although newly included resources in the second survey's analysis cost AUD$3183 per person. Among resources common to each analysis were significant increases in the average annual cost per person for ambulatory care of AUD$7380, non-government services AUD$2488 and pharmaceuticals AUD$1892, and an upward trend in supported accommodation costs. These increases were offset by over a halving of mental health inpatient costs of AUD$11,790 per person and a 84.6% (AUD$604) decrease in crisis accommodation costs. Productivity losses, the greatest component cost, changed minimally, reflecting the magnitude and constancy of reduced employment levels of individuals with psychosis across the surveys. Between 2000 and 2010 there was little change in total average annual costs of psychosis for individuals receiving treatment at public specialized mental health services. However, there was a significant redistribution of costs within and away from the health sector in line with government initiatives arising from the Second and Third National Mental Health Plans. Non-health sector costs are now a critical component of cost-of-illness analyses of mental illnesses reflecting, at least in part, a whole-of-government approach to care.

Cost-effectiveness of minimally invasive sacroiliac joint fusion.

PubMed

Cher, Daniel J; Frasco, Melissa A; Arnold, Renée Jg; Polly, David W

2016-01-01

Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. To determine the cost-effectiveness of minimally invasive SIJ fusion. Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162-$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption.

Cost-effectiveness of minimally invasive sacroiliac joint fusion

PubMed Central

Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

2016-01-01

Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

[Minimally invasive surgery and the economics of it. Can minimally invasive surgery be cost efficient from a business point of view?].

PubMed

Ritz, J P; Stufler, M; Buhr, H J

2007-06-01

Minimally invasive surgery (MIS) is now accepted as equally valid as the use of a standard access in some areas of surgery. It is not possible to decide whether this access is economically worthwhile and if so for whom without a full economic cost-benefit analysis, which must take account of the hospital's own characteristics in addition to the cost involved for surgery, staff, infrastructure and administration. In summary, the main economic advantage of MIS lies in the patient-related early postoperative results, while the main disadvantage is that the operative material costs are higher. At present, the payment made for each procedure performed under the DRG system includes 14-17% of the total cost for materials, regardless of the access route and of the technical sophistication of the operation. The actual material costs are greater by a factor of 2-50 for MIS than for a conventional procedure. The task of the hospital is thus to lower the costs for material and infrastructure; that of industry is to offer less expensive alternatives; and that of our politicians, to implement better remuneration of the material costs.

Cost analysis of adjustments of the epidemiological surveillance system to mass gatherings.

PubMed

Zieliński, Andrzej

2011-01-01

The article deals with the problem of economical analysis of public health activities at mass gatherings. After presentation of elementary review of basic economical approaches to cost analysis author tries to analyze applicability of those methods to planning of mass gatherings. Difficulties in comparability of different events and lack of the outcome data at the stage of planning make most of the economic approaches unsuitable to application at the planning stage. Even applicability of cost minimization analysis may be limited to comparison of predicted costs of preconceived standards of epidemiological surveillance. Cost effectiveness performed ex post after the event when both costs and obtained effects are known, may bring more information for future selection of most effective procedures.

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis.

PubMed

Lazzaro, Carlo; Lopiano, Leonardo; Cocito, Dario

2014-07-01

Prior researches have suggested that home-based subcutaneous immunoglobulin (SCIG) is equally effective and can be less expensive than hospital-based intravenous immunoglobulin (IVIG) in treating chronic inflammatory demyelinating polyneuropathy (CIDP) patients. This economic evaluation aims at comparing costs of SCIG vs IVIG for CIDP patients in Italy. A 1-year model-based cost-minimization analysis basically populated via neurologists' opinion was undertaken from a societal perspective. Health care resources included immunoglobulin; drugs for premedication and complications (rash, headache, and hypertension) management; time of various health care professionals; pump for SCIG self-administration; infusion disposables. Non-health care resources encompassed transport and parking; losses of working and leisure time for patients and caregivers. Unit or yearly costs for resources valuation were mainly obtained from published sources. Costs were expressed in Euro () 2013. An extensive one-way sensitivity analysis (OWSA) and a scenario SA tested the robustness of the base case findings. Overall costs per patient amount to 49,534.75 (SCIG) and 50,895.73 (IVIG); saving in favour of SCIG reaches 1360.98. For both SCIG and IVIG, the cost driver was immunoglobulin (94.06 vs 86.06 % of the overall costs, respectively). Sensitivity analyses confirmed the consistency of the baseline results. SCIG may be a cost-saving therapy for Italian CIDP patients.

Wellness programs: a remedy for reducing healthcare costs.

PubMed

Kocakulah, Mehmet C; Joseforsky, Holly

2002-01-01

Offering wellness programs has become a popular method for preserving the health of employees in the hope of generating lower healthcare expenses and, in turn, higher profits. This article offers a cost/benefits analysis of providing wellness programs, to determine whether such programs could add value to a company. Recommendations follow for how to implement a successful wellness program with minimal initial costs should an analysis find that wellness initiatives would prove beneficial.

Digital vs. conventional implant prosthetic workflows: a cost/time analysis.

PubMed

Joda, Tim; Brägger, Urs

2015-12-01

The aim of this prospective cohort trial was to perform a cost/time analysis for implant-supported single-unit reconstructions in the digital workflow compared to the conventional pathway. A total of 20 patients were included for rehabilitation with 2 × 20 implant crowns in a crossover study design and treated consecutively each with customized titanium abutments plus CAD/CAM-zirconia-suprastructures (test: digital) and with standardized titanium abutments plus PFM-crowns (control conventional). Starting with prosthetic treatment, analysis was estimated for clinical and laboratory work steps including measure of costs in Swiss Francs (CHF), productivity rates and cost minimization for first-line therapy. Statistical calculations were performed with Wilcoxon signed-rank test. Both protocols worked successfully for all test and control reconstructions. Direct treatment costs were significantly lower for the digital workflow 1815.35 CHF compared to the conventional pathway 2119.65 CHF [P = 0.0004]. For subprocess evaluation, total laboratory costs were calculated as 941.95 CHF for the test group and 1245.65 CHF for the control group, respectively [P = 0.003]. The clinical dental productivity rate amounted to 29.64 CHF/min (digital) and 24.37 CHF/min (conventional) [P = 0.002]. Overall, cost minimization analysis exhibited an 18% cost reduction within the digital process. The digital workflow was more efficient than the established conventional pathway for implant-supported crowns in this investigation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.

Minimizing center of mass vertical movement increases metabolic cost in walking.

PubMed

Ortega, Justus D; Farley, Claire T

2005-12-01

A human walker vaults up and over each stance limb like an inverted pendulum. This similarity suggests that the vertical motion of a walker's center of mass reduces metabolic cost by providing a mechanism for pendulum-like mechanical energy exchange. Alternatively, some researchers have hypothesized that minimizing vertical movements of the center of mass during walking minimizes the metabolic cost, and this view remains prevalent in clinical gait analysis. We examined the relationship between vertical movement and metabolic cost by having human subjects walk normally and with minimal center of mass vertical movement ("flat-trajectory walking"). In flat-trajectory walking, subjects reduced center of mass vertical displacement by an average of 69% (P = 0.0001) but consumed approximately twice as much metabolic energy over a range of speeds (0.7-1.8 m/s) (P = 0.0001). In flat-trajectory walking, passive pendulum-like mechanical energy exchange provided only a small portion of the energy required to accelerate the center of mass because gravitational potential energy fluctuated minimally. Thus, despite the smaller vertical movements in flat-trajectory walking, the net external mechanical work needed to move the center of mass was similar in both types of walking (P = 0.73). Subjects walked with more flexed stance limbs in flat-trajectory walking (P < 0.001), and the resultant increase in stance limb force generation likely helped cause the doubling in metabolic cost compared with normal walking. Regardless of the cause, these findings clearly demonstrate that human walkers consume substantially more metabolic energy when they minimize vertical motion.

Recommendations for reporting economic evaluations of haemophilia prophylaxis: a nominal groups consensus statement on behalf of the Economics Expert Working Group of The International Prophylaxis Study Group.

PubMed

Nicholson, A; Berger, K; Bohn, R; Carcao, M; Fischer, K; Gringeri, A; Hoots, K; Mantovani, L; Schramm, W; van Hout, B A; Willan, A R; Feldman, B M

2008-01-01

The need for clearly reported studies evaluating the cost of prophylaxis and its overall outcomes has been recommended from previous literature. To establish minimal ''core standards'' that can be followed when conducting and reporting economic evaluations of hemophilia prophylaxis. Ten members of the IPSG Economic Analysis Working Group participated in a consensus process using the Nominal Groups Technique (NGT). The following topics relating to the economic analysis of prophylaxis studies were addressed; Whose perspective should be taken? Which is the best methodological approach? Is micro- or macro-costing the best costing strategy? What information must be presented about costs and outcomes in order to facilitate local and international interpretation? The group suggests studies on the economic impact of prophylaxis should be viewed from a societal perspective and be reported using a Cost Utility Analysis (CUA) (with consideration of also reporting Cost Benefit Analysis [CBA]). All costs that exceed $500 should be used to measure the costs of prophylaxis (macro strategy) including items such as clotting factor costs, hospitalizations, surgical procedures, productivity loss and number of days lost from school or work. Generic and disease specific quality of lífe and utility measures should be used to report the outcomes of the study. The IPSG has suggested minimal core standards to be applied to the reporting of economic evaluations of hemophilia prophylaxis. Standardized reporting will facilitate the comparison of studies and will allow for more rational policy decisions and treatment choices.

Cost Minimization Analysis of Different Strategies of Management of Clinically Significant Scorpion Envenomation Among Pediatric Patients.

PubMed

Sinha, Madhumita; Quan, Dan; McDonald, Fred W; Valdez, André

2016-12-01

Scorpion antivenom was recently approved for use in patients with clinically significant scorpion envenomation in the United States; no formal economic analysis on its impact on cost of management has been performed. Three different strategies of management of scorpion envenomation with systemic neurotoxic symptoms in children were compared for cost minimization from a societal perspective. In strategy I, patients were managed with supportive care only without antivenom. In strategy II, an aggressive strategy of full-dose antivenom (initial dose of 3 vials with the use of additional vials administered 1 vial at a time) was considered. In strategy III, a single-vial serial antivenom dosing strategy titrated to clinical response was considered. Clinical probabilities for the different strategies were obtained from retrospective review of medical records of patients with scorpion envenomation over a 10-year period at our institution. Baseline cost values were obtained from patient reimbursement data from our institution. In baseline analysis, strategy I of supportive care only with no antivenom was least costly at US $3466.50/patient. Strategy III of single-vial serial dosing was intermediate but less expensive than strategy II of full-dose antivenom, with an incremental cost of US $3171.08 per patient. In a 1-way sensitivity analysis, at a threshold antivenom cost of US $1577.87, strategy III of single-vial serial dosing became the least costly strategy. For children with scorpion envenomation, use of a management strategy based on serial dosing of antivenom titrated to clinical response is less costly than a strategy of initial use of full-dose antivenom.

[Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain].

PubMed

Ariza, R; Van Walsem, A; Canal, C; Roldán, C; Betegón, L; Oyagüez, I; Janssen, K

2014-07-01

To compare the cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate, with subcutaneous abatacept versus other first-line biologic disease-modifying antirheumatic drugs. Subcutaneous abatacept was considered comparable to intravenous abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab and tocilizumab, based on indirect comparison using mixed treatment analysis. A cost-minimization analysis was therefore considered appropriate. The Spanish Health System perspective and a 3 year time horizon were selected. Pharmaceutical and administration costs (Euros 2013) of all available first-line biological disease-modifying antirheumatic drugs were considered. Administration costs were obtained from a local costs database. Patients were considered to have a weight of 70 kg. A 3% annual discount rate was applied. Deterministic and probabilistic sensitivity analyses were performed. Subcutaneous abatacept proved in the base case to be less costly than all other biologic antirrheumatic drugs (ranging from Euros -831.42 to Euros -9,741.69 versus infliximab and tocilizumab, respectively). Subcutaneous abatacept was associated with a cost of Euros 10,760.41 per patient during the first year of treatment and Euros 10,261.29 in subsequent years. The total 3-year cost of subcutaneous abatacept was Euros 29,953.89 per patient. Sensitivity analyses proved the model to be robust. Subcutaneous abatacept remained cost-saving in 100% of probabilistic sensitivity analysis simulations versus adalimumab, certolizumab, etanercept and golimumab, in more than 99.6% versus intravenous abatacept and tocilizumab and in 62.3% versus infliximab. Treatment with subcutaneous abatacept is cost-saving versus intravenous abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab and tocilizumab in the management of rheumatoid arthritis patients initiating treatment with biological antirheumatic drugs. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Economic analysis of threatened species conservation: The case of woodland caribou and oilsands development in Alberta, Canada.

PubMed

Hauer, Grant; Vic Adamowicz, W L; Boutin, Stan

2018-07-15

Tradeoffs between cost and recovery targets for boreal caribou herds, threatened species in Alberta, Canada, are examined using a dynamic cost minimization model. Unlike most approaches used for minimizing costs of achieving threatened species targets, we incorporate opportunity costs of surface (forests) and subsurface resources (energy) as well as direct costs of conservation (habitat restoration and direct predator control), into a forward looking model of species protection. Opportunity costs of conservation over time are minimized with an explicit target date for meeting species recovery targets; defined as the number of self-sustaining caribou herds, which requires that both habitat and population targets are met by a set date. The model was run under various scenarios including three species recovery criteria, two oil and gas price regimes, and targets for the number of herds to recover from 1 to 12. The derived cost curve follows a typical pattern as costs of recovery per herd increase as the number of herds targeted for recovery increases. The results also show that the opportunity costs for direct predator control are small compared to habitat restoration and protection costs. However, direct predator control is essential for meeting caribou population targets and reducing the risk of extirpation while habitat is recovered over time. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cost-minimization analysis of panitumumab compared with cetuximab for first-line treatment of patients with wild-type RAS metastatic colorectal cancer.

PubMed

Graham, Christopher N; Hechmati, Guy; Fakih, Marwan G; Knox, Hediyyih N; Maglinte, Gregory A; Hjelmgren, Jonas; Barber, Beth; Schwartzberg, Lee S

2015-01-01

To compare the costs of first-line treatment with panitumumab + FOLFOX in comparison to cetuximab + FOLFIRI among patients with wild-type (WT) RAS metastatic colorectal cancer (mCRC) in the US. A cost-minimization model was developed assuming similar treatment efficacy between both regimens. The model estimated the costs associated with drug acquisition, treatment administration frequency (every 2 weeks for panitumumab, weekly for cetuximab), and incidence of infusion reactions. Average anti-EGFR doses were calculated from the ASPECCT clinical trial, and average doses of chemotherapy regimens were based on product labels. Using the medical component of the consumer price index, adverse event costs were inflated to 2014 US dollars, and all other costs were reported in 2014 US dollars. The time horizon for the model was based on average first-line progression-free survival of a WT RAS patient, estimated from parametric survival analyses of PRIME clinical trial data. Relative to cetuximab + FOLFIRI in the first-line treatment of WT RAS mCRC, the cost-minimization model demonstrated lower projected drug acquisition, administration, and adverse event costs for patients who received panitumumab + FOLFOX. The overall cost per patient for first-line treatment was $179,219 for panitumumab + FOLFOX vs $202,344 for cetuximab + FOLFIRI, resulting in a per-patient saving of $23,125 (11.4%) in favor of panitumumab + FOLFOX. From a value perspective, the cost-minimization model supports panitumumab + FOLFOX instead of cetuximab + FOLFIRI as the preferred first-line treatment of WT RAS mCRC patients requiring systemic therapy.

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

PubMed Central

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

2014-01-01

Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health plan beneficiaries, and employers warrants further consideration. PMID:24904218

Nursing home medication administration cost minimization analysis.

PubMed

Hamrick, Irene; Nye, Ann Marie; Gardner, Casey K

2007-03-01

To assess the time it takes nurses to administer medications in the nursing home setting, to calculate nursing cost of medication administration, and to determine whether using extended-release products are justified by decreasing nursing costs. Cost-minimization analysis using observational data from a time-motion analysis. Two 150-bed nursing homes in rural eastern North Carolina. Nurses working during first and second shifts. Nurses were timed as they each administered medications to 12 patients. The mean time required to administer each dosage form was calculated. The cost of nursing time was based on the average nursing staff salary of $20.45 per hour as reported by the directors of nursing. Time and cost to dispense one more medication during an existing medication pass and an additional medication pass are calculated. The time to administer an additional dose of an oral medication to one patient was 45.01 seconds during an already scheduled medication pass and 63.05 seconds during a new medication pass. The cost of adding an oral medication once a day for a patient will cost $7.67 per month if administered at the same time as other medications or $10.74 per month if a new medication pass is required. The administration of other dosage forms, such as crushed, percutaneous enteroscopic gastrostomy, injection, and patch was more time involved and, thus, costlier. Formulas are provided to calculate medication administration cost based on local salary. Nursing time and costs for medication administration in the nursing home are great and should be considered when selecting a product. This may justify the selection of higher cost extended-release products.

Cost Minimization Analysis of Two Treatment Regimens for Low-Risk Rhabdomyosarcoma in Children: A Report From the Children’s Oncology Group

PubMed Central

Russell, Heidi; Swint, J. Michael; Lal, Lincy; Meza, Jane; Walterhouse, David; Hawkins, Douglas S.; Okcu, M. Fatih

2015-01-01

Background Recent Children’s Oncology Group trials for low-risk rhabdomyosarcoma attempted to reduce therapy while maintaining excellent outcomes. D9602 delivered 45 weeks of outpatient vincristine and dactinomycin (VA) for patients in Subgroup A. ARST0331 reduced the duration of therapy to 22 weeks but added four doses of cyclophosphamide to VA for patients in Subset 1. Failure-free survival was similar. We undertook a cost minimization comparison to help guide future decision-making. Procedure Addressing the costs of treatment from the healthcare perspective we modeled a simple decision-analytic model from aggregate clinical trial data. Medical care inputs and probabilities were estimated from trial reports and focused chart review. Costs of radiation, surgery and off-therapy surveillance were excluded. Unit costs were obtained from literature and national reimbursement and inpatient utilization databases and converted to 2012 US dollars. Model uncertainty was assessed with first-order sensitivity analysis. Results Direct medical costs were $46,393 for D9602 and $43,261 for ARST0331 respectively, making ARST0331 the less costly strategy. Dactinomycin contributed the most to D9602 total costs but varied with age (42–69%). Chemotherapy administration costs accounted for the largest proportion of ARST0331 total costs (39–57%). ARST0331 incurred fewer costs than D9602 under most alternative distributive models and alternative clinical practice assumptions. Conclusions Cost analysis suggests that ARST0331 may incur fewer costs than D9602 from the healthcare system’s perspective. Attention to the services driving the costs provides directions for future efficiency improvements. Future studies should prospectively consider the patient and family’s perspective. PMID:24453105

Cost minimization analysis of two treatment regimens for low-risk rhabdomyosarcoma in children: a report from the Children's Oncology Group.

PubMed

Russell, Heidi; Swint, J Michael; Lal, Lincy; Meza, Jane; Walterhouse, David; Hawkins, Douglas S; Okcu, M Fatih

2014-06-01

Recent Children's Oncology Group trials for low-risk rhabdomyosarcoma attempted to reduce therapy while maintaining excellent outcomes. D9602 delivered 45 weeks of outpatient vincristine and dactinomycin (VA) for patients in Subgroup A. ARST0331 reduced the duration of therapy to 22 weeks but added four doses of cyclophosphamide to VA for patients in Subset 1. Failure-free survival was similar. We undertook a cost minimization comparison to help guide future decision-making. Addressing the costs of treatment from the healthcare perspective we modeled a simple decision-analytic model from aggregate clinical trial data. Medical care inputs and probabilities were estimated from trial reports and focused chart review. Costs of radiation, surgery and off-therapy surveillance were excluded. Unit costs were obtained from literature and national reimbursement and inpatient utilization databases and converted to 2012 US dollars. Model uncertainty was assessed with first-order sensitivity analysis. Direct medical costs were $46,393 for D9602 and $43,261 for ARST0331 respectively, making ARST0331 the less costly strategy. Dactinomycin contributed the most to D9602 total costs but varied with age (42-69%). Chemotherapy administration costs accounted for the largest proportion of ARST0331 total costs (39-57%). ARST0331 incurred fewer costs than D9602 under most alternative distributive models and alternative clinical practice assumptions. Cost analysis suggests that ARST0331 may incur fewer costs than D9602 from the healthcare system's perspective. Attention to the services driving the costs provides directions for future efficiency improvements. Future studies should prospectively consider the patient and family's perspective. © 2014 Wiley Periodicals, Inc.

A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial.

PubMed

Wiedel, Anna-Paulina; Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-04-01

Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Treatment with FA or RA. There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Costs depend on local factors and should not be directly extrapolated to other locations. The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. This trial was not registered. The protocol was not published before trial commencement. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A cost minimization analysis of early correction of anterior crossbite—a randomized controlled trial

PubMed Central

Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-01-01

Summary Objective: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Design, Setting, and Participants: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents’ loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Interventions: Treatment with FA or RA. Results: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Limitations: Costs depend on local factors and should not be directly extrapolated to other locations. Conclusion: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. Trial registration: This trial was not registered. Protocol: The protocol was not published before trial commencement. PMID:25940585

Gas Fluxing of Molten Aluminum: An Overview

NASA Astrophysics Data System (ADS)

Sigworth, Geoffrey K.; Williams, Edward M.; Chesonis, D. Corleen

The aluminum industry is under continual pressure to improve metal quality, while at the same time reduce costs. Although a reasonably mature technology, there has been a continual evolution in degassing equipment over the years. A detailed review and theoretical analysis is given of the chemical and kinetic factors which control the metal quality after gas fluxing, and the evolution of degassing technology in Alcoa is summarized. Particular emphasis is placed on hydrogen removal, minimization of chlorine use, reduced operating costs and minimization of environmental emissions. Considerations related to inclusion removal are also discussed briefly.

Medical versus surgical abortion methods for pregnancy in China: a cost-minimization analysis.

PubMed

Xia, Wei; She, Shouzhang; Lam, Tai Hing

2011-01-01

Both medical and surgical abortions are popular in developing countries. However, the monetary costs of these two methods have not been compared. 430 women seeking abortions were recruited in 2008. Either a medical or surgical method was used for the abortion. We adopted the perspective of a third-party payer. Cost-minimization analysis was used based on all charges for the overall procedures in an out-patient clinic in Guangzhou, China. 219 subjects (51%) chose a medical method (mifepristone and misoprostol), whereas 211 subjects (49%) chose a surgical method. The efficacy in the surgical group was significantly higher than in the medical group (100 vs. 90%, p < 0.001). Surgical abortion incurred much more costs than medical abortion on average after initial treatment. When the subsequent costs were accumulated within the 2-week follow-up, the mean total cost in the medical group increased significantly due to failure of abortion and persistent bleeding. Patients undergoing medical abortion eventually incurred equivalent expenses compared to patients undergoing surgical abortion (p = 0.42). There was no difference in the mean final costs between the two abortion methods. Complications of persistent bleeding and failure to abort (requiring surgical intervention) in the medical treatment group increased the final mean total cost substantially. Copyright © 2011 S. Karger AG, Basel.

Targeted tuberculosis contact investigation saves money without sacrificing health.

PubMed

Pisu, Maria; Gerald, Joe; Shamiyeh, James E; Bailey, William C; Gerald, Lynn B

2009-01-01

Health departments require an efficient strategy to investigate individuals exposed to Mycobacterium tuberculosis. The contact priority model (CPM) uses a decision rule to minimize testing of low-risk contacts; however, its impact on costs and disease control is unknown. A cost-effectiveness analysis compared the CPM with the traditional concentric circle approach (CCA) in a simulated population of 1000 healthy, community-dwelling adults with a 10% background rate of latent tuberculosis (TB) infection. The analysis was conducted from the perspective of the Alabama Department of Public Health. Model inputs were derived from the literature and the Alabama Department of Public Health. Lifetime costs (2004 dollars) and outcomes were discounted 3 percent annually. Incremental cost-effectiveness ratios were used to compare the strategies. Over the lifetime of 1000 simulated contacts, the CPM saved $45,000 but led to 0.5 additional TB cases and 0.24 fewer years of life. The CCA is more effective than the CPM, but it costs $92,934 to prevent one additional TB case and $185,920 to gain one additional life year. The CPM reduces costs with minimal loss of disease control and is a viable alternative to the CCA under most conditions.

Rationale and design of the health economics evaluation registry for remote follow-up: TARIFF.

PubMed

Ricci, Renato P; D'Onofrio, Antonio; Padeletti, Luigi; Sagone, Antonio; Vicentini, Alfredo; Vincenti, Antonio; Morichelli, Loredana; Cavallaro, Ciro; Ricciardi, Giuseppe; Lombardi, Leonida; Fusco, Antonio; Rovaris, Giovanni; Silvestri, Paolo; Guidotto, Tiziana; Pollastrelli, Annalisa; Santini, Massimo

2012-11-01

The aims of the study are to develop a cost-minimization analysis from the hospital perspective and a cost-effectiveness analysis from the third payer standpoint, based on direct estimates of costs and QOL associated with remote follow-ups, using Merlin@home and Merlin.net, compared with standard ambulatory follow-ups, in the management of ICD and CRT-D recipients. Remote monitoring systems can replace ambulatory follow-ups, sparing human and economic resources, and increasing patient safety. TARIFF is a prospective, controlled, observational study aimed at measuring the direct and indirect costs and quality of life (QOL) of all participants by a 1-year economic evaluation. A detailed set of hospitalized and ambulatory healthcare costs and losses of productivity that could be directly influenced by the different means of follow-ups will be collected. The study consists of two phases, each including 100 patients, to measure the economic resources consumed during the first phase, associated with standard ambulatory follow-ups, vs. the second phase, associated with remote follow-ups. Remote monitoring systems enable caregivers to better ensure patient safety and the healthcare to limit costs. TARIFF will allow defining the economic value of remote ICD follow-ups for Italian hospitals, third payers, and patients. The TARIFF study, based on a cost-minimization analysis, directly comparing remote follow-up with standard ambulatory visits, will validate the cost effectiveness of the Merlin.net technology, and define a proper reimbursement schedule applicable for the Italian healthcare system. NCT01075516.

Cost-minimization Analysis of the Management of Acute Achilles Tendon Rupture.

PubMed

Truntzer, Jeremy N; Triana, Brian; Harris, Alex H S; Baker, Laurence; Chou, Loretta; Kamal, Robin N

2017-06-01

Outcomes of nonsurgical management of acute Achilles tendon rupture have been demonstrated to be noninferior to those of surgical management. We performed a cost-minimization analysis of surgical and nonsurgical management of acute Achilles tendon rupture. We used a claims database to identify patients who underwent surgical (n = 1,979) and nonsurgical (n = 3,065) management of acute Achilles tendon rupture and compared overall costs of treatment (surgical procedure, follow-up care, physical therapy, and management of complications). Complication rates were also calculated. Patients were followed for 1 year after injury. Average treatment costs in the year after initial diagnosis were higher for patients who underwent initial surgical treatment than for patients who underwent nonsurgical treatment ($4,292 for surgical treatment versus $2,432 for nonsurgical treatment; P < 0.001). However, surgical treatment required fewer office visits (4.52 versus 10.98; P < 0.001) and less spending on physical therapy ($595 versus $928; P < 0.001). Rates of rerupture requiring subsequent treatment (2.1% versus 2.4%; P = 0.34) and additional costs ($2,950 versus $2,515; P = 0.34) were not significantly different regardless whether initial treatment was surgical or nonsurgical. In both cohorts, management of complications contributed to approximately 5% of the total cost. From the payer's perspective, the overall costs of nonsurgical management of acute Achilles tendon rupture were significantly lower than the overall costs of surgical management. III, Economic Decision Analysis.

Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis.

PubMed

Marcolino, Milena Soriano; Polanczyk, Carisi Anne; Bovendorp, Ana Carolina Caixeta; Marques, Naiara Silveira; Silva, Lilian Azevedo da; Turquia, Cintia Proveti Barbosa; Ribeiro, Antonio Luiz

2016-01-01

Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. This study included 633 patients (59% women) of median age 62 years (interquartile range -49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $ 54.26 (US dollars). Direct costs accounted for 32.5% of the total cost. Of these, 69.5% were related to healthcare professionals. With regards to indirect costs, 52.4% were related to absence from work and 47.6% to transportation. Apixaban, dabigatran and rivaroxaban were being sold to Brazilian public institutions, on average, for $ 49.87, $ 51.40 and $ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.

Current trends in treatment of obesity in Karachi and possibilities of cost minimization.

PubMed

Hussain, Mirza Izhar; Naqvi, Baqir Shyum

2015-03-01

Our study finds out drug usage trends in over weight and obese patients without any compelling indications in Karachi, looks for deviations of current practices from evidence based antihypertensive therapeutic guidelines and identifies not only cost minimization opportunities but also communication strategies to improve patients' awareness and compliance to achieve therapeutic goal. In present study two sets were used. Randomized stratified independent surveys were conducted in hospital doctors and family physicians (general practitioners), using pretested questionnaires. Sample size was 100. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Opportunities of cost minimization were also analyzed. One the basis of doctors' feedback, preference is given to non-pharmacologic management of obesity. Mass media campaign and media usage were recommended to increase patients awareness and patients' education along with strengthening family support systems was recommended for better compliance of the patients to doctor's advice. Local therapeutic guidelines for weight reduction were not found. Feedbacks showed that global therapeutic guidelines were followed by the doctors practicing in the community and hospitals in Karachi. However, high price branded drugs were used instead of low priced generic therapeutic equivalents. Patient's education is required for better awareness and improving patients' compliance. The doctors found preferring brand leaders instead of low cost options. This trend increases cost of therapy by 0.59 to 4.17 times. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.

Health economic evaluation: important principles and methodology.

PubMed

Rudmik, Luke; Drummond, Michael

2013-06-01

To discuss health economic evaluation and improve the understanding of common methodology. This article discusses the methodology for the following types of economic evaluations: cost-minimization, cost-effectiveness, cost-utility, cost-benefit, and economic modeling. Topics include health-state utility measures, the quality-adjusted life year (QALY), uncertainty analysis, discounting, decision tree analysis, and Markov modeling. Economic evaluation is the comparative analysis of alternative courses of action in terms of both their costs and consequences. With increasing health care expenditure and limited resources, it is important for physicians to consider the economic impact of their interventions. Understanding common methodology involved in health economic evaluation will improve critical appraisal of the literature and optimize future economic evaluations. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

Recombinant versus highly-purified, urinary follicle-stimulating hormone (r-FSH vs. HP-uFSH) in ovulation induction: a prospective, randomized study with cost-minimization analysis.

PubMed

Revelli, Alberto; Poso, Francesca; Gennarelli, Gianluca; Moffa, Federica; Grassi, Giuseppina; Massobrio, Marco

2006-07-18

Both recombinant FSH (r-FSH) and highly-purified, urinary FSH (HP-uFSH) are frequently used in ovulation induction associated with timed sexual intercourse. Their effectiveness is reported to be similar, and therefore the costs of treatment represent a major issue to be considered. Although several studies about costs in IVF have been published, data obtained in low-technology infertility treatments are still scarce. Two hundred and sixty infertile women (184 with unexplained infertility, 76 with CC-resistant polycystic ovary syndrome) at their first treatment cycle were randomized and included in the study. Ovulation induction was accomplished by daily administration of rFSH or HP-uFSH according to a low-dose, step-up regimen aimed to obtain a monofollicular ovulation. A bi- or tri-follicular ovulation was anyway accepted, whereas hCG was withdrawn and the cycle cancelled when more than three follicles greater than or equal to 18 mm diameter were seen at ultrasound. The primary outcome measure was the cost of therapy per delivered baby, estimated according to a cost-minimization analysis. Secondary outcomes were the following: monofollicular ovulation rate, total FSH dose, cycle cancellation rate, length of the follicular phase, number of developing follicles (>12 mm diameter), endometrial thickness at hCG, incidence of twinning and ovarian hyperstimulation syndrome, delivery rate. The overall FSH dose needed to achieve ovulation was significantly lower with r-FSH, whereas all the other studied variables did not significantly differ with either treatments. However, a trend toward a higher delivery rate with r-FSH was observed in the whole group and also when results were considered subgrouping patients according to the indication to treatment. Considering the significantly lower number of vials/patient and the slight (although non-significant) increase in the delivery rate with r-FSH, the cost-minimization analysis showed a 9.4% reduction in the overall therapy cost per born baby in favor of r-FSH.

Optimal Inspection of Imports to Prevent Invasive Pest Introduction.

PubMed

Chen, Cuicui; Epanchin-Niell, Rebecca S; Haight, Robert G

2018-03-01

The United States imports more than 1 billion live plants annually-an important and growing pathway for introduction of damaging nonnative invertebrates and pathogens. Inspection of imports is one safeguard for reducing pest introductions, but capacity constraints limit inspection effort. We develop an optimal sampling strategy to minimize the costs of pest introductions from trade by posing inspection as an acceptance sampling problem that incorporates key features of the decision context, including (i) simultaneous inspection of many heterogeneous lots, (ii) a lot-specific sampling effort, (iii) a budget constraint that limits total inspection effort, (iv) inspection error, and (v) an objective of minimizing cost from accepted defective units. We derive a formula for expected number of accepted infested units (expected slippage) given lot size, sample size, infestation rate, and detection rate, and we formulate and analyze the inspector's optimization problem of allocating a sampling budget among incoming lots to minimize the cost of slippage. We conduct an empirical analysis of live plant inspection, including estimation of plant infestation rates from historical data, and find that inspections optimally target the largest lots with the highest plant infestation rates, leaving some lots unsampled. We also consider that USDA-APHIS, which administers inspections, may want to continue inspecting all lots at a baseline level; we find that allocating any additional capacity, beyond a comprehensive baseline inspection, to the largest lots with the highest infestation rates allows inspectors to meet the dual goals of minimizing the costs of slippage and maintaining baseline sampling without substantial compromise. © 2017 Society for Risk Analysis.

Private practice outcomes: validated outcomes data collection in private practice.

PubMed

Goldstein, Jack

2010-10-01

Improved patient care is related to validated outcome measures requiring the collection of three distinct data types: (1) demographics; (2) patient outcome measures; and (3) physician treatment. Previous impediments to widespread data collection have been: cost, office disruption, personnel requirements, physician motivation, data integration, and security. There are currently few means to collect data to be used for collaborative analysis. We therefore developed an inexpensive, patient-centric mechanism to reduce redundant data entry, limiting cost and personnel requirements. Using an intuitive touch-screen kiosk interface program, all data elements have been captured in a private practice setting since 2000. Developed for small to medium sized offices, this is scalable to larger organizations. Questionnaire navigation is patient driven, with demographics shared with EMR and billing systems. Integration of billing and EMR with outcomes minimizes cost and personnel time. Data are deidentified locally and may be centrally shared. Since data are entered by the patients, minimal personnel costs are incurred. Physician disincentives are minimized with cost reduction, time savings and ease of use. To date, we have collected high level data on most total joint patients, with excellent patient compliance. By addressing impediments to broad application, we may enable widespread local data collection in all practice settings. Data may be shared centrally, allowing comparative effectiveness research to become a reality. Future success will require broad physician participation, uniformity of data collected, and designation of a central site for receipt of data and its collaborative comparative analysis.

Cost minimization analysis for combinations of sampling techniques in bronchoscopy of endobronchial lesions.

PubMed

Roth, Kjetil; Hardie, Jon Andrew; Andreassen, Alf Henrik; Leh, Friedemann; Eagan, Tomas Mikal Lind

2009-06-01

The choice of sampling techniques in bronchoscopy with sampling from a visible lesion will depend on the expected diagnostic yields and the costs of the sampling techniques. The aim of this study was to determine the most economical combination of sampling techniques when approaching endobronchial visible lesions. A cost minimization analysis was performed. All bronchoscopies from 2003 and 2004 at Haukeland university hospital, Bergen, Norway, were reviewed retrospectively for diagnostic yields. 162 patients with endobronchial disease were included. Potential sampling techniques used were biopsy, brushing, endobronchial needle aspiration (EBNA) and washings. Costs were estimated based on registration of equipment costs and personnel costs. Sensitivity analyses were performed to determine threshold values. The combination of biopsy, brushing and EBNA was the most economical strategy with an average cost of Euro 893 (95% CI: 657, 1336). The cost of brushing had to be below Euro 83 and it had to increase the diagnostic yield more than 2.2%, for biopsy and brushing to be more economical than biopsy alone. The combination of biopsy, brushing and EBNA was more economical than biopsy and brushing when the cost of EBNA was below Euro 205 and the increase in diagnostic yield was above 5.2%. In the current study setting, biopsy, brushing and EBNA was the most economical combination of sampling techniques for endobronchial visible lesions.

Clinical outcomes and cost minimization with an alternative dosing regimen for meropenem in a community hospital.

PubMed

Patel, Gita Wasan; Duquaine, Susan M; McKinnon, Peggy S

2007-12-01

To compare outcomes and cost for the traditional United States Food and Drug Administration-approved dosing regimen for meropenem versus an alternative dosing regimen providing similar pharmacodynamic exposure with a lower total daily dose. Retrospective cohort study with a cost-minimization analysis. A 417-bed, privately owned community hospital. One hundred patients who received meropenem 1 g every 8 or 12 hours (traditional dosing regimen) between January 1 and September 30, 2004 (historical controls), and 192 patients who received meropenem 500 mg every 6 or 8 hours (alternative dosing regimen) between October 1, 2004, and September 30, 2005. Demographic and clinical data were collected for all patients. Cost-minimization analysis was performed by using the drug acquisition cost for meropenem. Demographics, sources of infection, distributions of organisms, and Charlson Comorbidity Index scores were similar between patients in the traditionally and alternatively dosed groups. Concomitant therapy, duration of therapy, success rates, lengths of stay, and in-hospital mortality rates were also similar between groups. Median time to the resolution of symptoms was 3 days for traditional dosing and 1.5 days for alternative dosing (p<0.0001). A logistic regression model including the dosing strategy showed that only polymicrobial infections and sepsis were associated with increased failure rates. The median cost for antibiotics was $439.05/patient for traditional dosing and $234.08/patient for alternative dosing (p<0.0001). An alternative dosing regimen for meropenem with a lower total daily dose yielded patient outcomes, including success rates and duration of therapy, equivalent to those of the traditional dosing regimen. Alternative dosing decreased total drug exposure, costs for antibiotics, and time to the resolution of infections.

Current trends in treatment of hypertension in Karachi and cost minimization possibilities.

PubMed

Hussain, Izhar M; Naqvi, Baqir S; Qasim, Rao M; Ali, Nasir

2015-01-01

This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Financial impact was also analyzed. On the basis of patients' doctors' feedback, Beta Blockers, and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective. This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.

How to interpret a healthcare economic analysis.

PubMed

Brown, Melissa M; Brown, Gary C

2005-06-01

The purpose of the review is to present guidelines to help the clinician to interpret healthcare economic analyses and review pertinent recent analysis in the ophthalmic literature. There are four variants of healthcare economic analyses: (1) cost-minimization analysis; (2) cost-benefit analysis; (3) cost-effectiveness analysis and (4) cost-utility analysis. Cost-utility utility analysis has assumed an increasingly important role in healthcare, with increasing number of analyses occurring in the peer-reviewed ophthalmic literature. These include cost-utility analyses of cataract surgery in the first and second eyes, amblyopia treatment, and cost-utility analyses encompassing the vitreoretinal interventions of the following: (1) laser photocoagulation for exudative macular degeneration; (2) laser treatment for diabetic retinopathy; (3) laser photocoagulation for branch retinal vein obstruction; (4) diabetic vitrectomy; (5) treatment of proliferative retinopathy of prematurity and (6) treatment of retinal detachment associated with proliferative vitreoretinopathy. As an increasing number of cost-utility analyses become available they will provide the information system for the practice of value-based medicine, or medicine based upon the patient-perceived value conferred by interventions. Increasing numbers of cost-utility analysis in the ophthalmic literature suggest that ophthalmic interventions, including vitreoretinal interventions, are cost effective. Cost-utility analysis is a major tool in value-based medicine, the practice of medicine based upon the patient-perceived value conferred by healthcare interventions.

Do Medicare Advantage Plans Minimize Costs? Investigating the Relationship Between Benchmarks, Costs, and Rebates.

PubMed

Zuckerman, Stephen; Skopec, Laura; Guterman, Stuart

2017-12-01

Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be. To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments. Regression analysis using 2015 data for HMO and local PPO plans. Costs and rebates are higher for MA plans in areas with higher benchmarks, and plan costs vary less than benchmarks do. A one-dollar increase in benchmarks is associated with 32-cent-higher plan costs and a 52-cent-higher rebate, even when controlling for market and plan factors that can affect costs. This suggests the current benchmark-and-bidding system allows plans to bid higher than local input prices and other market conditions would seem to warrant. To incentivize MA plans to maximize efficiency and minimize costs, Medicare could change the way benchmarks are set or used.

Cost-effectiveness of Early Division of the Forehead Flap Pedicle.

PubMed

Calloway, Hollin E; Moubayed, Sami P; Most, Sam P

2017-09-01

The paramedian forehead flap is considered the gold standard procedure to optimally reconstruct major defects of the nose, but this procedure generally requires 2 stages, where the flap pedicle is divided 3 weeks following the initial surgery to ensure adequate revascularization of the flap from the surrounding recipient tissue bed, which can cost a patient time out of work or away from normal social habits. It has previously been shown that the pedicle may be safely divided after 2 weeks in select patients where revascularization from the recipient bed was confirmed using intraoperative laser fluorescence angiography to potentially save the patient time and money. To demonstrate the cost-effectiveness of takedown of the paramedian forehead flap pedicle after 2 weeks using angiography with indocyanine green (ICG). Retrospective cohort study of all patients who underwent 2-week division of the forehead flap after nasal reconstruction. Patient, tumor, defect, and outcomes data were collected. Cost-minimization analysis was performed by comparing the overall costs of 2-week takedown with angiography to a hypothetical patient undergoing 3-week takedown without angiography. Two-week division of the forehead flap after nasal reconstruction. Cost-minimization analysis performed by calculating the total variable costs for a patient in our cohort vs costs to a theoretical patient for whom angiography was not performed and the pedicle was divided at the 3-week mark. A total of 22 patients were included (mean [SD] age, 70.3 [10.0] years; 8 women [36.4%] and 14 men [63.6%]). The selection criteria for 2-week division of the pedicle are a wound bed with at least 50% vascularized tissue present, partial-thickness defects, and absence of nicotine use. All were divided at the 2-week mark with no instances of flap necrosis. One patient had a squamous eccrine carcinoma histology before reconstruction, all other patients had basal cell carcinoma, squamous cell carcinoma, and melanoma. Cost-minimization analysis showed that the use of angiography with ICG results in cost savings of $177 per patient on average. Two-week takedown of select paramedian forehead flap patients can be performed safely with verification using angiography with ICG. Although this technology inherently adds cost, it is cost-effective, saving a total of $177 per patient. NA.

Cost-Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery.

PubMed

Joliat, Gaëtan-Romain; Labgaa, Ismaïl; Hübner, Martin; Blanc, Catherine; Griesser, Anne-Claude; Schäfer, Markus; Demartines, Nicolas

2016-10-01

Enhanced recovery after surgery (ERAS) programs have been shown to ease the postoperative recovery and improve clinical outcomes for various surgery types. ERAS cost-effectiveness was demonstrated for colorectal surgery but not for liver surgery. The present study aim was to analyze the implementation costs and benefits of a specific ERAS program in liver surgery. A dedicated ERAS protocol for liver surgery was implemented in our department in July 2013. The subsequent year all consecutive patients undergoing liver surgery were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital costs with a patient series before ERAS implementation (pre-ERAS group). Mean costs per patient were compared with a bootstrap T test. A cost-minimization analysis was performed. Seventy-four ERAS patients were compared with 100 pre-ERAS patients. There were no significant pre- and intraoperative differences between the two groups, except for the laparoscopy number (n = 18 ERAS, n = 9 pre-ERAS, p = 0.010). Overall postoperative complications were observed in 36 (49 %) and 64 patients (64 %) in the ERAS and pre-ERAS groups, respectively (p = 0.046). The median length of stay was significantly shorter for the ERAS group (8 vs. 10 days, p = 0.006). The total mean costs per patient were €38,726 and €42,356 for ERAS and pre-ERAS (p = 0.467). The cost-minimization analysis showed a total mean cost reduction of €3080 per patient after ERAS implementation. ERAS implementation for liver surgery induced a non-significant decrease in cost compared to standard care. Significant decreased complication rate and hospital stay were observed in the ERAS group.

The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program.

PubMed

Kagedan, Daniel J; Devitt, Katharine S; Tremblay St-Germain, Amélie; Ramjaun, Aliya; Cleary, Sean P; Wei, Alice C

2017-11-01

Clinical pathways (CPW) are considered safe and effective at decreasing postoperative length of stay (LoS), but the effect on economic costs is uncertain. This study sought to elucidate the effect of a CPW on direct hospitalization costs for patients undergoing pancreaticoduodenectomy (PD). A CPW for PD patients at a single Canadian institution was implemented. Outcomes included LoS, 30-day readmissions, and direct costs of hospital care. A retrospective cost minimization analysis compared patients undergoing PD prior to and following CPW implementation, using a bootstrapped t test and deviation-based cost modeling. 121 patients undergoing PD after CPW implementation were compared to 74 controls. Index LoS was decreased following CPW implementation (9 vs. 11 days, p = 0.005), as was total LoS (10 vs. 11 days, p = 0.003). The mean total cost of postoperative hospitalization per patient decreased in the CPW group ($15,678.45 CAD vs. $25,732.85 CAD, p = 0.024), as was the mean 30-day cost including readmissions ($16,627.15 CAD vs. $29,872.72 CAD, p = 0.016). Areas of significant cost savings included laboratory tests and imaging investigations. CPWs may generate cost savings by reducing unnecessary investigations, and improve quality of care through process standardization and decreasing practice variation. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Project Plan for Recreation Resources Development. North Hartland Lake, Hartland and Hartford, Vermont.

DTIC Science & Technology

1981-01-01

of reservoir management are included within the scope of thle project plan. The plan represents a culmination of knowledge gathered from past...a detailed inventory and analysis of the projects natural resources in order to minimize environment and aesthetic impact, promote logical development...and minimize development costs. Factors inventoried included soil types, vegetation, topography, wildlife, surface geology, historical

Lessons learned - MO&DA at JPL. [Mission Operations and Data Analysis cost reduction of planetary exploration

NASA Technical Reports Server (NTRS)

Handley, Thomas H., Jr.

1993-01-01

The issues of how to avoid future surprise growth in Mission Operations and Data Analysis (MO&DA) costs and how to minimize total MO&DA costs for planetary missions are discussed within the context of JPL mission operations support. It is argued that there is no simple, single solution: the entire Project life-cycle must be addressed. It is concluded that cost models that can predict both MO&DA cost as well as Ground System development costs are needed. The first year MO&DA budget plotted against the total of ground and flight systems developments is shown. In order to better recognize changes and control costs in general, a modified funding line item breakdown is recommended to distinguish between development costs (prelaunch and postlaunch) and MO&DA costs.

Industrial wastewater minimization using water pinch analysis: a case study on an old textile plant.

PubMed

Ujang, Z; Wong, C L; Manan, Z A

2002-01-01

Industrial wastewater minimization can be conducted using four main strategies: (i) reuse; (ii) regeneration-reuse; (iii) regeneration-recycling; and (iv) process changes. This study is concerned with (i) and (ii) to investigate the most suitable approach to wastewater minimization for an old textile industry plant. A systematic water networks design using water pinch analysis (WPA) was developed to minimize the water usage and wastewater generation for the textile plant. COD was chosen as the main parameter. An integrated design method has been applied, which brings the engineering insight using WPA that can determine the minimum flowrate of the water usage and then minimize the water consumption and wastewater generation as well. The overall result of this study shows that WPA has been effectively applied using both reuse and regeneration-reuse strategies for the old textile industry plant, and reduced the operating cost by 16% and 50% respectively.

The economics of data acquisition computers for ST and MST radars

NASA Technical Reports Server (NTRS)

Watkins, B. J.

1983-01-01

Some low cost options for data acquisition computers for ST (stratosphere, troposphere) and MST (mesosphere, stratosphere, troposphere) are presented. The particular equipment discussed reflects choices made by the University of Alaska group but of course many other options exist. The low cost microprocessor and array processor approach presented here has several advantages because of its modularity. An inexpensive system may be configured for a minimum performance ST radar, whereas a multiprocessor and/or a multiarray processor system may be used for a higher performance MST radar. This modularity is important for a network of radars because the initial cost is minimized while future upgrades will still be possible at minimal expense. This modularity also aids in lowering the cost of software development because system expansions should rquire little software changes. The functions of the radar computer will be to obtain Doppler spectra in near real time with some minor analysis such as vector wind determination.

Increased uniformity by planting clones will likely have a minimal effect on inventory costs

Treesearch

Curtis L. VanderSchaaf; Dean W. Coble; David B. South

2012-01-01

When conducting inventories, reducing variability among tree diameters, heights, and ultimately volumes or biomass, can reduce the number of points/plots needed to obtain a desired level of precision. We present a simple analysis examining the potential reduction in discounted inventory costs when stand variability is decreased (via improved genetics and intensive...

System for decision analysis support on complex waste management issues

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

Shropshire, D.E.

1997-10-01

A software system called the Waste Flow Analysis has been developed and applied to complex environmental management processes for the United States Department of Energy (US DOE). The system can evaluate proposed methods of waste retrieval, treatment, storage, transportation, and disposal. Analysts can evaluate various scenarios to see the impacts to waste slows and schedules, costs, and health and safety risks. Decision analysis capabilities have been integrated into the system to help identify preferred alternatives based on a specific objectives may be to maximize the waste moved to final disposition during a given time period, minimize health risks, minimize costs,more » or combinations of objectives. The decision analysis capabilities can support evaluation of large and complex problems rapidly, and under conditions of variable uncertainty. The system is being used to evaluate environmental management strategies to safely disposition wastes in the next ten years and reduce the environmental legacy resulting from nuclear material production over the past forty years.« less

A cost-minimization analysis of an RCT of three retention methods.

PubMed

Tynelius, Gudrun Edman; Lilja-Karlander, Eva; Petrén, Sofia

2014-08-01

There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis. © The Author 2013. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

PubMed

Tam, Samantha; Sun, Hongmei; Sarma, Sisira; Siu, Jennifer; Fung, Kevin; Sowerby, Leigh

2017-02-20

Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty. Cost minimization analysis conducted using a decision tree model. A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events. Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626. Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.

Cost-performance analysis of nutrient removal in a full-scale oxidation ditch process based on kinetic modeling.

PubMed

Li, Zheng; Qi, Rong; Wang, Bo; Zou, Zhe; Wei, Guohong; Yang, Min

2013-01-01

A full-scale oxidation ditch process for treating sewage was simulated with the ASM2d model and optimized for minimal cost with acceptable performance in terms of ammonium and phosphorus removal. A unified index was introduced by integrating operational costs (aeration energy and sludge production) with effluent violations for performance evaluation. Scenario analysis showed that, in comparison with the baseline (all of the 9 aerators activated), the strategy of activating 5 aerators could save aeration energy significantly with an ammonium violation below 10%. Sludge discharge scenario analysis showed that a sludge discharge flow of 250-300 m3/day (solid retention time (SRT), 13-15 days) was appropriate for the enhancement of phosphorus removal without excessive sludge production. The proposed optimal control strategy was: activating 5 rotating disks operated with a mode of "111100100" ("1" represents activation and "0" represents inactivation) for aeration and sludge discharge flow of 200 m3/day (SRT, 19 days). Compared with the baseline, this strategy could achieve ammonium violation below 10% and TP violation below 30% with substantial reduction of aeration energy cost (46%) and minimal increment of sludge production (< 2%). This study provides a useful approach for the optimization of process operation and control.

Pricing health benefits: a cost-minimization approach.

PubMed

Miller, Nolan H

2005-09-01

We study the role of health benefits in an employer's compensation strategy, given the overall goal of minimizing total compensation cost (wages plus health-insurance cost). When employees' health status is private information, the employer's basic benefit package consists of a base wage and a moderate health plan, with a generous plan available for an additional charge. We show that in setting the charge for the generous plan, a cost-minimizing employer should act as a monopolist who sells "health plan upgrades" to its workers, and we discuss ways tax policy can encourage efficiency under cost-minimization and alternative pricing rules.

Adopting epidemic model to optimize medication and surgical intervention of excess weight

NASA Astrophysics Data System (ADS)

Sun, Ruoyan

2017-01-01

We combined an epidemic model with an objective function to minimize the weighted sum of people with excess weight and the cost of a medication and surgical intervention in the population. The epidemic model is consisted of ordinary differential equations to describe three subpopulation groups based on weight. We introduced an intervention using medication and surgery to deal with excess weight. An objective function is constructed taking into consideration the cost of the intervention as well as the weight distribution of the population. Using empirical data, we show that fixed participation rate reduces the size of obese population but increases the size for overweight. An optimal participation rate exists and decreases with respect to time. Both theoretical analysis and empirical example confirm the existence of an optimal participation rate, u*. Under u*, the weighted sum of overweight (S) and obese (O) population as well as the cost of the program is minimized. This article highlights the existence of an optimal participation rate that minimizes the number of people with excess weight and the cost of the intervention. The time-varying optimal participation rate could contribute to designing future public health interventions of excess weight.

Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

PubMed

Bansal, Sukhchain S; Dogra, Tara; Smith, Peter W; Amran, Maisarah; Auluck, Ishna; Bhambra, Maninder; Sura, Manraj S; Rowe, Edward; Koupparis, Anthony

2018-03-01

To perform a cost analysis comparing the cost of robot-assisted radical cystectomy (RARC) with open RC (ORC) in a UK tertiary referral centre and to identify the key cost drivers. Data on hospital length of stay (LOS), operative time (OT), transfusion rate, and volume and complication rate were obtained from a prospectively updated institutional database for patients undergoing RARC or ORC. A cost decision tree model was created. Sensitivity analysis was performed to find key drivers of overall cost and to find breakeven points with ORC. Monte Carlo analysis was performed to quantify the variability in the dataset. One RARC procedure costs £12 449.87, or £12 106.12 if the robot was donated via charitable funds. In comparison, one ORC procedure costs £10 474.54. RARC is 18.9% more expensive than ORC. The key cost drivers were OT, LOS, and the number of cases performed per annum. High ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis.

PubMed

Boucher, Michel; Rodger, Marc; Johnson, Jeffrey A; Tierney, Mike

2003-03-01

To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults. Prospective, observational study with historical inpatient cases as controls. Ambulatory thrombosis clinic of a tertiary care teaching center in Canada. Forty-nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001. The 49 inpatients received unfractionated heparin, and the 51 outpatients received low-molecular-weight heparin (LMWH). A cost-minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was 248 Canadian dollars (95% confidence interval 216-280 Canadian dollars) and was significantly different from the mean cost/inpatient case of 2826 Canadian dollars (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%. Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.

Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture.

PubMed

Rourke, Keith F; Jordan, Gerald H

2005-04-01

Treatment for urethral stricture disease often requires a choice between readily available direct vision internal urethrotomy (DVIU) and highly efficacious but more technically complex open urethral reconstruction. Using the short segment bulbous urethral stricture as a model, we determined which strategy is less costly. The costs of DVIU and open urethral reconstruction with stricture excision and primary anastomosis for a 2 cm bulbous urethral stricture were compared using a cost minimization decision analysis model. Clinical probability estimates for the DVIU treatment arm were the risk of bleeding, urinary tract infection and the risk of stricture recurrence. Estimates for the primary urethral reconstruction strategy were the risk of wound complications, complications of exaggerated lithotomy and the risk of treatment failure. Direct third party payer costs were determined in 2002 United States dollars. The model predicted that treatment with DVIU was more costly (17,747 dollars per patient) than immediate open urethral reconstruction (16,444 dollars per patient). This yielded an incremental cost savings of $1,304 per patient, favoring urethral reconstruction. Sensitivity analysis revealed that primary treatment with urethroplasty was economically advantageous within the range of clinically relevant events. Treatment with DVIU became more favorable when the long-term risk of stricture recurrence after DVIU was less than 60%. Treatment for short segment bulbous urethral strictures with primary reconstruction is less costly than treatment with DVIU. From a fiscal standpoint urethral reconstruction should be considered over DVIU in the majority of clinical circumstances.

On a cost functional for H2/H(infinity) minimization

NASA Technical Reports Server (NTRS)

Macmartin, Douglas G.; Hall, Steven R.; Mustafa, Denis

1990-01-01

A cost functional is proposed and investigated which is motivated by minimizing the energy in a structure using only collocated feedback. Defined for an H(infinity)-norm bounded system, this cost functional also overbounds the H2 cost. Some properties of this cost functional are given, and preliminary results on the procedure for minimizing it are presented. The frequency domain cost functional is shown to have a time domain representation in terms of a Stackelberg non-zero sum differential game.

Recombinant versus highly-purified, urinary follicle-stimulating hormone (r-FSH vs. HP-uFSH) in ovulation induction: a prospective, randomized study with cost-minimization analysis

PubMed Central

Revelli, Alberto; Poso, Francesca; Gennarelli, Gianluca; Moffa, Federica; Grassi, Giuseppina; Massobrio, Marco

2006-01-01

Background Both recombinant FSH (r-FSH) and highly-purified, urinary FSH (HP-uFSH) are frequently used in ovulation induction associated with timed sexual intercourse. Their effectiveness is reported to be similar, and therefore the costs of treatment represent a major issue to be considered. Although several studies about costs in IVF have been published, data obtained in low-technology infertility treatments are still scarce. Methods Two hundred and sixty infertile women (184 with unexplained infertility, 76 with CC-resistant polycystic ovary syndrome) at their first treatment cycle were randomized and included in the study. Ovulation induction was accomplished by daily administration of rFSH or HP-uFSH according to a low-dose, step-up regimen aimed to obtain a monofollicular ovulation. A bi- or tri-follicular ovulation was anyway accepted, whereas hCG was withdrawn and the cycle cancelled when more than three follicles greater than or equal to 18 mm diameter were seen at ultrasound. The primary outcome measure was the cost of therapy per delivered baby, estimated according to a cost-minimization analysis. Secondary outcomes were the following: monofollicular ovulation rate, total FSH dose, cycle cancellation rate, length of the follicular phase, number of developing follicles (>12 mm diameter), endometrial thickness at hCG, incidence of twinning and ovarian hyperstimulation syndrome, delivery rate. Results The overall FSH dose needed to achieve ovulation was significantly lower with r-FSH, whereas all the other studied variables did not significantly differ with either treatments. However, a trend toward a higher delivery rate with r-FSH was observed in the whole group and also when results were considered subgrouping patients according to the indication to treatment. Conclusion Considering the significantly lower number of vials/patient and the slight (although non-significant) increase in the delivery rate with r-FSH, the cost-minimization analysis showed a 9.4% reduction in the overall therapy cost per born baby in favor of r-FSH. PMID:16848893

Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality-adjusted life years.

PubMed

Chatterton, Mary Lou; Chambers, Suzanne; Occhipinti, Stefano; Girgis, Afaf; Dunn, Jeffrey; Carter, Rob; Shih, Sophy; Mihalopoulos, Cathrine

2016-07-01

This study compared the cost-effectiveness of a psychologist-led, individualised cognitive behavioural intervention (PI) to a nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. This was an economic evaluation conducted alongside a randomised trial of highly distressed adult cancer patients and carers calling cancer helplines. Services used by participants were measured using a resource use questionnaire, and quality-adjusted life years were measured using the assessment of quality of life - eight-dimension - instrument collected through a computer-assisted telephone interview. The base case analysis stratified participants based on the baseline score on the Brief Symptom Inventory. Incremental cost-effectiveness ratio confidence intervals were calculated with a nonparametric bootstrap to reflect sampling uncertainty. The results were subjected to sensitivity analysis by varying unit costs for resource use and the method for handling missing data. No significant differences were found in overall total costs or quality-adjusted life years (QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probability of lower cost and greater QALYs for both carers and patients with high distress at baseline. For patients with low levels of distress at baseline, the PI had a higher probability of greater QALYs but at additional cost. Sensitivity analysis showed the results were robust. The PI may be cost-effective compared with the nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. More intensive psychological intervention for patients with greater levels of distress appears warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Supraorbital Versus Endoscopic Endonasal Approaches for Olfactory Groove Meningiomas: A Cost-Minimization Study.

PubMed

Gandhoke, Gurpreet S; Pease, Matthew; Smith, Kenneth J; Sekula, Raymond F

2017-09-01

To perform a cost-minimization study comparing the supraorbital and endoscopic endonasal (EEA) approach with or without craniotomy for the resection of olfactory groove meningiomas (OGMs). We built a decision tree using probabilities of gross total resection (GTR) and cerebrospinal fluid (CSF) leak rates with the supraorbital approach versus EEA with and without additional craniotomy. The cost (not charge or reimbursement) at each "stem" of this decision tree for both surgical options was obtained from our hospital's finance department. After a base case calculation, we applied plausible ranges to all parameters and carried out multiple 1-way sensitivity analyses. Probabilistic sensitivity analyses confirmed our results. The probabilities of GTR (0.8) and CSF leak (0.2) for the supraorbital craniotomy were obtained from our series of 5 patients who underwent a supraorbital approach for the resection of an OGM. The mean tumor volume was 54.6 cm 3 (range, 17-94.2 cm 3 ). Literature-reported rates of GTR (0.6) and CSF leak (0.3) with EEA were applied to our economic analysis. Supraorbital craniotomy was the preferred strategy, with an expected value of $29,423, compared with an EEA cost of $83,838. On multiple 1-way sensitivity analyses, supraorbital craniotomy remained the preferred strategy, with a minimum cost savings of $46,000 and a maximum savings of $64,000. Probabilistic sensitivity analysis found the lowest cost difference between the 2 surgical options to be $37,431. Compared with EEA, supraorbital craniotomy provides substantial cost savings in the treatment of OGMs. Given the potential differences in effectiveness between approaches, a cost-effectiveness analysis should be undertaken. Copyright © 2017 Elsevier Inc. All rights reserved.

The environmental cost of subsistence: Optimizing diets to minimize footprints.

PubMed

Gephart, Jessica A; Davis, Kyle F; Emery, Kyle A; Leach, Allison M; Galloway, James N; Pace, Michael L

2016-05-15

The question of how to minimize monetary cost while meeting basic nutrient requirements (a subsistence diet) was posed by George Stigler in 1945. The problem, known as Stigler's diet problem, was famously solved using the simplex algorithm. Today, we are not only concerned with the monetary cost of food, but also the environmental cost. Efforts to quantify environmental impacts led to the development of footprint (FP) indicators. The environmental footprints of food production span multiple dimensions, including greenhouse gas emissions (carbon footprint), nitrogen release (nitrogen footprint), water use (blue and green water footprint) and land use (land footprint), and a diet minimizing one of these impacts could result in higher impacts in another dimension. In this study based on nutritional and population data for the United States, we identify diets that minimize each of these four footprints subject to nutrient constraints. We then calculate tradeoffs by taking the composition of each footprint's minimum diet and calculating the other three footprints. We find that diets for the minimized footprints tend to be similar for the four footprints, suggesting there are generally synergies, rather than tradeoffs, among low footprint diets. Plant-based food and seafood (fish and other aquatic foods) commonly appear in minimized diets and tend to most efficiently supply macronutrients and micronutrients, respectively. Livestock products rarely appear in minimized diets, suggesting these foods tend to be less efficient from an environmental perspective, even when nutrient content is considered. The results' emphasis on seafood is complicated by the environmental impacts of aquaculture versus capture fisheries, increasing in aquaculture, and shifting compositions of aquaculture feeds. While this analysis does not make specific diet recommendations, our approach demonstrates potential environmental synergies of plant- and seafood-based diets. As a result, this study provides a useful tool for decision-makers in linking human nutrition and environmental impacts. Copyright © 2016 Elsevier B.V. All rights reserved.

Cost Scaling of a Real-World Exhaust Waste Heat Recovery Thermoelectric Generator: A Deeper Dive

NASA Astrophysics Data System (ADS)

Hendricks, Terry J.; Yee, Shannon; LeBlanc, Saniya

2016-03-01

Cost is equally important to power density or efficiency for the adoption of waste heat recovery thermoelectric generators (TEG) in many transportation and industrial energy recovery applications. In many cases, the system design that minimizes cost (e.g., the /W value) can be very different than the design that maximizes the system's efficiency or power density, and it is important to understand the relationship between those designs to optimize TEG performance-cost compromises. Expanding on recent cost analysis work and using more detailed system modeling, an enhanced cost scaling analysis of a waste heat recovery TEG with more detailed, coupled treatment of the heat exchangers has been performed. In this analysis, the effect of the heat lost to the environment and updated relationships between the hot-side and cold-side conductances that maximize power output are considered. This coupled thermal and thermoelectric (TE) treatment of the exhaust waste heat recovery TEG yields modified cost scaling and design optimization equations, which are now strongly dependent on the heat leakage fraction, exhaust mass flow rate, and heat exchanger effectiveness. This work shows that heat exchanger costs most often dominate the overall TE system costs, that it is extremely difficult to escape this regime, and in order to achieve TE system costs of 1/W it is necessary to achieve heat exchanger costs of 1/(W/K). Minimum TE system costs per watt generally coincide with maximum power points, but preferred TE design regimes are identified where there is little cost penalty for moving into regions of higher efficiency and slightly lower power outputs. These regimes are closely tied to previously identified low cost design regimes. This work shows that the optimum fill factor F opt minimizing system costs decreases as heat losses increase, and increases as exhaust mass flow rate and heat exchanger effectiveness increase. These findings have profound implications on the design and operation of various TE waste heat recovery systems. This work highlights the importance of heat exchanger costs on the overall TEG system costs, quantifies the possible TEG performance-cost domain space based on heat exchanger effects, and provides a focus for future system research and development efforts.

[Economic analysis versus the principle of guaranteed safety in blood transfusion].

PubMed

Moatti, J P; Loubière, S; Rotily, M

2000-06-01

This article shows that policies aimed at reducing risks of infectious agents transmissible through blood unfortunately follow a law of 'diminishing returns': increasing marginal costs have to be devoted for limited reductions in the risks of contamination through blood donations. Therefore, the economic cost-effectiveness analysis is appropriate to identify screening strategies which may minimize costs to reach a certain level of safety. Moreover, economic analysis can contribute to public debates about the level of residual risk that society is willing to accept. Empirical results from French studies about screening for hepatitis C virus (HCV) in individuals who have received blood transfusions and in blood donations are presented to illustrate these points.

Efficacy and cost-effectiveness of minimal guided and unguided internet-based mobile supported stress-management in employees with occupational stress: a three-armed randomised controlled trial.

PubMed

Ebert, David Daniel; Lehr, Dirk; Smit, Filip; Zarski, Anna-Carlotta; Riper, Heleen; Heber, Elena; Cuijpers, Pim; Berking, Matthias

2014-08-07

Internet- and mobile based stress-management interventions (iSMI) may be an effective means to address the negative consequences of occupational stress. However, available results from randomised controlled trials are conflicting. Moreover, it is yet not clear whether guided or unguided self-help iSMI provide better value for money. Internet-based mental health interventions without guidance are often much less effective than interventions including at least some guidance from a professional. However, direct comparisons in randomised controlled trials are scarce and, to the best of our knowledge, the comparative (cost)-effectiveness of guided vs. unguided iSMI has not yet been studied. Hence, this study investigates the acceptability and (cost-) effectiveness of minimal guided and unguided iSMI in employees with heightened levels of perceived stress. A three-armed randomised controlled trial (RCT) will be conducted to compare a minimal guided and unguided iSMI with a waiting list control condition (WLC). Both active conditions are based on the same iSMI, i.e. GET.ON Stress, and differ only with regard to the guidance format. Employees with heightened levels of perceived stress (PSS ≥ 22) will be randomised to one of three conditions. Primary outcome will be comparative changes in perceived stress (PSS). Secondary outcomes include changes in self-reported depression, work-engagement, presenteeism and absenteeism. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective, including both direct medical costs and costs related to productivity losses. In addition, a cost-benefit analysis will be conducted from the employer's perspective. Incremental net-benefit regression analyses will address the question if there are any baseline factors (i.e. subgroups of employees) associated with particularly favorable cost-effectiveness when the experimental intervention is offered. Assessments take place at baseline, 7 weeks post-treatment and 6 months after randomisation. Online-based (guided) self-help interventions could be an acceptable, effective and economically sustainable approach to offer evidence-based intervention alternatives to reduce the negative consequences associated with work-related stress. This study evaluates the (cost-) effectiveness of two versions of an iSMI, minimal guided and unguided iSMI. Thus, the present study will further enhance the evidence-base for iSMI and provide valuable information about the optimal balance between outcome and economic costs. German Clinical Trial Registration (DRKS): DRKS00005687.

Identifying cost-minimizing strategies for guaranteeing target dairy income over feed cost via use of the Livestock Gross Margin dairy insurance program.

PubMed

Valvekar, M; Cabrera, V E; Gould, B W

2010-07-01

Milk and feed price volatility are the major source of dairy farm risk. Since August 2008 a new federally reinsured insurance program has been available to many US dairy farmers to help minimize the negative effects of adverse price movements. This insurance program is referred to as Livestock Gross Margin Insurance for Dairy Cattle. Given the flexibility in contract design, the dairy farmer has to make 3 critical decisions when purchasing this insurance: 1) the percentage of monthly milk production to be covered, 3) declared feed equivalents used to produce this milk, and 3) the level of gross margin not covered by insurance (i.e., deductible). The objective of this analysis was to provide an optimal strategy of how a dairy farmer could incorporate this insurance program to help manage the variability in net farm income. In this analysis we assumed that a risk-neutral dairy farmer wants to design an insurance contract such that a target guaranteed income over feed cost is obtained at least cost. We undertook this analysis for a representative Wisconsin dairy farm (herd size: 120 cows) producing 8,873 kg (19,545 lb) of milk/cow per year. Wisconsin statistical data indicates that dairy farms of similar size must require an income over feed cost of at least $110/Mg ($5/cwt) of milk to be profitable during the coverage period. Therefore, using data for the July 2009 insurance contract to insure $110/Mg of milk, the least cost contract was found to have a premium of $1.22/Mg ($0.055/cwt) of milk produced insuring approximately 52% of the production with variable monthly production covered during the period of September 2009 to June 2010. This premium represented 1.10% of the desired IOFC. We compared the above optimal strategy with an alternative nonoptimal strategy, defined as a contract insuring the same proportion of milk as the optimal (52%) but with a constant amount insured across all contract months. The premium was found to be almost twice the level obtained under the cost-minimizing solution representing 1.9% of the insured amount. Our model identifies the lowest cost insurance contract for a desired target guaranteed income over feed cost. Copyright (c) 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Optimal speeds for walking and running, and walking on a moving walkway.

PubMed

Srinivasan, Manoj

2009-06-01

Many aspects of steady human locomotion are thought to be constrained by a tendency to minimize the expenditure of metabolic cost. This paper has three parts related to the theme of energetic optimality: (1) a brief review of energetic optimality in legged locomotion, (2) an examination of the notion of optimal locomotion speed, and (3) an analysis of walking on moving walkways, such as those found in some airports. First, I describe two possible connotations of the term "optimal locomotion speed:" that which minimizes the total metabolic cost per unit distance and that which minimizes the net cost per unit distance (total minus resting cost). Minimizing the total cost per distance gives the maximum range speed and is a much better predictor of the speeds at which people and horses prefer to walk naturally. Minimizing the net cost per distance is equivalent to minimizing the total daily energy intake given an idealized modern lifestyle that requires one to walk a given distance every day--but it is not a good predictor of animals' walking speeds. Next, I critique the notion that there is no energy-optimal speed for running, making use of some recent experiments and a review of past literature. Finally, I consider the problem of predicting the speeds at which people walk on moving walkways--such as those found in some airports. I present two substantially different theories to make predictions. The first theory, minimizing total energy per distance, predicts that for a range of low walkway speeds, the optimal absolute speed of travel will be greater--but the speed relative to the walkway smaller--than the optimal walking speed on stationary ground. At higher walkway speeds, this theory predicts that the person will stand still. The second theory is based on the assumption that the human optimally reconciles the sensory conflict between the forward speed that the eye sees and the walking speed that the legs feel and tries to equate the best estimate of the forward speed to the naturally preferred speed. This sensory conflict theory also predicts that people would walk slower than usual relative to the walkway yet move faster than usual relative to the ground. These predictions agree qualitatively with available experimental observations, but there are quantitative differences.

Shuttle's 160 hour ground turnaround - A design driver

NASA Technical Reports Server (NTRS)

Widick, F.

1977-01-01

Turnaround analysis added a new dimension to the Space Program with the advent of the Space Shuttle. The requirement to turn the flight hardware around in 160 working hours from landing to launch was a significant design driver and a useful tool in forcing the integration of flight and ground systems design to permit an efficient ground operation. Although there was concern that time constraints might increase program costs, the result of the analysis was to minimize facility requirements and simplify operations with resultant cost savings.

NECAP 4.1: NASA's energy-cost analysis program user's manual

NASA Technical Reports Server (NTRS)

Jensen, R. N.; Henninger, R. H.; Miner, D. L.

1983-01-01

The Enery Cost Analysis Program (NECAP) is a powerful computerized method to determine and to minimize building energy consumption. The program calculates hourly heat gain or losses taking into account the building thermal resistance and mass, using hourly weather and a "response factor' method. Internal temperatures are allowed to vary in accordance with thermostat settings and equipment capacity. A simplified input procedure and numerous other technical improvements are presented. This Users Manual describes the program and provides examples.

Clinical Laboratory Automation: A Case Study.

PubMed

Archetti, Claudia; Montanelli, Alessandro; Finazzi, Dario; Caimi, Luigi; Garrafa, Emirena

2017-04-13

This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs.

An analysis of UK waste minimization clubs: key requirements for future cost effective developments.

PubMed

Phillips, P S; Pratt, R M; Pike, K

2001-01-01

The UK waste strategy is based upon use of the best practicable environmental option (BPEO), by those making waste management decisions. BPEO is supported by the use of the waste hierarchy, with its range of preferable options for dealing with waste, and the proximity principle, where waste is treated/disposed of as close to its point of origin as possible. The national waste strategy emphasizes the key role of waste minimization and encourages industry, commerce and the public to move towards sustainable waste management practice for economic and environmental reasons. Waste minimization clubs have been used, since the early 1990s, to demonstrate to industry/commerce that reducing waste production can lead to significant financial savings. There have been around 75 such clubs in the UK and they receive support from a wide range of agencies, including the Environmental Technology Best Practice Program. The early Demonstration Clubs had significant savings to cost ratios, e.g. Aire and Calder at 8.4, but had very high costs, e.g. Aire and Calder at 400,000 pounds. It is acknowledged that the number of clubs will have to be approximately doubled in the next few years so as to have an adequate coverage of the UK. There are at present, marked regional variations in club development and cognizance needs to be taken, by facilitators, of the need for extensive coverage of the UK. Future clubs will probably have to operate in a financially constrained climate and they need to be designed to deliver significant savings and waste reduction at low cost. To aid future club design, final reports of all projects should report in a standard manner so that cost benefit analysis can be used to inform facilitators about the most effective club type. rights reserved.

The Automated Array Assembly Task of the Low-cost Silicon Solar Array Project, Phase 2

NASA Technical Reports Server (NTRS)

Coleman, M. G.; Grenon, L.; Pastirik, E. M.; Pryor, R. A.; Sparks, T. G.

1978-01-01

An advanced process sequence for manufacturing high efficiency solar cells and modules in a cost-effective manner is discussed. Emphasis is on process simplicity and minimizing consumed materials. The process sequence incorporates texture etching, plasma processes for damage removal and patterning, ion implantation, low pressure silicon nitride deposition, and plated metal. A reliable module design is presented. Specific process step developments are given. A detailed cost analysis was performed to indicate future areas of fruitful cost reduction effort. Recommendations for advanced investigations are included.

Evaluating the cost of one telehealth application connecting an acute and long-term care setting.

PubMed

Specht, J K; Wakefield, B; Flanagan, J

2001-01-01

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.

Design integration for minimal energy and cost

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

Halldane, J.E.

The authors present requirements for creating alternative energy conserving designs including energy management and architectural, plumbing, mechanical, electrical, electronic and optical design. Parameters of power, energy, life cycle costs and benefit for resource for an evaluation by the interested parties are discussed. They present an analysis of power systems through a seasonal power distribution diagram. An analysis of cost systems includes capital cost from the power components, annual costs from the utility energy use, and finance costs with loans, taxes, settlement and design fees. Equations are transposed to the evaluative parameter and are uniquely explicit with consistent symbols, parameter definitions,more » dual and balanced units, unit conversions, criteria for operation, incorporated constants for rapid calculations, references to data in the handbook, other common terms, and instrumentation for the measurement. Each component equation has a key power diagram.« less

Aircraft parameter estimation

NASA Technical Reports Server (NTRS)

Iliff, Kenneth W.

1987-01-01

The aircraft parameter estimation problem is used to illustrate the utility of parameter estimation, which applies to many engineering and scientific fields. Maximum likelihood estimation has been used to extract stability and control derivatives from flight data for many years. This paper presents some of the basic concepts of aircraft parameter estimation and briefly surveys the literature in the field. The maximum likelihood estimator is discussed, and the basic concepts of minimization and estimation are examined for a simple simulated aircraft example. The cost functions that are to be minimized during estimation are defined and discussed. Graphic representations of the cost functions are given to illustrate the minimization process. Finally, the basic concepts are generalized, and estimation from flight data is discussed. Some of the major conclusions for the simulated example are also developed for the analysis of flight data from the F-14, highly maneuverable aircraft technology (HiMAT), and space shuttle vehicles.

[Determination of cost-effective strategies in colorectal cancer screening].

PubMed

Dervaux, B; Eeckhoudt, L; Lebrun, T; Sailly, J C

1992-01-01

The object of the article is to implement particular methodologies in order to determine which strategies are cost-effective in the mass screening of colorectal cancer after a positive Hemoccult test. The first approach to be presented consists in proposing a method which enables all the admissible diagnostic strategies to be determined. The second approach enables a minimal cost function to be estimated using an adaptation of "Data Envelopment Analysis". This method proves to be particularly successful in cost-efficiency analysis, when the performance indicators are numerous and hard to aggregate. The results show that there are two cost-effective strategies after a positive Hemoccult test: coloscopy and sigmoidoscopy; they put into question the relevance of double contrast barium enema in the diagnosis of colo-rectal lesions.

Value-Based Medicine and Pharmacoeconomics.

PubMed

Brown, Gary C; Brown, Melissa M

2016-01-01

Pharmacoeconomics is assuming increasing importance in the pharmaceutical field since it is entering the public policy arena in many countries. Among the variants of pharmacoeconomic analysis are cost-minimization, cost-benefit, cost-effectiveness and cost-utility analyses. The latter is the most versatile and sophisticated in that it integrates the patient benefit (patient value) conferred by a drug in terms of improvement in length and/or quality of life. It also incorporates the costs expended for that benefit, as well as the dollars returned to patients and society from the use of a drug (financial value). Unfortunately, one cost-utility analysis in the literature is generally not comparable to another because of the lack of standardized formats and standardized input variables (costs, cost perspective, quality-of-life measurement instruments, quality-of-life respondents, discounting and so forth). Thus, millions of variants can be used. Value-based medicine® (VBM) cost-utility analysis standardizes these variants so that one VBM analysis is comparable to another. This system provides a highly rational methodology that allows providers and patients to quantify and compare the patient value and financial value gains associated with the use of pharmaceutical agents for example. © 2016 S. Karger AG, Basel.

Use of drug-eluting stents versus bare-metal stents in Korea: a cost-minimization analysis using population data.

PubMed

Suh, Hae Sun; Song, Hyun Jin; Jang, Eun Jin; Kim, Jung-Sun; Choi, Donghoon; Lee, Sang Moo

2013-07-01

The goal of this study was to perform an economic analysis of a primary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) admitted through an emergency room (ER) visit in Korea using population-based data. We employed a cost-minimization method using a decision analytic model with a two-year time period. Model probabilities and costs were obtained from a published systematic review and population-based data from which a retrospective database analysis of the national reimbursement database of Health Insurance Review and Assessment covering 2006 through 2010 was performed. Uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analyses. Among 513 979 cases with AMI during 2007 and 2008, 24 742 cases underwent stenting procedures and 20 320 patients admitted through an ER visit with primary stenting were identified in the base model. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-coronary artery bypass graft, and DES-to-balloon were 59.7%, 0.6%, 4.3%, and 35.3%, respectively, among these patients. The average two-year costs of DES and BMS in 2011 Korean won were 11 065 528 won/person and 9 647 647 won/person, respectively. DES resulted in higher costs than BMS by 1 417 882 won/person. The model was highly sensitive to the probability and costs of having no revascularization. Primary stenting with BMS for AMI with an ER visit was shown to be a cost-saving procedure compared with DES in Korea. Caution is needed when applying this finding to patients with a higher level of severity in health status.

The soft constraints hypothesis: a rational analysis approach to resource allocation for interactive behavior.

PubMed

Gray, Wayne D; Sims, Chris R; Fu, Wai-Tat; Schoelles, Michael J

2006-07-01

Soft constraints hypothesis (SCH) is a rational analysis approach that holds that the mixture of perceptual-motor and cognitive resources allocated for interactive behavior is adjusted based on temporal cost-benefit tradeoffs. Alternative approaches maintain that cognitive resources are in some sense protected or conserved in that greater amounts of perceptual-motor effort will be expended to conserve lesser amounts of cognitive effort. One alternative, the minimum memory hypothesis (MMH), holds that people favor strategies that minimize the use of memory. SCH is compared with MMH across 3 experiments and with predictions of an Ideal Performer Model that uses ACT-R's memory system in a reinforcement learning approach that maximizes expected utility by minimizing time. Model and data support the SCH view of resource allocation; at the under 1000-ms level of analysis, mixtures of cognitive and perceptual-motor resources are adjusted based on their cost-benefit tradeoffs for interactive behavior. ((c) 2006 APA, all rights reserved).

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.

A Statistical Analysis Of Construction Equipment Repair Costs Using Field Data & The Cumulative Cost Model.

DTIC Science & Technology

1998-04-28

be discussed. 2.1 ECONOMIC REPLACEMENT THEORY Decisions about heavy equipment should be made based on sound economic principles , not emotions...Life) will be less than L*. The converse is also true. 2.1.3 The Repair Limit Theory A different way of looking at the economic replacement decision...Summary Three different economic models have been reviewed in this section. The output of each is distinct. One seeks to minimize costs, one seeks to

Low cost quantitative digital imaging as an alternative to qualitative in vivo bioassays for analysis of active aflatoxin B1

USDA-ARS?s Scientific Manuscript database

Aflatoxin B1 (AFB1) producing fungi contaminate food and feed and are a major health concern. To minimize the sources and incidence of AFB1 illness there is a need to develop affordable, sensitive mobile devices for detection of active AFB1. In the present study we used a low cost fluorescence detec...

Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

PubMed

Sanclemente-Ansó, Carmen; Bosch, Xavier; Salazar, Albert; Moreno, Ramón; Capdevila, Cristina; Rosón, Beatriz; Corbella, Xavier

2016-05-01

Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere. Copyright © 2015. Published by Elsevier B.V.

Pharmacologic Hemostatic Agents in Total Joint Arthroplasty-A Cost-Effectiveness Analysis.

PubMed

Ramkumar, Dipak B; Ramkumar, Niveditta; Tapp, Stephanie J; Moschetti, Wayne E

2018-03-03

Total knee and hip arthroplasties can be associated with substantial blood loss, affecting morbidity and even mortality. Two pharmacological antifibrinolytics, ε-aminocaproic acid (EACA) and tranexamic acid (TXA) have been used to minimize perioperative blood loss, but both have associated morbidity. Given the added cost of these medications and the risks associated with then, a cost-effectiveness analysis was undertaken to ascertain the best strategy. A cost-effectiveness model was constructed using the payoffs of cost (in United States dollars) and effectiveness (quality-adjusted life expectancy, in days). The medical literature was used to ascertain various complications, their probabilities, utility values, and direct medical costs associated with various health states. A time horizon of 10 years and a willingness to pay threshold of $100,000 was used. The total cost and effectiveness (quality-adjusted life expectancy, in days) was $459.77, $951.22, and $1174.87 and 3411.19, 3248.02, and 3342.69 for TXA, no pharmacologic hemostatic agent, and EACA, respectively. Because TXA is less expensive and more effective than the competing alternatives, it was the favored strategy. One-way sensitivity analyses for probability of transfusion and myocardial infarction for all 3 strategies revealed that TXA remains the dominant strategy across all clinically plausible values. TXA, when compared with no pharmacologic hemostatic agent and with EACA, is the most cost-effective strategy to minimize intraoperative blood loss in hip and knee total joint arthroplasties. These findings are robust to sensitivity analyses using clinically plausible probabilities. Copyright © 2018 Elsevier Inc. All rights reserved.

Health care economic analyses and value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C; Sharma, Sanjay; Landy, Jennifer

2003-01-01

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect health). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

PubMed

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology compared with the traditional open approach. MIS versus open multilevel hemilaminectomy was associated with similar cost over 2 years while providing equivalent improvement in QALYs. In our experience, MIS versus open multilevel hemilaminectomy is a cost equivalent technology for patients with lumbar stenosis-associated radicular pain.

Development of Activity-based Cost Functions for Cellulase, Invertase, and Other Enzymes

NASA Astrophysics Data System (ADS)

Stowers, Chris C.; Ferguson, Elizabeth M.; Tanner, Robert D.

As enzyme chemistry plays an increasingly important role in the chemical industry, cost analysis of these enzymes becomes a necessity. In this paper, we examine the aspects that affect the cost of enzymes based upon enzyme activity. The basis for this study stems from a previously developed objective function that quantifies the tradeoffs in enzyme purification via the foam fractionation process (Cherry et al., Braz J Chem Eng 17:233-238, 2000). A generalized cost function is developed from our results that could be used to aid in both industrial and lab scale chemical processing. The generalized cost function shows several nonobvious results that could lead to significant savings. Additionally, the parameters involved in the operation and scaling up of enzyme processing could be optimized to minimize costs. We show that there are typically three regimes in the enzyme cost analysis function: the low activity prelinear region, the moderate activity linear region, and high activity power-law region. The overall form of the cost analysis function appears to robustly fit the power law form.

Bevacizumab plus interferon-α versus sunitinib for first-line treatment of renal cell carcinoma in Italy: a cost-minimization analysis.

PubMed

Ravasio, Roberto; Ortega, Cinzia; Sabbatini, Roberto; Porta, Camillo

2011-01-01

Renal cell carcinoma (RCC) is the most common form of kidney cancer. Immunotherapy with interferon-α (IFNα) and interleukin-2 (IL-2) has been the historical therapy of choice for the treatment of locally advanced or metastatic RCC prior to the more recent development of targeted therapies, including sunitinib and bevacizumab (combined with IFNα). Clinically and statistically significant advantages have been shown with both sunitinib and the combination of bevacizumab + IFNα versus IFNα alone in the treatment of advanced or metastatic RCC. The present study evaluated the incremental costs of bevacizumab + IFNα versus sunitinib for the first-line treatment of advanced or metastatic RCC assuming similar efficacy for these treatments. The efficacy profiles of bevacizumab + IFNα or sunitinib alone have been shown (indirectly) to be similar in patients with RCC; indeed, median progression-free survival (PFS) with either treatment is in the 10- to 11-month range. Therefore, a cost-minimization analysis was performed, focusing on direct medical costs only (drugs, administration and management of adverse events). The analysis considered the perspective of the Italian National Health Service (NHS), comparing the cost of bevacizumab (10 mg/kg) plus IFNα (9, 6 or 3 million IU [MIU]) versus sunitinib (50 mg) as first-line therapies for advanced or metastatic clear-cell RCC. The average cost per treated patient (year 2010 values) was assessed for the two treatment options at 11 months (median PFS). Assuming a PFS of 11 months for both treatment options, bevacizumab + IFNα (9 MIU) would be a lower cost strategy (cost savings of €2052 per patient) than sunitinib. This difference arises mainly from the reduction in the acquisition cost of bevacizumab to the NHS (risk-sharing agreement). The cost advantages for bevacizumab would increase in parallel with a reduction in IFNα dosing; for example, with IFNα 6 MIU the corresponding cost savings would be €4185, and with 3 MIU the cost advantage would be €6320 per patient. This analysis suggests that bevacizumab + IFNα is a cost-saving alternative to sunitinib in the treatment of first-line metastatic RCC. Its superior safety profile also meant that the cost of managing adverse events was lower for bevacizumab + IFNα than for sunitinib.

Cost considerations in using simulations for medical training.

PubMed

Fletcher, J D; Wind, Alexander P

2013-10-01

This article reviews simulation used for medical training, techniques for assessing simulation-based training, and cost analyses that can be included in such assessments. Simulation in medical training appears to take four general forms: human actors who are taught to simulate illnesses and ailments in standardized ways; virtual patients who are generally presented via computer-controlled, multimedia displays; full-body manikins that simulate patients using electronic sensors, responders, and controls; and part-task anatomical simulations of various body parts and systems. Techniques for assessing costs include benefit-cost analysis, return on investment, and cost-effectiveness analysis. Techniques for assessing the effectiveness of simulation-based medical training include the use of transfer effectiveness ratios and incremental transfer effectiveness ratios to measure transfer of knowledge and skill provided by simulation to the performance of medical procedures. Assessment of costs and simulation effectiveness can be combined with measures of transfer using techniques such as isoperformance analysis to identify ways of minimizing costs without reducing performance effectiveness or maximizing performance without increasing costs. In sum, economic analysis must be considered in training assessments if training budgets are to compete successfully with other requirements for funding. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

PubMed Central

Turchetti, G.; Bellelli, S.; Palla, I.; Forli, F.

2011-01-01

SUMMARY The aim of the study consists in a systematic review concerning the economic evaluation of cochlear implant (CI) in children by searching the main international clinical and economic electronic databases. All primary studies published in English from January 2000 to May 2010 were included. The types of studies selected concerned partial economic evaluation, including direct and indirect costs of cochlear implantation; complete economic evaluation, including minimization of costs, cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) performed through observational and experimental studies. A total of 68 articles were obtained from the database research. Of these, 54 did not meet the inclusion criteria and were eliminated. After reading the abstracts of the 14 articles selected, 11 were considered eligible. The articles were then read in full text. Furthermore, 5 articles identified by bibliography research were added manually. After reading 16 of the selected articles, 9 were included in the review. With regard to the studies included, countries examined, objectives, study design, methodology, prospect of analysis adopted, temporal horizon, the cost categories analyzed strongly differ from one study to another. Cost analysis, cost-effectiveness analysis and an analysis of educational costs associated with cochlear implants were performed. Regarding the cost analysis, only two articles reported both direct cost and indirect costs. The direct cost ranged between € 39,507 and € 68,235 (2011 values). The studies related to cost-effectiveness analysis were not easily comparable: one study reported a cost per QALY ranging between $ 5197 and $ 9209; another referred a cost of $ 2154 for QALY if benefits were not discounted, and $ 16,546 if discounted. Educational costs are significant, and increase with the level of hearing loss and type of school attended. This systematic review shows that the healthcare costs are high, but savings in terms of indirect and quality of life costs are also significant. Cochlear implantation in a paediatric age is cost-effective. The exiguity and heterogeneity of studies did not allow detailed comparative analysis of the studies included in the review. PMID:22287822

Decision and cost analysis of empirical antibiotic therapy of acute sinusitis in the era of increasing antimicrobial resistance: do we have an additional tool for antibiotic policy decisions?

PubMed

Babela, Robert; Jarcuska, Pavol; Uraz, Vladimir; Krčméry, Vladimír; Jadud, Branislav; Stevlik, Jan; Gould, Ian M

2017-11-01

No previous analyses have attempted to determine optimal therapy for upper respiratory tract infections on the basis of cost-minimization models and the prevalence of antimicrobial resistance among respiratory pathogens in Slovakia. This investigation compares macrolides and cephalosporines for empirical therapy and look at this new tool from the aspect of potential antibiotic policy decision-making process. We employed a decision tree model to determine the threshold level of macrolides and cephalosporines resistance among community respiratory pathogens that would make cephalosporines or macrolides cost-minimising. To obtain information on clinical outcomes and cost of URTIs, a systematic review of the literature was performed. The cost-minimization model of upper respiratory tract infections (URTIs) treatment was derived from the review of literature and published models. We found that the mean cost of empirical treatment with macrolides for an URTIs was €93.27 when the percentage of resistant Streptococcus pneumoniae in the community was 0%; at 5%, the mean cost was €96.45; at 10%, €99.63; at 20%, €105.99, and at 30%, €112.36. Our model demonstrated that when the percentage of macrolide resistant Streptococcus pneumoniae exceeds 13.8%, use of empirical cephalosporines rather than macrolides minimizes the treatment cost of URTIs. Empirical macrolide therapy is less expensive than cephalosporines therapy for URTIs unless macrolide resistance exceeds 13.8% in the community. Results have important antibiotic policy implications, since presented model can be use as an additional decision-making tool for new guidelines and reimbursement processes by local authorities in the era of continual increase in antibiotic resistance.

A New Model for Solving Time-Cost-Quality Trade-Off Problems in Construction

PubMed Central

Fu, Fang; Zhang, Tao

2016-01-01

A poor quality affects project makespan and its total costs negatively, but it can be recovered by repair works during construction. We construct a new non-linear programming model based on the classic multi-mode resource constrained project scheduling problem considering repair works. In order to obtain satisfactory quality without a high increase of project cost, the objective is to minimize total quality cost which consists of the prevention cost and failure cost according to Quality-Cost Analysis. A binary dependent normal distribution function is adopted to describe the activity quality; Cumulative quality is defined to determine whether to initiate repair works, according to the different relationships among activity qualities, namely, the coordinative and precedence relationship. Furthermore, a shuffled frog-leaping algorithm is developed to solve this discrete trade-off problem based on an adaptive serial schedule generation scheme and adjusted activity list. In the program of the algorithm, the frog-leaping progress combines the crossover operator of genetic algorithm and a permutation-based local search. Finally, an example of a construction project for a framed railway overpass is provided to examine the algorithm performance, and it assist in decision making to search for the appropriate makespan and quality threshold with minimal cost. PMID:27911939

Estimating costs of sea lice control strategy in Norway.

PubMed

Liu, Yajie; Bjelland, Hans Vanhauwaer

2014-12-01

This paper explores the costs of sea lice control strategies associated with salmon aquaculture at a farm level in Norway. Diseases can cause reduction in growth, low feed efficiency and market prices, increasing mortality rates, and expenditures on prevention and treatment measures. Aquaculture farms suffer the most direct and immediate economic losses from diseases. The goal of a control strategy is to minimize the total disease costs, including biological losses, and treatment costs while to maximize overall profit. Prevention and control strategies are required to eliminate or minimize the disease, while cost-effective disease control strategies at the fish farm level are designed to reduce the losses, and to enhance productivity and profitability. Thus, the goal can be achieved by integrating models of fish growth, sea lice dynamics and economic factors. A production function is first constructed to incorporate the effects of sea lice on production at a farm level, followed by a detailed cost analysis of several prevention and treatment strategies associated with sea lice in Norway. The results reveal that treatments are costly and treatment costs are very sensitive to treatment types used and timing of the treatment conducted. Applying treatment at an early growth stage is more economical than at a later stage. Copyright © 2014 Elsevier B.V. All rights reserved.

Contributions of metabolic and temporal costs to human gait selection.

PubMed

Summerside, Erik M; Kram, Rodger; Ahmed, Alaa A

2018-06-01

Humans naturally select several parameters within a gait that correspond with minimizing metabolic cost. Much less is understood about the role of metabolic cost in selecting between gaits. Here, we asked participants to decide between walking or running out and back to different gait specific markers. The distance of the walking marker was adjusted after each decision to identify relative distances where individuals switched gait preferences. We found that neither minimizing solely metabolic energy nor minimizing solely movement time could predict how the group decided between gaits. Of our twenty participants, six behaved in a way that tended towards minimizing metabolic energy, while eight favoured strategies that tended more towards minimizing movement time. The remaining six participants could not be explained by minimizing a single cost. We provide evidence that humans consider not just a single movement cost, but instead a weighted combination of these conflicting costs with their relative contributions varying across participants. Individuals who placed a higher relative value on time ran faster than individuals who placed a higher relative value on metabolic energy. Sensitivity to temporal costs also explained variability in an individual's preferred velocity as a function of increasing running distance. Interestingly, these differences in velocity both within and across participants were absent in walking, possibly due to a steeper metabolic cost of transport curve. We conclude that metabolic cost plays an essential, but not exclusive role in gait decisions. © 2018 The Author(s).

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.

Systematic review of the cost-effectiveness of sample size maintenance programs in studies involving postal questionnaires reveals insufficient economic information.

PubMed

David, Michael C; Bensink, Mark; Higashi, Hideki; Boyd, Roslyn; Williams, Lesley; Ware, Robert S

2012-10-01

To identify and assess the existing cost-effectiveness evidence for sample size maintenance programs. Articles were identified by searching Cochrane Central Register of Controlled Trials Embase, CINAHL, PubMed, and Web of Science from 1966 to July 2011. Randomized controlled trials in which investigators evaluated program cost-effectiveness in postal questionnaires were eligible for inclusion. Fourteen studies from 13 articles, with 11,165 participants met the inclusion criteria. Thirty-one distinct programs were identified; each incorporated at least one strategy (reminders, incentives, modified questionnaires, or types of postage) aimed at minimizing attrition. Reminders, in the form of replacement questionnaires and cards, were the most commonly used strategies, with 15 and 11 studies reporting their usage, respectively. All strategies improved response, with financial incentives being the most costly. Heterogeneity between studies was too great to allow for meta-analysis of the results. The implementation of strategies such as no-obligation incentives, modified questionnaires, and personalized reply paid postage improved program cost-effectiveness. Analyses of attrition minimization programs need to consider both cost and effect in their evaluation. Copyright © 2012 Elsevier Inc. All rights reserved.

Cost Scaling of a Real-World Exhaust Waste Heat Recovery Thermoelectric Generator: A Deeper Dive

NASA Technical Reports Server (NTRS)

Hendricks, Terry J.; Yee, Shannon; LeBlanc, Saniya

2015-01-01

Cost is equally important to power density or efficiency for the adoption of waste heat recovery thermoelectric generators (TEG) in many transportation and industrial energy recovery applications. In many cases the system design that minimizes cost (e.g., the $/W value) can be very different than the design that maximizes the system's efficiency or power density, and it is important to understand the relationship between those designs to optimize TEG performance-cost compromises. Expanding on recent cost analysis work and using more detailed system modeling, an enhanced cost scaling analysis of a waste heat recovery thermoelectric generator with more detailed, coupled treatment of the heat exchangers has been performed. In this analysis, the effect of the heat lost to the environment and updated relationships between the hot-side and cold-side conductances that maximize power output are considered. This coupled thermal and thermoelectric treatment of the exhaust waste heat recovery thermoelectric generator yields modified cost scaling and design optimization equations, which are now strongly dependent on the heat leakage fraction, exhaust mass flow rate, and heat exchanger effectiveness. This work shows that heat exchanger costs most often dominate the overall TE system costs, that it is extremely difficult to escape this regime, and in order to achieve TE system costs of $1/W it is necessary to achieve heat exchanger costs of $1/(W/K). Minimum TE system costs per watt generally coincide with maximum power points, but Preferred TE Design Regimes are identified where there is little cost penalty for moving into regions of higher efficiency and slightly lower power outputs. These regimes are closely tied to previously-identified low cost design regimes. This work shows that the optimum fill factor Fopt minimizing system costs decreases as heat losses increase, and increases as exhaust mass flow rate and heat exchanger effectiveness increase. These findings have profound implications on the design and operation of various thermoelectric (TE) waste heat 3 recovery systems. This work highlights the importance of heat exchanger costs on the overall TEG system costs, quantifies the possible TEG performance-cost domain space based on heat exchanger effects, and provides a focus for future system research and development efforts.

Can cover data be used as a surrogate for seedling counts in regeneration stocking evaluations in northern hardwood forests?

Treesearch

Todd E. Ristau; Susan L. Stout

2014-01-01

Assessment of regeneration can be time-consuming and costly. Often, foresters look for ways to minimize the cost of doing inventories. One potential method to reduce time required on a plot is use of percent cover data rather than seedling count data to determine stocking. Robust linear regression analysis was used in this report to predict seedling count data from...

Business case for Magnet® in a small hospital.

PubMed

Higdon, Karen; Clickner, Deborah; Gray, Frances; Woody, Gina; Shirey, Maria

2013-02-01

There is minimal evidence related to Magnet® designation and the benefits in small hospitals. A business strategy for small hospitals (<100 beds) to achieve Magnet designation is presented, including a cost-benefit analysis, outcome measures, and financial impact data.

Greedy algorithms in disordered systems

NASA Astrophysics Data System (ADS)

Duxbury, P. M.; Dobrin, R.

1999-08-01

We discuss search, minimal path and minimal spanning tree algorithms and their applications to disordered systems. Greedy algorithms solve these problems exactly, and are related to extremal dynamics in physics. Minimal cost path (Dijkstra) and minimal cost spanning tree (Prim) algorithms provide extremal dynamics for a polymer in a random medium (the KPZ universality class) and invasion percolation (without trapping) respectively.

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

PubMed

Mouraviev, Vladimir; Nosnik, Israel; Sun, Leon; Robertson, Cary N; Walther, Philip; Albala, David; Moul, Judd W; Polascik, Thomas J

2007-02-01

To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Out-of-pocket costs of HAART limit HIV treatment responses in Botswana's private sector.

PubMed

Bisson, Gregory P; Frank, Ian; Gross, Robert; Lo Re, Vincent; Strom, Jordan B; Wang, Xingmei; Mogorosi, Mpho; Gaolathe, Tendani; Ndwapi, Ndwapi; Friedman, Harvey; Strom, Brian L; Dickinson, Diana

2006-06-12

A large number of HIV-infected patients in sub-Saharan Africa pay out-of-pocket for HAART. This analysis from Botswana indicates that higher median out-of-pocket regimen costs to patients for the initial 30 days of HAART are associated with failure to achieve a viral load< 400 copies/ml [US$32; interquartile range (IQR), 20-84 compared with US$22; (IQR, 17-36), P = 0.001]. HAART costs should be minimized as scale-up efforts in sub-Saharan Africa progress.

Restoration ecology: two-sex dynamics and cost minimization.

PubMed

Molnár, Ferenc; Caragine, Christina; Caraco, Thomas; Korniss, Gyorgy

2013-01-01

We model a spatially detailed, two-sex population dynamics, to study the cost of ecological restoration. We assume that cost is proportional to the number of individuals introduced into a large habitat. We treat dispersal as homogeneous diffusion in a one-dimensional reaction-diffusion system. The local population dynamics depends on sex ratio at birth, and allows mortality rates to differ between sexes. Furthermore, local density dependence induces a strong Allee effect, implying that the initial population must be sufficiently large to avert rapid extinction. We address three different initial spatial distributions for the introduced individuals; for each we minimize the associated cost, constrained by the requirement that the species must be restored throughout the habitat. First, we consider spatially inhomogeneous, unstable stationary solutions of the model's equations as plausible candidates for small restoration cost. Second, we use numerical simulations to find the smallest rectangular cluster, enclosing a spatially homogeneous population density, that minimizes the cost of assured restoration. Finally, by employing simulated annealing, we minimize restoration cost among all possible initial spatial distributions of females and males. For biased sex ratios, or for a significant between-sex difference in mortality, we find that sex-specific spatial distributions minimize the cost. But as long as the sex ratio maximizes the local equilibrium density for given mortality rates, a common homogeneous distribution for both sexes that spans a critical distance yields a similarly low cost.

Restoration Ecology: Two-Sex Dynamics and Cost Minimization

PubMed Central

Molnár, Ferenc; Caragine, Christina; Caraco, Thomas; Korniss, Gyorgy

2013-01-01

We model a spatially detailed, two-sex population dynamics, to study the cost of ecological restoration. We assume that cost is proportional to the number of individuals introduced into a large habitat. We treat dispersal as homogeneous diffusion in a one-dimensional reaction-diffusion system. The local population dynamics depends on sex ratio at birth, and allows mortality rates to differ between sexes. Furthermore, local density dependence induces a strong Allee effect, implying that the initial population must be sufficiently large to avert rapid extinction. We address three different initial spatial distributions for the introduced individuals; for each we minimize the associated cost, constrained by the requirement that the species must be restored throughout the habitat. First, we consider spatially inhomogeneous, unstable stationary solutions of the model’s equations as plausible candidates for small restoration cost. Second, we use numerical simulations to find the smallest rectangular cluster, enclosing a spatially homogeneous population density, that minimizes the cost of assured restoration. Finally, by employing simulated annealing, we minimize restoration cost among all possible initial spatial distributions of females and males. For biased sex ratios, or for a significant between-sex difference in mortality, we find that sex-specific spatial distributions minimize the cost. But as long as the sex ratio maximizes the local equilibrium density for given mortality rates, a common homogeneous distribution for both sexes that spans a critical distance yields a similarly low cost. PMID:24204810

Mining Association Rules Between Credits in the Leadership in Energy and Environmental Design for New Construction (LEED-NC) Green Building Assessment System

DTIC Science & Technology

2008-03-01

in subject areas that rely mostly on intuition, like marketing, sales , and customer relationship management (Berry and Linoff, 2004). Commonly...closely related to this study might be Amazon or iTunes ’ use of market basket analysis. Today, most e-commerce consumers are accustomed to receiving... sales is to minimize the costs and hassle of warranty-related repairs and replacements. Of course, the best way to minimize those liabilities is to

The Preventive Control of a Dengue Disease Using Pontryagin Minimum Principal

NASA Astrophysics Data System (ADS)

Ratna Sari, Eminugroho; Insani, Nur; Lestari, Dwi

2017-06-01

Behaviour analysis for host-vector model without control of dengue disease is based on the value of basic reproduction number obtained using next generation matrices. Furthermore, the model is further developed involving a preventive control to minimize the contact between host and vector. The purpose is to obtain an optimal preventive strategy with minimal cost. The Pontryagin Minimum Principal is used to find the optimal control analytically. The derived optimality model is then solved numerically to investigate control effort to reduce infected class.

BMP analysis system for watershed-based stormwater management.

PubMed

Zhen, Jenny; Shoemaker, Leslie; Riverson, John; Alvi, Khalid; Cheng, Mow-Soung

2006-01-01

Best Management Practices (BMPs) are measures for mitigating nonpoint source (NPS) pollution caused mainly by stormwater runoff. Established urban and newly developing areas must develop cost effective means for restoring or minimizing impacts, and planning future growth. Prince George's County in Maryland, USA, a fast-growing region in the Washington, DC metropolitan area, has developed a number of tools to support analysis and decision making for stormwater management planning and design at the watershed level. These tools support watershed analysis, innovative BMPs, and optimization. Application of these tools can help achieve environmental goals and lead to significant cost savings. This project includes software development that utilizes GIS information and technology, integrates BMP processes simulation models, and applies system optimization techniques for BMP planning and selection. The system employs the ESRI ArcGIS as the platform, and provides GIS-based visualization and support for developing networks including sequences of land uses, BMPs, and stream reaches. The system also provides interfaces for BMP placement, BMP attribute data input, and decision optimization management. The system includes a stand-alone BMP simulation and evaluation module, which complements both research and regulatory nonpoint source control assessment efforts, and allows flexibility in the examining various BMP design alternatives. Process based simulation of BMPs provides a technique that is sensitive to local climate and rainfall patterns. The system incorporates a meta-heuristic optimization technique to find the most cost-effective BMP placement and implementation plan given a control target, or a fixed cost. A case study is presented to demonstrate the application of the Prince George's County system. The case study involves a highly urbanized area in the Anacostia River (a tributary to Potomac River) watershed southeast of Washington, DC. An innovative system of management practices is proposed to minimize runoff, improve water quality, and provide water reuse opportunities. Proposed management techniques include bioretention, green roof, and rooftop runoff collection (rain barrel) systems. The modeling system was used to identify the most cost-effective combinations of management practices to help minimize frequency and size of runoff events and resulting combined sewer overflows to the Anacostia River.

Oral vinorelbine plus cisplatin versus pemetrexed plus cisplatin as first-line treatment of advanced non-squamous non-small-cell lung cancer: cost minimization analysis in 12 European countries.

PubMed

Grossi, Francesco; Bennouna, Jaafar; Havel, Libor; Hochmair, Maximillian; Almodovar, Teresa

2016-09-01

A combination of vinorelbine and cisplatin is a standard treatment in non-small-cell lung cancer; oral vinorelbine is registered in 45 countries. Pemetrexed and cisplatin are recommended in front-line chemotherapy of non-squamous non-small-cell lung cancer (NS-NSCLC). The objective of this study was to conduct a cost minimization analysis from the perspective of the national health service (NHS) in each of 12 European countries, based on a randomized phase II study in NS-NSCLC (NAVoTRIAL01), with 100 oral vinorelbine plus cisplatin patients (arm A) and 51 pemetrexed plus cisplatin patients (arm B). Country-specific costs and DRG codes considered included those relating to anticancer drugs, administration settings (out-patient/in-patient/at home), serious adverse events (defined as involving hospitalization and considered due to anticancer drugs) and concomitant medications. Relevant costs were calculated based on country-specific reimbursement procedures and official tariffs. Cost and savings per patient. Using the NHS perspective, savings per patient treated with oral vinorelbine ranged from €1317 (Denmark) to €35,001 (Germany). Expressed as percentages, savings per patient treated with oral vinorelbine compared with pemetrexed ranged between 5% (France) and 83% (Czech Republic). Pooled average costs for each treatment arm across the 12 countries resulted in cost savings for payers of €12,871, favoring oral vinorelbine plus cisplatin. Given the reported efficacy with both regimens, this pan-European economic analysis provides compelling evidence supporting oral vinorelbine use over pemetrexed for the treatment of NS-NSCLC. Oral vinorelbine provides similar efficacy and an easily manageable safety profile at lower overall cost per patient treated, combined with an easier/more convenient mode of administration. Sensitivity analysis across varied scenarios demonstrated the robustness of the results. The principle weakness of our study was its reliance upon a single small scale study to provide efficacy data, since this is the only study conducted in this specific population of patients. Further large scale trials are needed to confirm these results.

A methodology for commonality analysis, with applications to selected space station systems

NASA Technical Reports Server (NTRS)

Thomas, Lawrence Dale

1989-01-01

The application of commonality in a system represents an attempt to reduce costs by reducing the number of unique components. A formal method for conducting commonality analysis has not been established. In this dissertation, commonality analysis is characterized as a partitioning problem. The cost impacts of commonality are quantified in an objective function, and the solution is that partition which minimizes this objective function. Clustering techniques are used to approximate a solution, and sufficient conditions are developed which can be used to verify the optimality of the solution. This method for commonality analysis is general in scope. It may be applied to the various types of commonality analysis required in the conceptual, preliminary, and detail design phases of the system development cycle.

An emulator for minimizing computer resources for finite element analysis

NASA Technical Reports Server (NTRS)

Melosh, R.; Utku, S.; Islam, M.; Salama, M.

1984-01-01

A computer code, SCOPE, has been developed for predicting the computer resources required for a given analysis code, computer hardware, and structural problem. The cost of running the code is a small fraction (about 3 percent) of the cost of performing the actual analysis. However, its accuracy in predicting the CPU and I/O resources depends intrinsically on the accuracy of calibration data that must be developed once for the computer hardware and the finite element analysis code of interest. Testing of the SCOPE code on the AMDAHL 470 V/8 computer and the ELAS finite element analysis program indicated small I/O errors (3.2 percent), larger CPU errors (17.8 percent), and negligible total errors (1.5 percent).

Method of Evaluating the Life Cycle Cost of Small Earth Dams Considering the Risk of Heavy Rainfall and Selection Method of the Optimum Countermeasure

NASA Astrophysics Data System (ADS)

Hori, Toshikazu; Mohri, Yoshiyuki; Matsushima, Kenichi; Ariyoshi, Mitsuru

In recent years the increase in the number of heavy rainfall occurrences such as through unpredictable cloudbursts have resulted in the safety of the embankments of small earth dams needing to be improved. However, the severe financial condition of the government and local autonomous bodies necessitate the cost of improving them to be reduced. This study concerns the development of a method of evaluating the life cycle cost of small earth dams considered to pose a risk and in order to improve the safety of the downstream areas of small earth dams at minimal cost. Use of a safety evaluation method that is based on a combination of runoff analysis, saturated and unsaturated seepage analysis, and slope stability analysis enables the probability of a dam breach and its life cycle cost with the risk of heavy rainfall taken into account to be calculated. Moreover, use of the life cycle cost evaluation method will lead to the development of a technique for selecting the method of the optimal improvement or countermeasures against heavy rainfall.

Reliability and cost analysis methods

NASA Technical Reports Server (NTRS)

Suich, Ronald C.

1991-01-01

In the design phase of a system, how does a design engineer or manager choose between a subsystem with .990 reliability and a more costly subsystem with .995 reliability? When is the increased cost justified? High reliability is not necessarily an end in itself but may be desirable in order to reduce the expected cost due to subsystem failure. However, this may not be the wisest use of funds since the expected cost due to subsystem failure is not the only cost involved. The subsystem itself may be very costly. We should not consider either the cost of the subsystem or the expected cost due to subsystem failure separately but should minimize the total of the two costs, i.e., the total of the cost of the subsystem plus the expected cost due to subsystem failure. This final report discusses the Combined Analysis of Reliability, Redundancy, and Cost (CARRAC) methods which were developed under Grant Number NAG 3-1100 from the NASA Lewis Research Center. CARRAC methods and a CARRAC computer program employ five models which can be used to cover a wide range of problems. The models contain an option which can include repair of failed modules.

The role of pharmacoeconomics in current Indian healthcare system.

PubMed

Ahmad, Akram; Patel, Isha; Parimilakrishnan, Sundararajan; Mohanta, Guru Prasad; Chung, HaeChung; Chang, Jongwha

2013-01-01

Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.

The role of pharmacoeconomics in current Indian healthcare system

PubMed Central

Ahmad, Akram; Patel, Isha; Parimilakrishnan, Sundararajan; Mohanta, Guru Prasad; Chung, HaeChung; Chang, Jongwha

2013-01-01

Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy. PMID:24991597

Optimal synthesis and design of the number of cycles in the leaching process for surimi production.

PubMed

Reinheimer, M Agustina; Scenna, Nicolás J; Mussati, Sergio F

2016-12-01

Water consumption required during the leaching stage in the surimi manufacturing process strongly depends on the design and the number and size of stages connected in series for the soluble protein extraction target, and it is considered as the main contributor to the operating costs. Therefore, the optimal synthesis and design of the leaching stage is essential to minimize the total annual cost. In this study, a mathematical optimization model for the optimal design of the leaching operation is presented. Precisely, a detailed Mixed Integer Nonlinear Programming (MINLP) model including operating and geometric constraints was developed based on our previous optimization model (NLP model). Aspects about quality, water consumption and main operating parameters were considered. The minimization of total annual costs, which considered a trade-off between investment and operating costs, led to an optimal solution with lesser number of stages (2 instead of 3 stages) and higher volumes of the leaching tanks comparing with previous results. An analysis was performed in order to investigate how the optimal solution was influenced by the variations of the unitary cost of fresh water, waste treatment and capital investment.

A Two-Dimensional Variational Analysis Method for NSCAT Ambiguity Removal: Methodology, Sensitivity, and Tuning

NASA Technical Reports Server (NTRS)

Hoffman, R. N.; Leidner, S. M.; Henderson, J. M.; Atlas, R.; Ardizzone, J. V.; Bloom, S. C.; Atlas, Robert (Technical Monitor)

2001-01-01

In this study, we apply a two-dimensional variational analysis method (2d-VAR) to select a wind solution from NASA Scatterometer (NSCAT) ambiguous winds. 2d-VAR determines a "best" gridded surface wind analysis by minimizing a cost function. The cost function measures the misfit to the observations, the background, and the filtering and dynamical constraints. The ambiguity closest in direction to the minimizing analysis is selected. 2d-VAR method, sensitivity and numerical behavior are described. 2d-VAR is compared to statistical interpolation (OI) by examining the response of both systems to a single ship observation and to a swath of unique scatterometer winds. 2d-VAR is used with both NSCAT ambiguities and NSCAT backscatter values. Results are roughly comparable. When the background field is poor, 2d-VAR ambiguity removal often selects low probability ambiguities. To avoid this behavior, an initial 2d-VAR analysis, using only the two most likely ambiguities, provides the first guess for an analysis using all the ambiguities or the backscatter data. 2d-VAR and median filter selected ambiguities usually agree. Both methods require horizontal consistency, so disagreements occur in clumps, or as linear features. In these cases, 2d-VAR ambiguities are often more meteorologically reasonable and more consistent with satellite imagery.

Performance modeling and techno-economic analysis of a modular concentrated solar power tower with latent heat storage

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

Rea, Jonathan E.; Oshman, Christopher J.; Olsen, Michele L.

In this paper, we present performance simulations and techno-economic analysis of a modular dispatchable solar power tower. Using a heliostat field and power block three orders of magnitude smaller than conventional solar power towers, our unique configuration locates thermal storage and a power block directly on a tower receiver. To make the system dispatchable, a valved thermosyphon controls heat flow from a latent heat thermal storage tank to a Stirling engine. The modular design results in minimal balance of system costs and enables high deployment rates with a rapid realization of economies of scale. In this new analysis, we combinemore » performance simulations with techno-economic analysis to evaluate levelized cost of electricity, and find that the system has potential for cost-competitiveness with natural gas peaking plants and alternative dispatchable renewables.« less

Anthropogenic microfibres pollution in marine biota. A new and simple methodology to minimize airborne contamination.

PubMed

Torre, Michele; Digka, Nikoletta; Anastasopoulou, Aikaterini; Tsangaris, Catherine; Mytilineou, Chryssi

2016-12-15

Research studies on the effects of microlitter on marine biota have become more and more frequent the last few years. However, there is strong evidence that scientific results based on microlitter analyses can be biased by contamination from air transported fibres. This study demonstrates a low cost and easy to apply methodology to minimize the background contamination and thus to increase results validity. The contamination during the gastrointestinal content analysis of 400 fishes was tested for several sample processing steps of high risk airborne contamination (e.g. dissection, stereomicroscopic analysis, and chemical digestion treatment for microlitter extraction). It was demonstrated that, using our methodology based on hermetic enclosure devices, isolating the working areas during the various processing steps, airborne contamination reduced by 95.3%. The simplicity and low cost of this methodology provide the benefit that it could be applied not only to laboratory but also to field or on board work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis

PubMed Central

Gajic-Veljanoski, O.; Pham, B.; Pechlivanoglou, P.; Krahn, M.; Higgins, Caroline; Bielecki, Joanna

2016-01-01

Background Minimal residual disease (MRD) testing by higher performance techniques such as flow cytometry and polymerase chain reaction (PCR) can be used to detect the proportion of remaining leukemic cells in bone marrow or peripheral blood during and after the first phases of chemotherapy in children with acute lymphoblastic leukemia (ALL). The results of MRD testing are used to reclassify these patients and guide changes in treatment according to their future risk of relapse. We conducted a systematic review of the economic literature, cost-effectiveness analysis, and budget-impact analysis to ascertain the cost-effectiveness and economic impact of MRD testing by flow cytometry for management of childhood precursor B-cell ALL in Ontario. Methods A systematic literature search (1998–2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years. Results In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In the budget-impact analysis, the 1-year cost expenditure for MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL was estimated at $340,760. We forecasted that the province would have to pay approximately $1.3 million over 3 years and $2.4 million over 5 years for MRD testing by flow cytometry in this population. Conclusions Compared with no testing, MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL represents good value for money at commonly used willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY. PMID:27099644

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis.

PubMed

2016-01-01

Minimal residual disease (MRD) testing by higher performance techniques such as flow cytometry and polymerase chain reaction (PCR) can be used to detect the proportion of remaining leukemic cells in bone marrow or peripheral blood during and after the first phases of chemotherapy in children with acute lymphoblastic leukemia (ALL). The results of MRD testing are used to reclassify these patients and guide changes in treatment according to their future risk of relapse. We conducted a systematic review of the economic literature, cost-effectiveness analysis, and budget-impact analysis to ascertain the cost-effectiveness and economic impact of MRD testing by flow cytometry for management of childhood precursor B-cell ALL in Ontario. A systematic literature search (1998-2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years. In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In the budget-impact analysis, the 1-year cost expenditure for MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL was estimated at $340,760. We forecasted that the province would have to pay approximately $1.3 million over 3 years and $2.4 million over 5 years for MRD testing by flow cytometry in this population. Compared with no testing, MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL represents good value for money at commonly used willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY.

Minimizing communication cost among distributed controllers in software defined networks

NASA Astrophysics Data System (ADS)

Arlimatti, Shivaleela; Elbreiki, Walid; Hassan, Suhaidi; Habbal, Adib; Elshaikh, Mohamed

2016-08-01

Software Defined Networking (SDN) is a new paradigm to increase the flexibility of today's network by promising for a programmable network. The fundamental idea behind this new architecture is to simplify network complexity by decoupling control plane and data plane of the network devices, and by making the control plane centralized. Recently controllers have distributed to solve the problem of single point of failure, and to increase scalability and flexibility during workload distribution. Even though, controllers are flexible and scalable to accommodate more number of network switches, yet the problem of intercommunication cost between distributed controllers is still challenging issue in the Software Defined Network environment. This paper, aims to fill the gap by proposing a new mechanism, which minimizes intercommunication cost with graph partitioning algorithm, an NP hard problem. The methodology proposed in this paper is, swapping of network elements between controller domains to minimize communication cost by calculating communication gain. The swapping of elements minimizes inter and intra communication cost among network domains. We validate our work with the OMNeT++ simulation environment tool. Simulation results show that the proposed mechanism minimizes the inter domain communication cost among controllers compared to traditional distributed controllers.

Production Functions for Water Delivery Systems: Analysis and Estimation Using Dual Cost Function and Implicit Price Specifications

NASA Astrophysics Data System (ADS)

Teeples, Ronald; Glyer, David

1987-05-01

Both policy and technical analysis of water delivery systems have been based on cost functions that are inconsistent with or are incomplete representations of the neoclassical production functions of economics. We present a full-featured production function model of water delivery which can be estimated from a multiproduct, dual cost function. The model features implicit prices for own-water inputs and is implemented as a jointly estimated system of input share equations and a translog cost function. Likelihood ratio tests are performed showing that a minimally constrained, full-featured production function is a necessary specification of the water delivery operations in our sample. This, plus the model's highly efficient and economically correct parameter estimates, confirms the usefulness of a production function approach to modeling the economic activities of water delivery systems.

Re-Engineering JPL's Mission Planning Ground System Architecture for Cost Efficient Operations in the 21st Century

NASA Technical Reports Server (NTRS)

Fordyce, Jess

1996-01-01

Work carried out to re-engineer the mission analysis segment of JPL's mission planning ground system architecture is reported on. The aim is to transform the existing software tools, originally developed for specific missions on different support environments, into an integrated, general purpose, multi-mission tool set. The issues considered are: the development of a partnership between software developers and users; the definition of key mission analysis functions; the development of a consensus based architecture; the move towards evolutionary change instead of revolutionary replacement; software reusability, and the minimization of future maintenance costs. The current status and aims of new developments are discussed and specific examples of cost savings and improved productivity are presented.

Gene Architectures that Minimize Cost of Gene Expression.

PubMed

Frumkin, Idan; Schirman, Dvir; Rotman, Aviv; Li, Fangfei; Zahavi, Liron; Mordret, Ernest; Asraf, Omer; Wu, Song; Levy, Sasha F; Pilpel, Yitzhak

2017-01-05

Gene expression burdens cells by consuming resources and energy. While numerous studies have investigated regulation of expression level, little is known about gene design elements that govern expression costs. Here, we ask how cells minimize production costs while maintaining a given protein expression level and whether there are gene architectures that optimize this process. We measured fitness of ∼14,000 E. coli strains, each expressing a reporter gene with a unique 5' architecture. By comparing cost-effective and ineffective architectures, we found that cost per protein molecule could be minimized by lowering transcription levels, regulating translation speeds, and utilizing amino acids that are cheap to synthesize and that are less hydrophobic. We then examined natural E. coli genes and found that highly expressed genes have evolved more forcefully to minimize costs associated with their expression. Our study thus elucidates gene design elements that improve the economy of protein expression in natural and heterologous systems. Copyright © 2017 Elsevier Inc. All rights reserved.

Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors.

PubMed

Fontes, Ricardo B V; Wewel, Joshua T; OʼToole, John E

2016-04-01

Minimally invasive spinal surgery (MIS) has emerged as a clinically effective tool but its cost-effectiveness remains unclear. No studies have compared MIS vs open surgical techniques for the treatment of intradural extramedullary (IDEM) tumors. To analyze and compare open and MIS techniques for resection of IDEM tumors, with focus on perioperative costs. Retrospective analysis of a prospectively collected database including 35 IDEM patients (18 open, 17 MIS). Perioperative data, hospital costs, and hospital and physician charges for in-hospital services associated with the index surgical procedure and readmissions within 90 days were compared. Mean estimated blood loss, operative time, preoperative hospital charges, and physician fees were similar between open and MIS techniques. Patient and tumor characteristics were similar between groups. MIS cases were associated with shorter intensive care unit and floor stay. There were 3 complications in the open group, requiring 2 readmissions and 1 reoperation. Hospital costs ($21 307.80 open, $15 015.20 MIS, P < .01), and postoperative ($75 383.48 open, $56 006.88 MIS, P < .01) and total charges ($100 779.38 open, $76 100.92 MIS, P < .01) were significantly lower in the MIS group. There were no tumor recurrences in either group. All patients except for one in the open group maintained or improved their Nurick score. Both MIS and open techniques were able to adequately treat IDEM tumors. Reductions in complication rate and intensive care unit and hospital stay led to a decrease in hospital costs of almost 30% in the MIS group. MIS resection of IDEM tumors is not only an effective and safe option, but allows faster hospital discharge and significant cost savings.

The role of radiation hard solar cells in minimizing the costs of global satellite communication systems

NASA Technical Reports Server (NTRS)

Summers, Geoffrey P.; Walters, Robert J.; Messenger, Scott R.; Burke, Edward A.

1996-01-01

An analysis embodied in a PC computer program is presented, which quantitatively demonstrates how the availability of radiation hard solar cells can help minimize the cost of a global satellite communications system. An important distinction between the currently proposed systems, such as Iridium, Odyssey and Ellipsat, is the number of satellites employed and their operating altitudes. Analysis of the major costs associated with implementing these systems shows that operation at orbital altitudes within the earth's radiation belts (10(exp 3) to 10(exp 4)km) can reduce the total cost of a system by several hundred percent, so long as radiation hard components including solar cells can be used. A detailed evaluation of the predicted performance of photovoltaic arrays using several different planar solar cell technologies is given, including commercially available Si and GaAs/Ge, and InP/Si which is currently under development. Several examples of applying the program are given, which show that the end of life (EOL) power density of different technologies can vary by a factor of ten for certain missions. Therefore, although a relatively radiation-soft technology can usually provide the required EOL power by simply increasing the size of the array, the impact upon the total system budget could be unacceptable, due to increased launch and hardware costs. In aggregate, these factors can account for more than a 10% increase in the total system cost. Since the estimated total costs of proposed global-coverage systems range from $1B to $9B, the availability of radiation-hard solar cells could make a decisive difference in the selection of a particular constellation architecture.

Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected.

PubMed

Vercruysse, Gary A; Friese, Randall S; Khalil, Mazhar; Ibrahim-Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; Tang, Andrew; O'Keeffe, Terrence; Kulvatunyou, Narong; Green, Donald J; Gries, Lynn; Joseph, Bellal; Rhee, Peter M

2015-03-01

Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6).On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. Epidemiologic study, level III. Therapeutic study, level IV.

A MATERIAL COST-MINIMIZATION ANALYSIS FOR HERNIA REPAIRS AND MINOR PROCEDURES DURING A SURGICAL MISSION IN THE DOMINICAN REPUBLIC

PubMed Central

Cavallo, Jaime A.; Ousley, Jenny; Barrett, Christopher D.; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J. Ross; Perotti, Gary; Frisella, Margaret M.; Matthews, Brent D.

2013-01-01

INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions. PMID:24162140

STS propellant scavenging systems study. Part 2, volume 2: Cost and WBS/dictionary

NASA Technical Reports Server (NTRS)

Williams, Frank L.

1987-01-01

Presented are the results of the cost analysis performed to update and refine the program phase C/D cost estimates for a Shuttle Derived Vehicle (SDV) tanker. The SDV tanker concept is an unmanned cargo vehicle incorporating a set of propellant tanks in the vehicle's payload module. The tanker will be used to meet the demand for a cryogenic propellant supply in orbit. The propellant tanks are delivered to a low Earth orbit or to an orbit in the vicinity of the Space Station. The intent of the economic analysis is to provide NASA with economic justification for the propellant scavenging concept that minimizes the total Space Transportation System life cycle cost. The detailed costs supporting the concept selection process are presented with descriptive text to aid in forecasting the phase C/D project and program planning. Included are all propellant scavenging costs as well as all SDV, STS and Orbital Maneuvering Vehicle charges to deliver the propellants to the Space Station.

Improving log transportation with data based monitoring and analysis in northern Wisconsin and upper peninsula of Michigan.

DOT National Transportation Integrated Search

2012-02-01

Minimizing transportation cost is essential in the forest products industry. Logs and wood chips are relatively low value. Logs are a dense heavy weight product to transport, while chips are light and bulky. These handling characteristics along with ...

Separation and quantitation of plant and insect carbohydrate isomers found on the surface of cotton

USDA-ARS?s Scientific Manuscript database

Cotton stickiness researchers have worked to create ion chromatography (IC) carbohydrate separation methods which allow for minimal analysis time and reduced operational costs. Researchers have also tried to correlate scientifically backed IC data with the available physical stickiness tests, such ...

A Technical Survey on Optimization of Processing Geo Distributed Data

NASA Astrophysics Data System (ADS)

Naga Malleswari, T. Y. J.; Ushasukhanya, S.; Nithyakalyani, A.; Girija, S.

2018-04-01

With growing cloud services and technology, there is growth in some geographically distributed data centers to store large amounts of data. Analysis of geo-distributed data is required in various services for data processing, storage of essential information, etc., processing this geo-distributed data and performing analytics on this data is a challenging task. The distributed data processing is accompanied by issues in storage, computation and communication. The key issues to be dealt with are time efficiency, cost minimization, utility maximization. This paper describes various optimization methods like end-to-end multiphase, G-MR, etc., using the techniques like Map-Reduce, CDS (Community Detection based Scheduling), ROUT, Workload-Aware Scheduling, SAGE, AMP (Ant Colony Optimization) to handle these issues. In this paper various optimization methods and techniques used are analyzed. It has been observed that end-to end multiphase achieves time efficiency; Cost minimization concentrates to achieve Quality of Service, Computation and reduction of Communication cost. SAGE achieves performance improvisation in processing geo-distributed data sets.

Calculating Optimum sowing factor: A tool to evaluate sowing strategies and minimize seedling production cost

Treesearch

Eric van Steenis

2013-01-01

This paper illustrates how to use an excel spreadsheet as a decision-making tool to determine optimum sowing factor to minimize seedling production cost. Factors incorporated into the spreadsheet calculations include germination percentage, seeder accuracy, cost per seed, cavities per block, costs of handling, thinning, and transplanting labor, and more. In addition to...

Learning Together; part 2: training costs and health gain - a cost analysis.

PubMed

Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John

2017-01-01

Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.

The 2-year cost-effectiveness of 3 options to treat lumbar spinal stenosis patients.

PubMed

Udeh, Belinda L; Costandi, Shrif; Dalton, Jarrod E; Ghosh, Raktim; Yousef, Hani; Mekhail, Nagy

2015-02-01

Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild(®) ) is an alternative. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild(®) to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. The mild(®) strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost-effective ($125,985/QALY). © 2014 World Institute of Pain.

Cost-Minimization Analysis of Open and Endoscopic Carpal Tunnel Release.

PubMed

Zhang, Steven; Vora, Molly; Harris, Alex H S; Baker, Laurence; Curtin, Catherine; Kamal, Robin N

2016-12-07

Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost. We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014. The cohort consisted of records with an ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis of carpal tunnel syndrome and a CPT (Current Procedural Terminology) code for carpal tunnel release. Payer fees were used to define cost. We also assessed other associated costs of care, including those of electrodiagnostic studies and occupational therapy. Bivariate comparisons were performed using the chi-square test and the Student t test. Data showed that 86% of the patients underwent open carpal tunnel release. Reimbursement fees for endoscopic release were significantly higher than for open release. Facility fees were responsible for most of the difference between the procedures in reimbursement: facility fees averaged $1,884 for endoscopic release compared with $1,080 for open release (p < 0.0001). Endoscopic release also demonstrated significantly higher physician fees than open release (an average of $555 compared with $428; p < 0.0001). Occupational therapy fees associated with endoscopic release were less than those associated with open release (an average of $237 per session compared with $272; p = 0.07). The total average annual reimbursement per patient for endoscopic release (facility, surgeon, and occupational therapy fees) was significantly higher than for open release ($2,602 compared with $1,751; p < 0.0001). Our data showed that the total average fees per patient for endoscopic release were significantly higher than those for open release, although there currently is no strong evidence supporting better clinical outcomes of either technique. Value-based health-care models that favor delivering high-quality care and improving patient health, while also minimizing costs, may favor open carpal tunnel release.

Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial.

PubMed

Boriani, Giuseppe; Manolis, Antonis S; Tukkie, Raymond; Mont, Lluis; Pürerfellner, Helmut; Santini, Massimo; Inama, Giuseppe; Serra, Paolo; Gulizia, Michele; Samoilenko, Igor Vasilyevich; Wolff, Claudia; Holbrook, Reece; Gavazza, Federica; Padeletti, Luigi

2015-06-01

Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

A high volume cost efficient production macrostructuring process. [for silicon solar cell surface treatment

NASA Technical Reports Server (NTRS)

Chitre, S. R.

1978-01-01

The paper presents an experimentally developed surface macro-structuring process suitable for high volume production of silicon solar cells. The process lends itself easily to automation for high throughput to meet low-cost solar array goals. The tetrahedron structure observed is 0.5 - 12 micron high. The surface has minimal pitting with virtually no or very few undeveloped areas across the surface. This process has been developed for (100) oriented as cut silicon. Chemi-etched, hydrophobic and lapped surfaces were successfully texturized. A cost analysis as per Samics is presented.

The Costs of Legislated Minimal Competency Requirements. A background paper prepared for the Minimal Cometency Workshops sponsored by the Education Commission of the States and the National Institute of Education.

ERIC Educational Resources Information Center

Anderson, Barry D.

Little is known about the costs of setting up and implementing legislated minimal competency testing (MCT). To estimate the financial obstacles which lie between the idea and its implementation, MCT requirements are viewed from two perspectives. The first, government regulation, views legislated minimal competency requirements as an attempt by the…

[Flat rate reimbursement system for minimally invasive management of unstable vertebral fractures. An analysis of costs and benefits].

PubMed

Hartwig, E; Schultheiss, M; Bischoff, M

2002-08-01

Some 30% of unstable vertebral fractures of the thoracic and lumbar spine involve a destruction of the ventral column and thus of the supporting structures of the spine. This requires extensive surgical reconstruction procedures, which are carried out using minimally invasive techniques. The disadvantages of the minimally invasive methods are the high cost, the technical equipment and the expenditure of time required in the initial phase for the performance of the surgical procedure. With the structural reform of the health care system in the year 2000, the private-sector regulatory bodies were called upon to introduce a flat-rate compensation system for hospital services according to section 17b of the Hospital Law (KHG). The previous financing system which involved per-diem operating cost rates has thus been abolished. Calculations of individual entities are now required. Considering the case values to date, a contribution margin deficit of EUR 4628.45 has been calculated for our patients with fractures of the thoracic and lumbar spine without neurological defunctionalization symptoms. An economically efficient medical care is thus no longer possible. Consequently, an adjustment of the German relative weights must urgently be demanded in order to guarantee a high-quality medical care of patients.

Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations

PubMed Central

2010-01-01

Background Numerous pen devices are available to administer recombinant Human Growth Hormone (rhGH), and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration. Methods Study objectives were to conduct 1) Time-and-Motion (TM) simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2) a Cost Minimization Analysis (CMA) relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution) via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1) Learning (initial use instructions), 2) Preparation (arrange device for use), 3) Administration (actual simulation manikin injection), and 4) Storage (maintain product viability between doses), in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages), non-drug medical supplies, and drug product costs. Results Norditropin® NordiFlex and Norditropin® NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsværd, Denmark) took less weekly Total Time (p < 0.05) to use than either of the comparator products, Genotropin® Pen (GTP, Pfizer, Inc, New York, New York) or HumatroPen® (HTP, Eli Lilly and Company, Indianapolis, Indiana). Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes), NNP (2.48 minutes) GTP (4.11 minutes), HTP (8.64 minutes), p < 0.05)). Administration and Storage times were not statistically different. NNF (15.8 minutes) and NNP (16.2 minutes) also took less time to Learn than HTP (24.0 minutes) and GTP (26.0 minutes), p < 0.05). The number of weekly required administration steps was also least with NNF and NNP. Opportunity cost savings were greater in devices that were easier to prepare for use; GTP represented an 11.8% drug product savings over NNF, NNP and HTP at time of study. Overall supply costs represented <1% of drug costs for all devices. Conclusions Time-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs. PMID:20377905

Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations.

PubMed

Nickman, Nancy A; Haak, Sandra W; Kim, Jaewhan

2010-04-08

Numerous pen devices are available to administer recombinant Human Growth Hormone (rhGH), and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration. Study objectives were to conduct 1) Time-and-Motion (TM) simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2) a Cost Minimization Analysis (CMA) relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution) via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1) Learning (initial use instructions), 2) Preparation (arrange device for use), 3) Administration (actual simulation manikin injection), and 4) Storage (maintain product viability between doses), in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages), non-drug medical supplies, and drug product costs. Norditropin(R) NordiFlex and Norditropin(R) NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsvaerd, Denmark) took less weekly Total Time (p < 0.05) to use than either of the comparator products, Genotropin(R) Pen (GTP, Pfizer, Inc, New York, New York) or HumatroPen(R) (HTP, Eli Lilly and Company, Indianapolis, Indiana). Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes), NNP (2.48 minutes) GTP (4.11 minutes), HTP (8.64 minutes), p < 0.05)). Administration and Storage times were not statistically different. NNF (15.8 minutes) and NNP (16.2 minutes) also took less time to Learn than HTP (24.0 minutes) and GTP (26.0 minutes), p < 0.05). The number of weekly required administration steps was also least with NNF and NNP. Opportunity cost savings were greater in devices that were easier to prepare for use; GTP represented an 11.8% drug product savings over NNF, NNP and HTP at time of study. Overall supply costs represented <1% of drug costs for all devices. Time-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs.

Economic impact of minimally invasive lumbar surgery.

PubMed

Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

2015-03-18

Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.

Maternal Serologic Screening to Prevent Congenital Toxoplasmosis: A Decision-Analytic Economic Model

PubMed Central

Stillwaggon, Eileen; Carrier, Christopher S.; Sautter, Mari; McLeod, Rima

2011-01-01

Objective To determine a cost-minimizing option for congenital toxoplasmosis in the United States. Methodology/Principal Findings A decision-analytic and cost-minimization model was constructed to compare monthly maternal serological screening, prenatal treatment, and post-natal follow-up and treatment according to the current French (Paris) protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. One- and two-way sensitivity analyses are used to evaluate robustness of results. Universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, following the French protocol, is found to be cost-saving, with savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, and to bivariate analysis of test costs and incidence of primary T. gondii infection in pregnancy. Given the parameters in this model and a maternal screening test cost of $12, screening is cost-saving for rates of congenital infection above 1 per 10,000 live births. If universal testing generates economies of scale in diagnostic tools—lowering test costs to about $2 per test—universal screening is cost-saving at rates of congenital infection well below the lowest reported rates in the United States of 1 per 10,000 live births. Conclusion/Significance Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities. PMID:21980546

Economic evaluations in pain management: principles and methods.

PubMed

Asche, Carl V; Seal, Brian; Jackson, Kenneth C; Oderda, Gary M

2006-01-01

This paper describes how investigators may design, conduct, and report economic evaluations of pharmacotherapy for pain and symptom management. Because economic evaluation of therapeutic interventions is becoming increasingly important, there is a need for guidance on how economic evaluations can be optimally conducted. The steps required to conduct an economic evaluation are described to provide this guidance. Economic evaluations require two or more therapeutic interventions to be compared in relation to costs and effects. There are five types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, (4) cost-consequence, and (5) cost-benefit analyses. The six required steps are: identify the perspective of the study; identify the alternatives that will be compared; identify the relevant costs and effects; determine how to collect the cost and effect data; determine how to perform calculation for cost and effects data; and determine the manner in which to depict the results and draw comparisons.

Design and analysis procedures for asphalt mixtures containing high RAP contents and/or RAS : [research project capsule].

DOT National Transportation Integrated Search

2015-07-01

Asphalt recycling has become an important instrument used to minimize production : costs of new pavements as well as to mitigate its impacts of the environment. Some of : the bene ts of utilizing recycled materials include the conservation of nonr...

Optimization in the design of a 12 gigahertz low cost ground receiving system for broadcast satellites. Volume 1: System design, performance, and cost analysis

NASA Technical Reports Server (NTRS)

Ohkubo, K.; Han, C. C.; Albernaz, J.; Janky, J. M.; Lusignan, B. B.

1972-01-01

The technical and economical feasibility of using the 12 GHz band for broadcasting from satellites were examined. Among the assigned frequency bands for broadcast satellites, the 12 GHz band system offers the most channels. It also has the least interference on and from the terrestrial communication links. The system design and analysis are carried out on the basis of a decision analysis model. Technical difficulties in achieving low-cost 12 GHz ground receivers are solved by making use of a die cast aluminum packaging, a hybrid integrated circuit mixer, a cavity stabilized Gunn oscillator and other state-of-the-art microwave technologies for the receiver front-end. A working model was designed and tested, which used frequency modulation. A final design for the 2.6 GHz system ground receiver is also presented. The cost of the ground-terminal was analyzed and minimized for a given figure-of-merit (a ratio of receiving antenna gain to receiver system noise temperature). The results were used to analyze the performance and cost of the whole satellite system.

A dimension-wise analysis method for the structural-acoustic system with interval parameters

NASA Astrophysics Data System (ADS)

Xu, Menghui; Du, Jianke; Wang, Chong; Li, Yunlong

2017-04-01

The interval structural-acoustic analysis is mainly accomplished by interval and subinterval perturbation methods. Potential limitations for these intrusive methods include overestimation or interval translation effect for the former and prohibitive computational cost for the latter. In this paper, a dimension-wise analysis method is thus proposed to overcome these potential limitations. In this method, a sectional curve of the system response surface along each input dimensionality is firstly extracted, the minimal and maximal points of which are identified based on its Legendre polynomial approximation. And two input vectors, i.e. the minimal and maximal input vectors, are dimension-wisely assembled by the minimal and maximal points of all sectional curves. Finally, the lower and upper bounds of system response are computed by deterministic finite element analysis at the two input vectors. Two numerical examples are studied to demonstrate the effectiveness of the proposed method and show that, compared to the interval and subinterval perturbation method, a better accuracy is achieved without much compromise on efficiency by the proposed method, especially for nonlinear problems with large interval parameters.

Permanent magnet design for magnetic heat pumps using total cost minimization

NASA Astrophysics Data System (ADS)

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

2017-11-01

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

Clustered-dot halftoning with direct binary search.

PubMed

Goyal, Puneet; Gupta, Madhur; Staelin, Carl; Fischer, Mani; Shacham, Omri; Allebach, Jan P

2013-02-01

In this paper, we present a new algorithm for aperiodic clustered-dot halftoning based on direct binary search (DBS). The DBS optimization framework has been modified for designing clustered-dot texture, by using filters with different sizes in the initialization and update steps of the algorithm. Following an intuitive explanation of how the clustered-dot texture results from this modified framework, we derive a closed-form cost metric which, when minimized, equivalently generates stochastic clustered-dot texture. An analysis of the cost metric and its influence on the texture quality is presented, which is followed by a modification to the cost metric to reduce computational cost and to make it more suitable for screen design.

Health versus money. Value judgments in the perspective of decision analysis.

PubMed

Thompson, M S

1983-01-01

An important, but largely uninvestigated, value trade-off balances marginal nonhealth consumption against marginal medical care. Benefit-cost analysts have traditionally, if not fully satisfactorily, dealt with this issue by valuing health gains by their effects on productivity. Cost-effectiveness analysts compare monetary and health effects and leave their relative valuations to decision makers. A decision-analytic model using the satisfaction or utility gained from nonhealth consumption and the level of health enables one to calculate willingness to pay--a theoretically superior way of assigning monetary values to effects for benefit-cost analysis-and to determine minimally acceptable cost-effectiveness ratios. Examples show how a decision-analytic model of utility can differentiate medical actions so essential that failure to take them would be considered negligent from actions so expensive as to be unjustifiable, and can help to determine optimal legal arrangements for compensation for medical malpractice.

Cost - effectiveness analysis of the antiplatelet treatment administered on ischemic stroke patients using goal programming approach

NASA Astrophysics Data System (ADS)

Rajendran, Rasvini; Zainuddin, Zaitul Marlizawati; Idris, Badrisyah

2014-09-01

There are numerous ways to prevent or treat ischemic stroke and each of these competing alternatives is associated with a different effectiveness and a cost. In circumstances where health funds are budgeted and thus fixed, cost-effectiveness analysis (CEA) can provide information on how to comprehend the largest health gains with that limited fund as CEA is used to compare different strategies for preventing or treating a single disease. The most common medications for ischemic stroke are the anti-platelet drugs. While some drugs are more effective than others, they are also more expensive. This paper will thus assess the CEA of anti-platelet drug available for ischemic stroke patients using goal programming (GP) approach subject to in-patients days and patients' quality-of-life. GP presents a way of striving towards several objectives simultaneously whereby in this case we will consider minimizing the cost and maximizing the effectiveness.

Make or buy decision model with multi-stage manufacturing process and supplier imperfect quality

NASA Astrophysics Data System (ADS)

Pratama, Mega Aria; Rosyidi, Cucuk Nur

2017-11-01

This research develops an make or buy decision model considering supplier imperfect quality. This model can be used to help companies make the right decision in case of make or buy component with the best quality and the least cost in multistage manufacturing process. The imperfect quality is one of the cost component that must be minimizing in this model. Component with imperfect quality, not necessarily defective. It still can be rework and used for assembly. This research also provide a numerical example and sensitivity analysis to show how the model work. We use simulation and help by crystal ball to solve the numerical problem. The sensitivity analysis result show that percentage of imperfect generally not affect to the model significantly, and the model is not sensitive to changes in these parameters. This is because the imperfect cost are smaller than overall total cost components.

Multi objective optimization model for minimizing production cost and environmental impact in CNC turning process

NASA Astrophysics Data System (ADS)

Widhiarso, Wahyu; Rosyidi, Cucuk Nur

2018-02-01

Minimizing production cost in a manufacturing company will increase the profit of the company. The cutting parameters will affect total processing time which then will affect the production cost of machining process. Besides affecting the production cost and processing time, the cutting parameters will also affect the environment. An optimization model is needed to determine the optimum cutting parameters. In this paper, we develop an optimization model to minimize the production cost and the environmental impact in CNC turning process. The model is used a multi objective optimization. Cutting speed and feed rate are served as the decision variables. Constraints considered are cutting speed, feed rate, cutting force, output power, and surface roughness. The environmental impact is converted from the environmental burden by using eco-indicator 99. Numerical example is given to show the implementation of the model and solved using OptQuest of Oracle Crystal Ball software. The results of optimization indicate that the model can be used to optimize the cutting parameters to minimize the production cost and the environmental impact.

Climate targets and cost-effective climate stabilization pathways

NASA Astrophysics Data System (ADS)

Held, H.

2015-08-01

Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

Optimal system sizing in grid-connected photovoltaic applications

NASA Astrophysics Data System (ADS)

Simoens, H. M.; Baert, D. H.; de Mey, G.

A costs/benefits analysis for optimizing the combination of photovoltaic (PV) panels, batteries and an inverter for grid interconnected systems at a 500 W/day Belgian residence is presented. It is assumed that some power purchases from the grid will always be necessary, and that excess PV power can be fed into the grid. A minimal value for the cost divided by the performance is defined for economic optimization. Shortages and excesses are calculated for PV panels of 0.5-10 kWp output, with consideration given to the advantages of a battery back-up. The minimal economic value is found to increase with the magnitude of PV output, and an inverter should never be rated at more than half the array maximum output. A maximum panel size for the Belgian residence is projected to be 6 kWp.

Sizing a rainwater harvesting cistern by minimizing costs

NASA Astrophysics Data System (ADS)

Pelak, Norman; Porporato, Amilcare

2016-10-01

Rainwater harvesting (RWH) has the potential to reduce water-related costs by providing an alternate source of water, in addition to relieving pressure on public water sources and reducing stormwater runoff. Existing methods for determining the optimal size of the cistern component of a RWH system have various drawbacks, such as specificity to a particular region, dependence on numerical optimization, and/or failure to consider the costs of the system. In this paper a formulation is developed for the optimal cistern volume which incorporates the fixed and distributed costs of a RWH system while also taking into account the random nature of the depth and timing of rainfall, with a focus on RWH to supply domestic, nonpotable uses. With rainfall inputs modeled as a marked Poisson process, and by comparing the costs associated with building a cistern with the costs of externally supplied water, an expression for the optimal cistern volume is found which minimizes the water-related costs. The volume is a function of the roof area, water use rate, climate parameters, and costs of the cistern and of the external water source. This analytically tractable expression makes clear the dependence of the optimal volume on the input parameters. An analysis of the rainfall partitioning also characterizes the efficiency of a particular RWH system configuration and its potential for runoff reduction. The results are compared to the RWH system at the Duke Smart Home in Durham, NC, USA to show how the method could be used in practice.

Minimum cost to control bovine tuberculosis in cow-calf herds

PubMed Central

Smith, Rebecca L.; Tauer, Loren W.; Sanderson, Michael W.; Grohn, Yrjo T.

2014-01-01

Bovine tuberculosis (bTB) outbreaks in US cattle herds, while rare, are expensive to control. A stochastic model for bTB control in US cattle herds was adapted to more accurately represent cow-calf herd dynamics and was validated by comparison to 2 reported outbreaks. Control cost calculations were added to the model, which was then optimized to minimize costs for either the farm or the government. The results of the optimization showed that test-and-removal costs were minimized for both farms and the government if only 2 negative whole-herd tests were required to declare a herd free of infection, with a 2–3 month testing interval. However, the optimal testing interval for governments was increased to 2–4 months if the model was constrained to reject control programs leading to an infected herd being declared free of infection. Although farms always preferred test-and-removal to depopulation from a cost standpoint, government costs were lower with depopulation more than half the time in 2 of 8 regions. Global sensitivity analysis showed that indemnity costs were significantly associated with a rise in the cost to the government, and that low replacement rates were responsible for the long time to detection predicted by the model, but that improving the sensitivity of slaughterhouse screening and the probability that a slaughtered animal’s herd of origin can be identified would result in faster detection times. PMID:24703601

Minimum cost to control bovine tuberculosis in cow-calf herds.

PubMed

Smith, Rebecca L; Tauer, Loren W; Sanderson, Michael W; Gröhn, Yrjo T

2014-07-01

Bovine tuberculosis (bTB) outbreaks in US cattle herds, while rare, are expensive to control. A stochastic model for bTB control in US cattle herds was adapted to more accurately represent cow-calf herd dynamics and was validated by comparison to 2 reported outbreaks. Control cost calculations were added to the model, which was then optimized to minimize costs for either the farm or the government. The results of the optimization showed that test-and-removal costs were minimized for both farms and the government if only 2 negative whole-herd tests were required to declare a herd free of infection, with a 2-3 month testing interval. However, the optimal testing interval for governments was increased to 2-4 months if the model was constrained to reject control programs leading to an infected herd being declared free of infection. Although farms always preferred test-and-removal to depopulation from a cost standpoint, government costs were lower with depopulation more than half the time in 2 of 8 regions. Global sensitivity analysis showed that indemnity costs were significantly associated with a rise in the cost to the government, and that low replacement rates were responsible for the long time to detection predicted by the model, but that improving the sensitivity of slaughterhouse screening and the probability that a slaughtered animal's herd of origin can be identified would result in faster detection times. Copyright © 2014 Elsevier B.V. All rights reserved.

NECAP 4.1: NASA's Energy-Cost Analysis Program fast input manual and example

NASA Technical Reports Server (NTRS)

Jensen, R. N.; Miner, D. L.

1982-01-01

NASA's Energy-Cost Analysis Program (NECAP) is a powerful computerized method to determine and to minimize building energy consumption. The program calculates hourly heat gain or losses taking into account the building thermal resistance and mass, using hourly weather and a response factor method. Internal temperatures are allowed to vary in accordance with thermostat settings and equipment capacity. NECAP 4.1 has a simplified input procedure and numerous other technical improvements. A very short input method is provided. It is limited to a single zone building. The user must still describe the building's outside geometry and select the type of system to be used.

Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis.

PubMed

Kortram, Kirsten; Ijzermans, Jan N M; Dor, Frank J M F

2016-11-01

Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs. One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate. The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.

Three essays on pricing and risk management in electricity markets

NASA Astrophysics Data System (ADS)

Kotsan, Serhiy

2005-07-01

A set of three papers forms this dissertation. In the first paper I analyze an electricity market that does not clear. The system operator satisfies fixed demand at a fixed price, and attempts to minimize "cost" as indicated by independent generators' supply bids. No equilibrium exists in this situation, and the operator lacks information sufficient to minimize actual cost. As a remedy, we propose a simple efficient tax mechanism. With the tax, Nash equilibrium bids still diverge from marginal cost but nonetheless provide sufficient information to minimize actual cost, regardless of the tax rate or number of generators. The second paper examines a price mechanism with one price assigned for each level of bundled real and reactive power. Equilibrium allocation under this pricing approach raises system efficiency via better allocation of the reactive power reserves, neglected in the traditional pricing approach. Pricing reactive power should be considered in the bundle with real power since its cost is highly dependent on real power output. The efficiency of pricing approach is shown in the general case, and tested on the 30-bus IEEE network with piecewise linear cost functions of the generators. Finally the third paper addresses the problem of optimal investment in generation based on mean-variance portfolio analysis. It is assumed the investor can freely create a portfolio of shares in generation located on buses of the electrical network. Investors are risk averse, and seek to minimize the variance of the weighted average Locational Marginal Price (LMP) in their portfolio, and to maximize its expected value. I conduct simulations using a standard IEEE 68-bus network that resembles the New York - New England system and calculate LMPs in accordance with the PJM methodology for a fully optimal AC power flow solution. Results indicate that the network topology is a crucial determinant of the investment decision as line congestion makes it difficult to deliver power to certain nodes at system peak load. Determining those nodes is an important task for an investor in generation as well as the transmission system operator.

Assessing recovery feasibility for piping plovers using optimization and simulation

USGS Publications Warehouse

Larson, M.A.; Ryan, M.R.; Murphy, R.K.

2003-01-01

Optimization and simulation modeling can be used to account for demographic and economic factors simultaneously in a comprehensive analysis of endangered-species population recovery. This is a powerful approach that is broadly applicable but underutilized in conservation biology. We applied the approach to a population recovery analysis of threatened and endangered piping plovers (Charadrius melodus) in the Great Plains of North America. Predator exclusion increases the reproductive success of piping plovers, but the most cost-efficient strategy of applying predator exclusion and the number of protected breeding pairs necessary to prevent further population declines were unknown. We developed a linear programming model to define strategies that would either maximize fledging rates or minimize financial costs by allocating plover pairs to 1 of 6 types of protection. We evaluated the optimal strategies using a stochastic population simulation model. The minimum cost to achieve a 20% chance of stabilizing simulated populations was approximately $1-11 million over 50 years. Increasing reproductive success to 1.24 fledglings/pair at minimal cost in any given area required fencing 85% of pairs at managed sites but cost 23% less than the current approach. Maximum fledging rates resulted in >20% of simulated populations reaching recovery goals in 30-50 years at cumulative costs of <$16 million. Protecting plover pairs within 50 km of natural resource agency field offices was sufficient to increase simulated populations to established recovery goals. A range-wide management plan needs to be developed and implemented to foster the involvement and cooperation among managers that will be necessary for recovery efforts to be successful. We also discuss how our approach can be applied to a variety of wildlife management issues.

Minim typing--a rapid and low cost MLST based typing tool for Klebsiella pneumoniae.

PubMed

Andersson, Patiyan; Tong, Steven Y C; Bell, Jan M; Turnidge, John D; Giffard, Philip M

2012-01-01

Here we report a single nucleotide polymorphism (SNP) based genotyping method for Klebsiella pneumoniae utilising high-resolution melting (HRM) analysis of fragments within the multilocus sequence typing (MLST) loci. The approach is termed mini-MLST or Minim typing and it has previously been applied to Streptococcus pyogenes, Staphylococcus aureus and Enterococcus faecium. Six SNPs were derived from concatenated MLST sequences on the basis of maximisation of the Simpsons Index of Diversity (D). DNA fragments incorporating these SNPs and predicted to be suitable for HRM analysis were designed. Using the assumption that HRM alleles are defined by G+C content, Minim typing using six fragments was predicted to provide a D = 0.979 against known STs. The method was tested against 202 K. pneumoniae using a blinded approach in which the MLST analyses were performed after the HRM analyses. The HRM-based alleles were indeed in accordance with G+C content, and the Minim typing identified known STs and flagged new STs. The tonB MLST locus was determined to be very diverse, and the two Minim fragments located herein contribute greatly to the resolving power. However these fragments are refractory to amplification in a minority of isolates. Therefore, we assessed the performance of two additional formats: one using only the four fragments located outside the tonB gene (D = 0.929), and the other using HRM data from these four fragments in conjunction with sequencing of the tonB MLST fragment (D = 0.995). The HRM assays were developed on the Rotorgene 6000, and the method was shown to also be robust on the LightCycler 480, allowing a 384-well high through-put format. The assay provides rapid, robust and low-cost typing with fully portable results that can directly be related to current MLST data. Minim typing in combination with molecular screening for antibiotic resistance markers can be a powerful surveillance tool kit.

Minim Typing – A Rapid and Low Cost MLST Based Typing Tool for Klebsiella pneumoniae

PubMed Central

Andersson, Patiyan; Tong, Steven Y. C.; Bell, Jan M.; Turnidge, John D.; Giffard, Philip M.

2012-01-01

Here we report a single nucleotide polymorphism (SNP) based genotyping method for Klebsiella pneumoniae utilising high-resolution melting (HRM) analysis of fragments within the multilocus sequence typing (MLST) loci. The approach is termed mini-MLST or Minim typing and it has previously been applied to Streptococcus pyogenes, Staphylococcus aureus and Enterococcus faecium. Six SNPs were derived from concatenated MLST sequences on the basis of maximisation of the Simpsons Index of Diversity (D). DNA fragments incorporating these SNPs and predicted to be suitable for HRM analysis were designed. Using the assumption that HRM alleles are defined by G+C content, Minim typing using six fragments was predicted to provide a D = 0.979 against known STs. The method was tested against 202 K. pneumoniae using a blinded approach in which the MLST analyses were performed after the HRM analyses. The HRM-based alleles were indeed in accordance with G+C content, and the Minim typing identified known STs and flagged new STs. The tonB MLST locus was determined to be very diverse, and the two Minim fragments located herein contribute greatly to the resolving power. However these fragments are refractory to amplification in a minority of isolates. Therefore, we assessed the performance of two additional formats: one using only the four fragments located outside the tonB gene (D = 0.929), and the other using HRM data from these four fragments in conjunction with sequencing of the tonB MLST fragment (D = 0.995). The HRM assays were developed on the Rotorgene 6000, and the method was shown to also be robust on the LightCycler 480, allowing a 384-well high through-put format. The assay provides rapid, robust and low-cost typing with fully portable results that can directly be related to current MLST data. Minim typing in combination with molecular screening for antibiotic resistance markers can be a powerful surveillance tool kit. PMID:22428067

PET/CT and contrast enhanced CT in single vs. two separate sessions: a cost analysis study.

PubMed

Picchio, M; Mansueto, M; Crivellaro, C; Guerra, L; Marcelli, S; Arosio, M; Sironi, S; Gianolli, L; Grimaldi, A; Messa, C

2012-06-01

Aim of the study was to quantify the economic impact of PET/CT and contrast enhanced (c.e.) CT performed in a single session examination vs. stand-alone modalities in oncological patients. One-hundred-forty-five cancer patients referred to both PET/CT and c.e. CT, to either stage (N.=46) or re-stage (N.=99) the disease, were included. Seventy-two/145 performed both studies in a single session (innovative method) and 73/145 in two different sessions (traditional method). The cost-minimization analysis was performed by evaluating: 1) institutional costs, data obtained by hospital accountability (staff, medical materials, equipment maintenance and depreciation, departments utilities); 2) patients costs, data obtained by a specific survey provided to patients (travel, food, accommodation costs, productivity loss). Economic data analysis showed that the costs for innovative method was lower than those of traditional method, both for Institution (106 € less per test) and for patient (21 € less per patient). The loss of productivity for patient and caregivers resulted lower for the innovative method than the traditional method (3 work-hour less per person). PET/CT and c.e. CT performed in a single session is more cost-effective than stand-alone modalities, by reducing both Institutional and patients costs. These advantages are mainly due to lower Institutional cost (single procedure) and to lower cost related to travel and housing.

HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

PubMed

Knapp, Herschel; Chan, Kee

2015-07-01

To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients. A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation. At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process. Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings. Copyright © 2015. Published by Elsevier Inc.

Time-based management of patient processes.

PubMed

Kujala, Jaakko; Lillrank, Paul; Kronström, Virpi; Peltokorpi, Antti

2006-01-01

The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes. This paper discusses the applicability of time-based competition and work-in-progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies. The paper finds that a patient episode is analogous to a customer order-to-delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non-value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode. The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community. In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes. This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

Development of coordination system model on single-supplier multi-buyer for multi-item supply chain with probabilistic demand

NASA Astrophysics Data System (ADS)

Olivia, G.; Santoso, A.; Prayogo, D. N.

2017-11-01

Nowadays, the level of competition between supply chains is getting tighter and a good coordination system between supply chains members is very crucial in solving the issue. This paper focused on a model development of coordination system between single supplier and buyers in a supply chain as a solution. Proposed optimization model was designed to determine the optimal number of deliveries from a supplier to buyers in order to minimize the total cost over a planning horizon. Components of the total supply chain cost consist of transportation costs, handling costs of supplier and buyers and also stock out costs. In the proposed optimization model, the supplier can supply various types of items to retailers whose item demand patterns are probabilistic. Sensitivity analysis of the proposed model was conducted to test the effect of changes in transport costs, handling costs and production capacities of the supplier. The results of the sensitivity analysis showed a significant influence on the changes in the transportation cost, handling costs and production capacity to the decisions of the optimal numbers of product delivery for each item to the buyers.

Maximum Likelihood Estimation with Emphasis on Aircraft Flight Data

NASA Technical Reports Server (NTRS)

Iliff, K. W.; Maine, R. E.

1985-01-01

Accurate modeling of flexible space structures is an important field that is currently under investigation. Parameter estimation, using methods such as maximum likelihood, is one of the ways that the model can be improved. The maximum likelihood estimator has been used to extract stability and control derivatives from flight data for many years. Most of the literature on aircraft estimation concentrates on new developments and applications, assuming familiarity with basic estimation concepts. Some of these basic concepts are presented. The maximum likelihood estimator and the aircraft equations of motion that the estimator uses are briefly discussed. The basic concepts of minimization and estimation are examined for a simple computed aircraft example. The cost functions that are to be minimized during estimation are defined and discussed. Graphic representations of the cost functions are given to help illustrate the minimization process. Finally, the basic concepts are generalized, and estimation from flight data is discussed. Specific examples of estimation of structural dynamics are included. Some of the major conclusions for the computed example are also developed for the analysis of flight data.

Final Report of the AMC Committee-Armament. Armament Development Center Concept Plan. Volume 2

DTIC Science & Technology

1974-12-01

Considerations 111-22 Section C Operational Considerations 111-26 Section D Community Economic Impact 111-35 Statements Section E Delphi Benefit Analysis 111-37...Cost Analysis 111-3 B Personnel Considerations III-22 C Operational Considerations 111-26 D Community Economic Impact Statements 111-35 E Delphi ...sidered to be minimal. 111-36 S SECTION E. Delphi Benefit Analysis 1. Introduction. The assessment and comparison of the relative benefits of the various

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

Toxic release consequence analysis tool (TORCAT) for inherently safer design plant.

PubMed

Shariff, Azmi Mohd; Zaini, Dzulkarnain

2010-10-15

Many major accidents due to toxic release in the past have caused many fatalities such as the tragedy of MIC release in Bhopal, India (1984). One of the approaches is to use inherently safer design technique that utilizes inherent safety principle to eliminate or minimize accidents rather than to control the hazard. This technique is best implemented in preliminary design stage where the consequence of toxic release can be evaluated and necessary design improvements can be implemented to eliminate or minimize the accidents to as low as reasonably practicable (ALARP) without resorting to costly protective system. However, currently there is no commercial tool available that has such capability. This paper reports on the preliminary findings on the development of a prototype tool for consequence analysis and design improvement via inherent safety principle by utilizing an integrated process design simulator with toxic release consequence analysis model. The consequence analysis based on the worst-case scenarios during process flowsheeting stage were conducted as case studies. The preliminary finding shows that toxic release consequences analysis tool (TORCAT) has capability to eliminate or minimize the potential toxic release accidents by adopting the inherent safety principle early in preliminary design stage. 2010 Elsevier B.V. All rights reserved.

Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services.

PubMed

Pham, Clarabelle; Caffrey, Orla; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria; Karnon, Jonathan

2012-08-21

Methods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions--risk adjusted cost-effectiveness (RAC-E) analysis--with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia. Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated. Unadjusted results showed that at one hospital patients incurred fewer costs and gained more life years than at the other hospitals (i.e. it was the dominant hospital). After risk adjustment, the cost minimizing hospital incurred the lowest costs, but with fewer life-years gained than one other hospital. The mean incremental cost per life-year gained of services provided at the most effective hospital was under $20,000, with an associated 65% probability of being cost-effective at a $50,000 per life year monetary threshold. RAC-E analyses can be used to identify important variation in the costs and outcomes associated with clinical practice at alternative institutions. Such data provides an impetus for further investigation to identify specific areas of variation, which may then inform the dissemination of best practice service delivery and organisation.

A cost analysis of family planning in Bangladesh.

PubMed

Fiedler, J L; Day, L M

1997-01-01

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

Cost-effectiveness analysis of strategies using new immunological diagnostic tests of latent tuberculosis infection before TNF-blockers therapy.

PubMed

Freund, Romain; Granger, Benjamin; Francois, Cécile; Carcelain, Guislaine; Ravaud, Philippe; Mariette, Xavier; Fautrel, Bruno

2018-02-01

Several tests have been proposed to detect latent tuberculosis (LTB). To evaluate the cost-effectiveness of different interferon-gamma release assays based strategies used to screen LTB before tumour necrosis factor (TNF) blockers initiation. Consecutive patients with rheumatoid arthritis, spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were recruited in 15 tertiary care centres. All were screened for LTB with tuberculin skin test (TST), QuantiFERON TB Gold ® in tube (QFT) and T-SPOT.TB ® (TSpot) on the same day. Cost-minimization and cost-effectiveness analysis, testing 8 screening test combinations, were conducted. Effectiveness was defined as the percentage of LTB treatment avoided and compared with TST alone. Cost were elicited in the payer perspective, included all the costs related to the screening procedure. No tuberculosis reactivation was observed after TNF-blocker initiation. TST followed by QFT if TST was positive was found as the best screening strategy, i.e. the less costly (-54€ compared to reference) and most effective (effectiveness 0.93), resulting in an incremental cost-effectiveness ratio of -192€ per treatment avoided. A probabilistic sensitivity analysis confirmed this result in 72.3% of simulations. TST followed by QFT if TST was positive is the most cost-effective strategy in screening for LTB in patients before starting anti-TNF therapy. NCT00811343. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Computer Support for Conducting Supportability Trade-Offs in a Team Setting

DTIC Science & Technology

1990-01-01

maintenance visits, and spares costs. To minimize the total system LCC, which includes both acquisition and support costs, a method for obtaining the...from different departments with a range of skills to work for a common goal is not an easy task. Ignoring the logistical concerns, a fundamental problem...maintenance visits, and spares costs. To minimize the total system LCC, which includes both acquisition and support costs, a method for obtaining the

The use of a break-even analysis: financial analysis of a fast-track program.

PubMed

Saywell, R M; Cordell, W H; Nyhuis, A W; Giles, B K; Culler, S D; Woods, J R; Chu, D K; McKinzie, J P; Rodman, G H

1995-08-01

To calculate the financial break-even point and illustrate how changes in third-party reimbursement and eligibility could affect a program's fiscal standing. Demographic, clinical, and financial data were collected retrospectively for 446 patients treated in a fast-track program during June 1993. The fast-track program is located within the confines of the emergency medicine and trauma center at a 1,050-bed tertiary care Midwestern teaching hospital and provides urgent treatment to minimally ill patients. A financial break-even analysis was performed to determine the point where the program generated enough revenue to cover its total variable and fixed costs, both direct and indirect. Given the relatively low average collection rate (62%) and high percentage of uninsured patients (31%), the analysis showed that the program's revenues covered its direct costs but not all of the indirect costs. Examining collection rates or payer class mix without examining both costs and revenues may lead to an erroneous conclusion about a program's fiscal viability. Sensitivity analysis also shows that relatively small changes in third-party coverage or eligibility (income) requirements can have a large impact on the program's financial solvency and break-even volumes.

A Highly Efficient Design Strategy for Regression with Outcome Pooling

PubMed Central

Mitchell, Emily M.; Lyles, Robert H.; Manatunga, Amita K.; Perkins, Neil J.; Schisterman, Enrique F.

2014-01-01

The potential for research involving biospecimens can be hindered by the prohibitive cost of performing laboratory assays on individual samples. To mitigate this cost, strategies such as randomly selecting a portion of specimens for analysis or randomly pooling specimens prior to performing laboratory assays may be employed. These techniques, while effective in reducing cost, are often accompanied by a considerable loss of statistical efficiency. We propose a novel pooling strategy based on the k-means clustering algorithm to reduce laboratory costs while maintaining a high level of statistical efficiency when predictor variables are measured on all subjects, but the outcome of interest is assessed in pools. We perform simulations motivated by the BioCycle study to compare this k-means pooling strategy with current pooling and selection techniques under simple and multiple linear regression models. While all of the methods considered produce unbiased estimates and confidence intervals with appropriate coverage, pooling under k-means clustering provides the most precise estimates, closely approximating results from the full data and losing minimal precision as the total number of pools decreases. The benefits of k-means clustering evident in the simulation study are then applied to an analysis of the BioCycle dataset. In conclusion, when the number of lab tests is limited by budget, pooling specimens based on k-means clustering prior to performing lab assays can be an effective way to save money with minimal information loss in a regression setting. PMID:25220822

A highly efficient design strategy for regression with outcome pooling.

PubMed

Mitchell, Emily M; Lyles, Robert H; Manatunga, Amita K; Perkins, Neil J; Schisterman, Enrique F

2014-12-10

The potential for research involving biospecimens can be hindered by the prohibitive cost of performing laboratory assays on individual samples. To mitigate this cost, strategies such as randomly selecting a portion of specimens for analysis or randomly pooling specimens prior to performing laboratory assays may be employed. These techniques, while effective in reducing cost, are often accompanied by a considerable loss of statistical efficiency. We propose a novel pooling strategy based on the k-means clustering algorithm to reduce laboratory costs while maintaining a high level of statistical efficiency when predictor variables are measured on all subjects, but the outcome of interest is assessed in pools. We perform simulations motivated by the BioCycle study to compare this k-means pooling strategy with current pooling and selection techniques under simple and multiple linear regression models. While all of the methods considered produce unbiased estimates and confidence intervals with appropriate coverage, pooling under k-means clustering provides the most precise estimates, closely approximating results from the full data and losing minimal precision as the total number of pools decreases. The benefits of k-means clustering evident in the simulation study are then applied to an analysis of the BioCycle dataset. In conclusion, when the number of lab tests is limited by budget, pooling specimens based on k-means clustering prior to performing lab assays can be an effective way to save money with minimal information loss in a regression setting. Copyright © 2014 John Wiley & Sons, Ltd.

An Economic Analysis of Solar Water & Space Heating.

ERIC Educational Resources Information Center

Energy Research and Development Administration, Washington, DC. Div. of Solar Energy.

Solar system designs for 13 cities were optimized so as to minimize the life cycle cost over the assumed 20-year lifetime of the solar energy systems. A number of major assumptions were made regarding the solar system, type and use of building, financial considerations, and economic environment used in the design optimization. Seven optimum…

Fishing decisions under uncertainty

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

Harrison, C.G.

1982-02-01

The drilling manager often is forced by an extended fishing operation to choose between the known costs incurred with abandonment of retrieval attempts and the unknown costs of continuing fishing operations. The successful manager makes the decision that costs the company the least money. Continuing fishing operations beyond some economic limit is failure, even if the fish is retrieved and that portion of the hole saved, because more money has been spent in the fishing attempt than would have been spent by not fishing. The strategy is to minimize losses. This analysis closely follows the theory of utility developed bymore » J. von Neuman and O. Morgenstern. 1 ref.« less

Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.

PubMed

McLean, Kendra; Day, Lesley; Dalton, Andrew

2015-03-26

Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

[Pharmacoeconomic analysis of community-acquired pneumonia treatment with telithromycin or clarithromycin].

PubMed

Rubio-Terrés, C; Cots, J M; Domínguez-Gil, A; Herreras, A; Sánchez Gascón, F; Chang, J; Trilla, A

2003-09-01

A pharmacoeconomic analysis was carried out comparing the efficacy of two treatment options for community-acquired pneumonia (CAP): telithromycin and clarithromycin. It was a retrospective analysis using a decision tree model. The efficacy of the two treatment options was estimated from a randomized, double-blind clinical trial, in which 800 mg/day oral telithromycin for 10 days was compared to 1000 mg/day oral clarithromycin for 10 days in patients with CAP (162 and 156 respectively). The use of resources was estimated based on the clinical trial and Spanish sources, and the unit costs from a Spanish health costs database. Costs were evaluated for the acquisition of antibiotic treatments, change of antibiotic due to therapeutic failure, hospital admissions, adverse reactions to treatment, primary care visits, tests and indirect costs (working days lost). The model was validated by a panel of Spanish clinical experts. As the clinical trial was designed to show equivalence, there were no significant differences in efficacy between the treatment options (clinical cure rate 88.3% and 88.5%, respectively), and a cost minimization analysis was performed. In the base case, the average cost of the disease per patient was 308.29 euros with telithromycin and 331.5 euros with clarithromycin (a difference of 23.21 euros). The results were stable in the susceptibility analysis, with differences favorable to telithromycin ranging between 5.50 and 45.45 euros. Telithromycin results in a cost savings of up to 45.45 euros per CAP patient compared to clarithromycin.

Economic Evaluation of Hospital and Community Pharmacy Services.

PubMed

Gammie, Todd; Vogler, Sabine; Babar, Zaheer-Ud-Din

2017-01-01

To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included "health economics" and "evaluation" "assessment" or "appraisal," "methods," "hospital" or "community" or "residential care," "pharmacy" or "pharmacy services" and "cost minimisation analysis" or "cost utility analysis" or "cost effectiveness analysis" or "cost benefit analysis." The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.

A cost analysis of first-line chemotherapy for low-risk gestational trophoblastic neoplasia.

PubMed

Shah, Neel T; Barroilhet, Lisa; Berkowitz, Ross S; Goldstein, Donald P; Horowitz, Neil

2012-01-01

To determine the optimal approach to first-line treatment for low-risk gestational trophoblastic neoplasia (GTN) using a cost analysis of 3 commonly used regimens. A decision tree of the 3 most commonly used first-line low-risk GTN treatment strategies was created, accounting for toxicities, response rates and need for second- or third-line therapy. These strategies included 8-day methotrexate (MTX)/folinic acid, weekly MTX, and pulsed actinomycin-D (act-D). Response rates, average number of cycles needed for remission, and toxicities were determined by review of the literature. Costs of each strategy were examined from a societal perspective, including the direct total treatment costs as well as the indirect lost labor production costs from work absences. Sensitivity analysis on these costs was performed using both deterministic and probabilistic cost-minimization models with the aid of decision tree software (TreeAge Pro 2011, TreeAge Inc., Williamstown, Massachusetts). We found that 8-day MTX/folinic acid is the least expensive to society, followed by pulsed act-D ($4,867 vs. $6,111 average societal cost per cure, respectively), with act-D becoming more favorable only with act-D per-cycle cost <$231, or response rate to first-line therapy > 99%. Weekly MTX is the most expensive first-line treatment strategy to society ($9,089 average cost per cure), despite being least expensive to administer per cycle, based on lower first-line response rate. Absolute societal cost of each strategy is driven by the probability of needing expensive third-line multiagent chemotherapy, however relative cost differences are robust to sensitivity analysis over the reported range of cycle number and response rate for all therapies. Based on similar efficacy and lower societal cost, we recommend 8-day MTX/folinic acid for first-line treatment of low-risk GTN.

A planning model for the short-term management of cash.

PubMed

Broyles, Robert W; Mattachione, Steven; Khaliq, Amir

2011-02-01

This paper develops a model that enables the health administrator to identify the balance that minimizes the projected cost of holding cash. Adopting the principles of mathematical expectation, the model estimates the expected total costs of adopting each of the several strategies concerning the cash balance that the organization might maintain. Expected total costs consist of anticipated short costs, resulting from a potential shortage of funds. Long costs are associated with a potential surplus of funds and an opportunity cost represented by foregone investment income. Of importance to the model is the potential for the health service organization to realize a surplus of funds during periods characterized by a net cash disbursement. The paper also develops an interactive spreadsheet that enables the administrator to perform sensitivity analysis and examine the response of the desired or target cash balance to changes in the parameters that define the expected long and short cost functions.

Comparison of multihardware parallel implementations for a phase unwrapping algorithm

NASA Astrophysics Data System (ADS)

Hernandez-Lopez, Francisco Javier; Rivera, Mariano; Salazar-Garibay, Adan; Legarda-Sáenz, Ricardo

2018-04-01

Phase unwrapping is an important problem in the areas of optical metrology, synthetic aperture radar (SAR) image analysis, and magnetic resonance imaging (MRI) analysis. These images are becoming larger in size and, particularly, the availability and need for processing of SAR and MRI data have increased significantly with the acquisition of remote sensing data and the popularization of magnetic resonators in clinical diagnosis. Therefore, it is important to develop faster and accurate phase unwrapping algorithms. We propose a parallel multigrid algorithm of a phase unwrapping method named accumulation of residual maps, which builds on a serial algorithm that consists of the minimization of a cost function; minimization achieved by means of a serial Gauss-Seidel kind algorithm. Our algorithm also optimizes the original cost function, but unlike the original work, our algorithm is a parallel Jacobi class with alternated minimizations. This strategy is known as the chessboard type, where red pixels can be updated in parallel at same iteration since they are independent. Similarly, black pixels can be updated in parallel in an alternating iteration. We present parallel implementations of our algorithm for different parallel multicore architecture such as CPU-multicore, Xeon Phi coprocessor, and Nvidia graphics processing unit. In all the cases, we obtain a superior performance of our parallel algorithm when compared with the original serial version. In addition, we present a detailed comparative performance of the developed parallel versions.

Development of low cost medium for ethanol production from syngas by Clostridium ragsdalei.

PubMed

Gao, Jie; Atiyeh, Hasan K; Phillips, John R; Wilkins, Mark R; Huhnke, Raymond L

2013-11-01

The development of a low cost medium for ethanol production is critical for process feasibility. Ten media were formulated for Clostridium ragsdalei by reduction, elimination and replacement of expensive nutrients. Cost analysis and effects of medium components on growth and product formation were investigated. Fermentations were performed in 250 mL bottles using syngas (20% CO, 15% CO2, 5% H2 and 60% N2). The standard medium M1 cost is $9.83/L, of which 93% is attributed to morpholinoethane sulfonic acid (MES) buffer. Statistical analysis of the results showed that MES removal did not affect cell growth and ethanol production (P>0.05). Based on cells' elemental composition, a minimal mineral concentration medium M7 was formulated, which provided 29% higher ethanol yield from CO at 3% of the cost compared to medium M1. Ethanol yield from CO in the completely defined medium M9 was 36% higher than while at 5% the cost of medium M1. Copyright © 2013 Elsevier Ltd. All rights reserved.

The analytic solution of the firm's cost-minimization problem with box constraints and the Cobb-Douglas model

NASA Astrophysics Data System (ADS)

Bayón, L.; Grau, J. M.; Ruiz, M. M.; Suárez, P. M.

2012-12-01

One of the most well-known problems in the field of Microeconomics is the Firm's Cost-Minimization Problem. In this paper we establish the analytical expression for the cost function using the Cobb-Douglas model and considering maximum constraints for the inputs. Moreover we prove that it belongs to the class C1.

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

PubMed

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

2016-07-01

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

Objective analysis of pseudostress over the Indian Ocean using a direct-minimization approach

NASA Technical Reports Server (NTRS)

Legler, David M.; Navon, I. M.; O'Brien, James J.

1989-01-01

A technique not previously used in objective analysis of meteorological data is used here to produce monthly average surface pseudostress data over the Indian Ocean. An initial guess field is derived and a cost functional is constructed with five terms: approximation to initial guess, approximation to climatology, a smoothness parameter, and two kinematic terms. The functional is minimized using a conjugate-gradient technique, and the weight for the climatology term controls the overall balance of influence between the climatology and the initial guess. Results from various weight combinations are presented for January and July 1984. Quantitative and qualitative comparisons to the subject analysis are made to find which weight combination provides the best results. The weight on the approximation to climatology is found to balance the influence of the original field and climatology.

Statistical Optimality in Multipartite Ranking and Ordinal Regression.

PubMed

Uematsu, Kazuki; Lee, Yoonkyung

2015-05-01

Statistical optimality in multipartite ranking is investigated as an extension of bipartite ranking. We consider the optimality of ranking algorithms through minimization of the theoretical risk which combines pairwise ranking errors of ordinal categories with differential ranking costs. The extension shows that for a certain class of convex loss functions including exponential loss, the optimal ranking function can be represented as a ratio of weighted conditional probability of upper categories to lower categories, where the weights are given by the misranking costs. This result also bridges traditional ranking methods such as proportional odds model in statistics with various ranking algorithms in machine learning. Further, the analysis of multipartite ranking with different costs provides a new perspective on non-smooth list-wise ranking measures such as the discounted cumulative gain and preference learning. We illustrate our findings with simulation study and real data analysis.

Wing attachment position of fruit fly minimizes flight cost

NASA Astrophysics Data System (ADS)

Noest, Robert; Wang, Jane

Flight is energetically costly which means insects need to find ways to reduce their energy expenditure during sustained flight. Previous work has shown that insect muscles can recover some of the energy used for producing flapping motion. Moreover the form of flapping motions are efficient for generating the required force to balance the weight. In this talk, we show that one of the morphological parameters, the wing attachment point on a fly, is suitably located to further reduce the cost for flight, while allowing the fly to be close to stable. We investigate why this is the case and attempt to find a general rule for the optimal location of the wing hinge. Our analysis is based on computations of flapping free flight together with the Floquet stability analysis of periodic flight for descending, hovering and ascending cases.

Probabilistic distance-based quantizer design for distributed estimation

NASA Astrophysics Data System (ADS)

Kim, Yoon Hak

2016-12-01

We consider an iterative design of independently operating local quantizers at nodes that should cooperate without interaction to achieve application objectives for distributed estimation systems. We suggest as a new cost function a probabilistic distance between the posterior distribution and its quantized one expressed as the Kullback Leibler (KL) divergence. We first present the analysis that minimizing the KL divergence in the cyclic generalized Lloyd design framework is equivalent to maximizing the logarithmic quantized posterior distribution on the average which can be further computationally reduced in our iterative design. We propose an iterative design algorithm that seeks to maximize the simplified version of the posterior quantized distribution and discuss that our algorithm converges to a global optimum due to the convexity of the cost function and generates the most informative quantized measurements. We also provide an independent encoding technique that enables minimization of the cost function and can be efficiently simplified for a practical use of power-constrained nodes. We finally demonstrate through extensive experiments an obvious advantage of improved estimation performance as compared with the typical designs and the novel design techniques previously published.

Economics of gynecologic morcellation.

PubMed

Bortoletto, Pietro; Friedman, Jaclyn; Milad, Magdy P

2018-02-01

As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspective, and consistently found that with careful patient selection, by preventing laparotomies, it can be a cost-effective tool. Changes since 2014 have resulted in new techniques and technologies to allow these minimally invasive procedures to continue to be offered in a safe manner. With this rapid change, physicians are altering their practice and patients are attempting to educate themselves to decide what is best for them. This evolution has allowed us to refocus on the cost implications of new developments, allowing stakeholders the opportunity to maximize patient safety and surgical outcomes while minimizing cost.

Cost analysis when open surgeons perform minimally invasive hysterectomy.

PubMed

Shepherd, Jonathan P; Kantartzis, Kelly L; Ahn, Ki Hoon; Bonidie, Michael J; Lee, Ted

2014-01-01

The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P < .001). By cost subcategory, laparoscopic hysterectomy was lower than robotic hysterectomy in 6 and higher in 1. When performing robotic hysterectomy, open and robotic surgeon costs were similar. With laparoscopic hysterectomy, open surgeons had higher costs than laparoscopic surgeons for 1 of 2 statistical transformations (P = .007). Open surgeons had lower costs performing laparoscopic hysterectomy than robotic hysterectomy with robotic maintenance and depreciation included (P < .001) but similar costs if these variables were excluded. Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.

It is not only the empty vials that go into the garbage can during chemotherapy drugs preparation: a cost analysis of unused chemotherapy drugs in cancer treatment.

PubMed

Ata, A; Abali, H; Yengel, E; Arican, A

2012-01-01

Cancer therapy is a costly treatment. Costs of drugs used in cancer therapy are gradually increasing with the addition of new and expensive drugs. This fact imposes obligation on reasonable drug usage. Occasionally, all of the prescribed drugs are not used for various reasons, and a number of drugs can be left over. In this study, we aimed to calculate the costs of unused chemotherapeutic drugs in our oncology clinics. A total of 117 patients with 17 different types of cancer were administered 32 cancer therapy protocols during 2 months. After administration of ideal doses of the prescribed drugs calculated on an individual basis, the number of unused drug doses in the packages was recorded and the costs of the unused drugs were calculated based on current prices of the drugs. The cumulative cost of the unused drugs calculated for all patients was US dollars (USD) 6406.93, and average cost of the drug per capita was USD 54.76. Minimal and maximal unused drug costs per drug were USD 0.29 for 5-fluorouracil, and USD 247.12 for bevacizumab, respectively. Minimal increase in drug costs per recipe was USD 0.50 for a prescription containing cyclophosphamide and 5-fluorouracil, while the total cost of bevacizumab plus irinotecan combination increased tremendously to USD 309.12. Among chemotherapeutic protocols the cheapest one was AC (adriamycin, cyclophosphamide) with USD 4.77, while the most expensive one (USD 116.02) was FOLFIRI-B (5-fluorouracil, calcium folinate, irinotecan, and bevacizumab). The important financial burden of unused drugs goes unrecognized among routine chemotherapeutic applications. In order to be able to avoid this extravagance, drug industry, prescribing physicians, and practice nurses must assume important roles.

Neuraxial blockade for external cephalic version: Cost analysis.

PubMed

Yamasato, Kelly; Kaneshiro, Bliss; Salcedo, Jennifer

2015-07-01

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

Neuraxial blockade for external cephalic version: Cost analysis

PubMed Central

Yamasato, Kelly; Kaneshiro, Bliss; Salcedo, Jennifer

2017-01-01

Aim Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates. Methods A decision–analysis model was developed using costs and probabilities occurring prenatally through the delivery hospital admission. Model inputs were derived from the literature, national databases, and local supply costs. Univariate and bivariate sensitivity analyses and Monte Carlo simulations were performed to assess model robustness. Results Neuraxial blockade was cost saving to both hospitals ($30 per delivery) and insurers ($539 per delivery) using baseline estimates. From both perspectives, however, the model was sensitive to multiple variables. Monte Carlo simulation indicated neuraxial blockade to be more costly in approximately 50% of scenarios. The model demonstrated that routine use of neuraxial blockade during external cephalic version, compared to no neuraxial blockade, prevented 17 cesarean deliveries for every 100 external cephalic versions attempted. Conclusions Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate. PMID:25771920

Cost-minimization analysis of imipenem/cilastatin versus meropenem in moderate to severe infections at a tertiary care hospital in Saudi Arabia.

PubMed

Joosub, Imraan; Gray, Andy; Crisostomo, Analyn; Salam, Abdul

2015-11-01

The aim of this study was to compare the costs of management of moderate to severe infections in patients treated with imipenem/cilastatin (IC) and meropenem (MEM). Pharmacoeconomic studies in Saudi Arabia are scarce. The current hospital formulary contains 2 carbapenems: IC and MEM. These antibiotics share a similar spectrum of activity. There are conflicting reviews with regard to the relative cost-effectiveness of these two agents. A retrospective, single-centre cohort study of 88 patients of IC versus MEM in moderate to severe infections was performed, applying cost-minimization analysis (CMA) methods. In accordance with CMA methods, the assumption of equivalent efficacy was first demonstrated by literature retrieved and appraised. Adult patients (⩾18 years old) diagnosed with moderate to severe infections, including skin and skin structure infections (SSIs), sepsis, intra-abdominal infections (IAIs), respiratory tract infections, urinary tract infections (UTIs) and hospital-acquired infections (HAIs), who were prescribed IC 500 mg every six hours intravenously (2 g per day) or MEM 1 g every eight hours (3 g per day), were included in the study. Only direct costs related to the management of the infections were included, in accordance with a payer perspective. Overall there was no difference in the mean total daily costs between IC (SAR 4784.46, 95% CI 4140.68, 5428.24) and MEM (4390.14, 95% CI 3785.82, 4994.45; p = 0.37). A significantly lower medicine acquisition cost per vial of IC was observed when compared to MEM, however there was a significantly higher cost attached to administration sets used in the IC group than the MEM group. Consultation, nursing and physician costs were not significantly different between the groups. No differences were observed in costs associated with adverse drug events (ADEs). This study has shown that while acquisition costs of IC at a dose of 500 mg q6 h may be lower than for MEM 1 g q8 h, mean total costs per day were not significantly different between IC and MEM, indicating that medicine costs are only a small element of the overall costs of managing moderate to severe infections.

Optimum allocation of redundancy among subsystems connected in series. Ph.D. Thesis - Case Western Reserve Univ., Sep. 1970

NASA Technical Reports Server (NTRS)

Bien, D. D.

1973-01-01

This analysis considers the optimum allocation of redundancy in a system of serially connected subsystems in which each subsystem is of the k-out-of-n type. Redundancy is optimally allocated when: (1) reliability is maximized for given costs; or (2) costs are minimized for given reliability. Several techniques are presented for achieving optimum allocation and their relative merits are discussed. Approximate solutions in closed form were attainable only for the special case of series-parallel systems and the efficacy of these approximations is discussed.

An EOQ model for weibull distribution deterioration with time-dependent cubic demand and backlogging

NASA Astrophysics Data System (ADS)

Santhi, G.; Karthikeyan, K.

2017-11-01

In this article we introduce an economic order quantity model with weibull deterioration and time dependent cubic demand rate where holding costs as a linear function of time. Shortages are allowed in the inventory system are partially and fully backlogging. The objective of this model is to minimize the total inventory cost by using the optimal order quantity and the cycle length. The proposed model is illustrated by numerical examples and the sensitivity analysis is performed to study the effect of changes in parameters on the optimum solutions.

Improving Learning Performance Through Rational Resource Allocation

NASA Technical Reports Server (NTRS)

Gratch, J.; Chien, S.; DeJong, G.

1994-01-01

This article shows how rational analysis can be used to minimize learning cost for a general class of statistical learning problems. We discuss the factors that influence learning cost and show that the problem of efficient learning can be cast as a resource optimization problem. Solutions found in this way can be significantly more efficient than the best solutions that do not account for these factors. We introduce a heuristic learning algorithm that approximately solves this optimization problem and document its performance improvements on synthetic and real-world problems.

Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients.

PubMed

Wang, Michael Y; Lerner, Jason; Lesko, James; McGirt, Matthew J

2012-08-01

Retrospective multi-institutional database review. To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.

Offshore wind farm layout optimization

NASA Astrophysics Data System (ADS)

Elkinton, Christopher Neil

Offshore wind energy technology is maturing in Europe and is poised to make a significant contribution to the U.S. energy production portfolio. Building on the knowledge the wind industry has gained to date, this dissertation investigates the influences of different site conditions on offshore wind farm micrositing---the layout of individual turbines within the boundaries of a wind farm. For offshore wind farms, these conditions include, among others, the wind and wave climates, water depths, and soil conditions at the site. An analysis tool has been developed that is capable of estimating the cost of energy (COE) from offshore wind farms. For this analysis, the COE has been divided into several modeled components: major costs (e.g. turbines, electrical interconnection, maintenance, etc.), energy production, and energy losses. By treating these component models as functions of site-dependent parameters, the analysis tool can investigate the influence of these parameters on the COE. Some parameters result in simultaneous increases of both energy and cost. In these cases, the analysis tool was used to determine the value of the parameter that yielded the lowest COE and, thus, the best balance of cost and energy. The models have been validated and generally compare favorably with existing offshore wind farm data. The analysis technique was then paired with optimization algorithms to form a tool with which to design offshore wind farm layouts for which the COE was minimized. Greedy heuristic and genetic optimization algorithms have been tuned and implemented. The use of these two algorithms in series has been shown to produce the best, most consistent solutions. The influences of site conditions on the COE have been studied further by applying the analysis and optimization tools to the initial design of a small offshore wind farm near the town of Hull, Massachusetts. The results of an initial full-site analysis and optimization were used to constrain the boundaries of the farm. A more thorough optimization highlighted the features of the area that would result in a minimized COE. The results showed reasonable layout designs and COE estimates that are consistent with existing offshore wind farms.

Minimization of bovine tuberculosis control costs in US dairy herds

PubMed Central

Smith, Rebecca L.; Tauer, Loren W.; Schukken, Ynte H.; Lu, Zhao; Grohn, Yrjo T.

2013-01-01

The objective of this study was to minimize the cost of controlling an isolated bovine tuberculosis (bTB) outbreak in a US dairy herd, using a stochastic simulation model of bTB with economic and biological layers. A model optimizer produced a control program that required 2-month testing intervals (TI) with 2 negative whole-herd tests to leave quarantine. This control program minimized both farm and government costs. In all cases, test-and-removal costs were lower than depopulation costs, although the variability in costs increased for farms with high holding costs or small herd sizes. Increasing herd size significantly increased costs for both the farm and the government, while increasing indemnity payments significantly decreased farm costs and increasing testing costs significantly increased government costs. Based on the results of this model, we recommend 2-month testing intervals for herds after an outbreak of bovine tuberculosis, with 2 negative whole herd tests being sufficient to lift quarantine. A prolonged test and cull program may cause a state to lose its bTB-free status during the testing period. When the cost of losing the bTB-free status is greater than $1.4 million then depopulation of farms could be preferred over a test and cull program. PMID:23953679

Effectiveness and Cost-effectiveness of Opportunistic Screening and Stepped-care Interventions for Older Alcohol Users in Primary Care.

PubMed

Coulton, Simon; Bland, Martin; Crosby, Helen; Dale, Veronica; Drummond, Colin; Godfrey, Christine; Kaner, Eileen; Sweetman, Jennifer; McGovern, Ruth; Newbury-Birch, Dorothy; Parrott, Steve; Tober, Gillian; Watson, Judith; Wu, Qi

2017-11-01

To compare the clinical effectiveness and cost-effectiveness of a stepped-care intervention versus a minimal intervention for the treatment of older hazardous alcohol users in primary care. Multi-centre, pragmatic RCT, set in Primary Care in UK. Patients aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test were allocated either to 5-min of brief advice or to 'Stepped Care': an initial 20-min of behavioural change counselling, with Step 2 being three sessions of Motivational Enhancement Therapy and Step 3 referral to local alcohol services (progression between each Step being determined by outcomes 1 month after each Step). Outcome measures included average drinks per day, AUDIT-C, alcohol-related problems using the Drinking Problems Index, health-related quality of life using the Short Form 12, costs measured from a NHS/Personal Social Care perspective and estimated health gains in quality adjusted life-years measured assessed EQ-5D. Both groups reduced alcohol consumption at 12 months but the difference between groups was small and not significant. No significant differences were observed between the groups on secondary outcomes. In economic terms stepped care was less costly and more effective than the minimal intervention. Stepped care does not confer an advantage over a minimal intervention in terms of reduction in alcohol use for older hazardous alcohol users in primary care. However, stepped care has a greater probability of being more cost-effective. Current controlled trials ISRCTN52557360. A stepped care approach was compared with brief intervention for older at-risk drinkers attending primary care. While consumption reduced in both groups over 12 months there was no significant difference between the groups. An economic analysis indicated the stepped care which had a greater probability of being more cost-effective than brief intervention. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Spacelab cost reduction alternatives study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1976-01-01

Alternative approaches to payload operations planning and control and flight crew training are defined for spacelab payloads with the goal of: lowering FY77 and FY 78 costs for new starts; lowering costs to achieve Spacelab operational capability; and minimizing the cost per Spacelab flight. These alternatives attempt to minimize duplication of hardware, software, and personnel, and the investment in supporting facility and equipment. Of particular importance is the possible reduction of equipment, software, and manpower resources such as comtational systems, trainers, and simulators.

Understanding health economic analysis in critical care: insights from recent randomized controlled trials.

PubMed

Sud, Sachin; Cuthbertson, Brian H

2011-10-01

The article reviews the methods of health economic analysis (HEA) in clinical trials of critically ill patients. Emphasis is placed on the usefulness of HEA in the context of positive and 'no effect' studies, with recent examples. The need to control costs and promote effective spending in caring for the critically ill has garnered considerable attention due to the high cost of critical illness. Many clinical trials focus on short-term mortality, ignoring costs and quality of life, and fail to change clinical practice or promote efficient use of resources. Incorporating HEA into clinical trials is a possible solution. Such studies have shown some interventions, although expensive, provide good value, whereas others should be withdrawn from clinical practice. Incorporating HEA into randomized controlled trials (RCTs) requires careful attention to collect all relevant costs. Decision trees, modeling assumptions and methods for collecting costs and measuring outcomes should be planned and published beforehand to minimize bias. Costs and cost-effectiveness are potentially useful outcomes in RCTs of critically ill patients. Future RCTs should incorporate parallel HEA to provide both economic outcomes, which are important to the community, alongside patient-centered outcomes, which are important to individuals.

Space station preliminary design report

NASA Technical Reports Server (NTRS)

1982-01-01

The results of a 3 month preliminary design and analysis effort is presented. The configuration that emerged consists of a very stiff deployable truss structure with an overall triangular cross section having universal modules attached at the apexes. Sufficient analysis was performed to show feasibility of the configuration. An evaluation of the structure shows that desirable attributes of the configuration are: (1) the solar cells, radiators, and antennas will be mounted to stiff structure to minimize control problems during orbit maintenance and correction, docking, and attitude control; (2) large flat areas are available for mounting and servicing of equipment; (3) Large mass items can be mounted near the center of gravity of the system to minimize gravity gradient torques; (4) the trusses are lightweight structures and can be transported into orbit in one Shuttle flight; (5) the trusses are expandable and will require a minimum of EVA; and (6) the modules are anticipated to be structurally identical except for internal equipment to minimize cost.

Multi-Mission System Analysis for Planetary Entry (M-SAPE) Version 1

NASA Technical Reports Server (NTRS)

Samareh, Jamshid; Glaab, Louis; Winski, Richard G.; Maddock, Robert W.; Emmett, Anjie L.; Munk, Michelle M.; Agrawal, Parul; Sepka, Steve; Aliaga, Jose; Zarchi, Kerry;

On-chip electrical detection of parallel loop-mediated isothermal amplification with DG-BioFETs for the detection of foodborne bacterial pathogens

USDA-ARS?s Scientific Manuscript database

The use of field effect transistors (FETs) as the transduction element for the detection of DNA amplification reactions will enable portable and inexpensive nucleic acid analysis. Transistors used as biological sensors,or BioFETs, minimize the cost and size of detection platforms by leveraging fabri...

Selection of Reserves for Woodland Caribou Using an Optimization Approach

PubMed Central

Schneider, Richard R.; Hauer, Grant; Dawe, Kimberly; Adamowicz, Wiktor; Boutin, Stan

2012-01-01

Habitat protection has been identified as an important strategy for the conservation of woodland caribou (Rangifer tarandus). However, because of the economic opportunity costs associated with protection it is unlikely that all caribou ranges can be protected in their entirety. We used an optimization approach to identify reserve designs for caribou in Alberta, Canada, across a range of potential protection targets. Our designs minimized costs as well as three demographic risk factors: current industrial footprint, presence of white-tailed deer (Odocoileus virginianus), and climate change. We found that, using optimization, 60% of current caribou range can be protected (including 17% in existing parks) while maintaining access to over 98% of the value of resources on public lands. The trade-off between minimizing cost and minimizing demographic risk factors was minimal because the spatial distributions of cost and risk were similar. The prospects for protection are much reduced if protection is directed towards the herds that are most at risk of near-term extirpation. PMID:22363702

Unifying cost and information in information-theoretic competitive learning.

PubMed

Kamimura, Ryotaro

2005-01-01

In this paper, we introduce costs into the framework of information maximization and try to maximize the ratio of information to its associated cost. We have shown that competitive learning is realized by maximizing mutual information between input patterns and competitive units. One shortcoming of the method is that maximizing information does not necessarily produce representations faithful to input patterns. Information maximizing primarily focuses on some parts of input patterns that are used to distinguish between patterns. Therefore, we introduce the cost, which represents average distance between input patterns and connection weights. By minimizing the cost, final connection weights reflect input patterns well. We applied the method to a political data analysis, a voting attitude problem and a Wisconsin cancer problem. Experimental results confirmed that, when the cost was introduced, representations faithful to input patterns were obtained. In addition, improved generalization performance was obtained within a relatively short learning time.

Pharmacoeconomics and macular degeneration.

PubMed

Brown, Gary C; Brown, Melissa M; Brown, Heidi; Godshalk, Ashlee N

2007-05-01

To describe pharmacoeconomics and its relationship to drug interventions. Pharmacoeconomics is the branch of economics which applies cost-minimization, cost-benefit, cost-effectiveness and cost-utility analyses to compare the economics of different pharmaceutical products or to compare drug therapy to other treatments. Among the four instruments, cost-utility analysis is the most sophisticated, relevant and clinically applicable as it measures the value conferred by drugs for the monies expended. Value-based medicine incorporates cost-utility principles but with strict standardization of all input and output parameters to allow the comparability of analyses, unlike the current situation in the healthcare literature. Pharmacoeconomics is assuming an increasingly important role with regard to whether drugs are listed on the drug formulary of a country or province. It has been estimated that the application of standardized, value-based medicine drug analyses can save over 35% from a public healthcare insurer drug formulary while maintaining or improving patient care.

Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.

PubMed

Schuurman, Jaap-Peter; Schoonhoven, Lisette; Defloor, Tom; van Engelshoven, Ilse; van Ramshorst, Bert; Buskens, Erik

2009-01-01

The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals. Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.

Optimization of power systems with voltage security constraints

NASA Astrophysics Data System (ADS)

Rosehart, William Daniel

As open access market principles are applied to power systems, significant changes in their operation and control are occurring. In the new marketplace, power systems are operating under higher loading conditions as market influences demand greater attention to operating cost versus stability margins. Since stability continues to be a basic requirement in the operation of any power system, new tools are being considered to analyze the effect of stability on the operating cost of the system, so that system stability can be incorporated into the costs of operating the system. In this thesis, new optimal power flow (OPF) formulations are proposed based on multi-objective methodologies to optimize active and reactive power dispatch while maximizing voltage security in power systems. The effects of minimizing operating costs, minimizing reactive power generation and/or maximizing voltage stability margins are analyzed. Results obtained using the proposed Voltage Stability Constrained OPF formulations are compared and analyzed to suggest possible ways of costing voltage security in power systems. When considering voltage stability margins the importance of system modeling becomes critical, since it has been demonstrated, based on bifurcation analysis, that modeling can have a significant effect of the behavior of power systems, especially at high loading levels. Therefore, this thesis also examines the effects of detailed generator models and several exponential load models. Furthermore, because of its influence on voltage stability, a Static Var Compensator model is also incorporated into the optimization problems.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

Optimal ordering quantities for substitutable deteriorating items under joint replenishment with cost of substitution

NASA Astrophysics Data System (ADS)

Mishra, Vinod Kumar

2017-09-01

In this paper we develop an inventory model, to determine the optimal ordering quantities, for a set of two substitutable deteriorating items. In this inventory model the inventory level of both items depleted due to demands and deterioration and when an item is out of stock, its demands are partially fulfilled by the other item and all unsatisfied demand is lost. Each substituted item incurs a cost of substitution and the demands and deterioration is considered to be deterministic and constant. Items are order jointly in each ordering cycle, to take the advantages of joint replenishment. The problem is formulated and a solution procedure is developed to determine the optimal ordering quantities that minimize the total inventory cost. We provide an extensive numerical and sensitivity analysis to illustrate the effect of different parameter on the model. The key observation on the basis of numerical analysis, there is substantial improvement in the optimal total cost of the inventory model with substitution over without substitution.

Discrete homotopy analysis for optimal trading execution with nonlinear transient market impact

NASA Astrophysics Data System (ADS)

Curato, Gianbiagio; Gatheral, Jim; Lillo, Fabrizio

2016-10-01

Optimal execution in financial markets is the problem of how to trade a large quantity of shares incrementally in time in order to minimize the expected cost. In this paper, we study the problem of the optimal execution in the presence of nonlinear transient market impact. Mathematically such problem is equivalent to solve a strongly nonlinear integral equation, which in our model is a weakly singular Urysohn equation of the first kind. We propose an approach based on Homotopy Analysis Method (HAM), whereby a well behaved initial trading strategy is continuously deformed to lower the expected execution cost. Specifically, we propose a discrete version of the HAM, i.e. the DHAM approach, in order to use the method when the integrals to compute have no closed form solution. We find that the optimal solution is front loaded for concave instantaneous impact even when the investor is risk neutral. More important we find that the expected cost of the DHAM strategy is significantly smaller than the cost of conventional strategies.

Exact solution for the optimal neuronal layout problem.

PubMed

Chklovskii, Dmitri B

2004-10-01

Evolution perfected brain design by maximizing its functionality while minimizing costs associated with building and maintaining it. Assumption that brain functionality is specified by neuronal connectivity, implemented by costly biological wiring, leads to the following optimal design problem. For a given neuronal connectivity, find a spatial layout of neurons that minimizes the wiring cost. Unfortunately, this problem is difficult to solve because the number of possible layouts is often astronomically large. We argue that the wiring cost may scale as wire length squared, reducing the optimal layout problem to a constrained minimization of a quadratic form. For biologically plausible constraints, this problem has exact analytical solutions, which give reasonable approximations to actual layouts in the brain. These solutions make the inverse problem of inferring neuronal connectivity from neuronal layout more tractable.

The cost of conversion in robotic and laparoscopic colorectal surgery.

PubMed

Cleary, Robert K; Mullard, Andrew J; Ferraro, Jane; Regenbogen, Scott E

2018-03-01

Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments. This is an observational study from a linked data registry including clinical data from the Michigan Surgical Quality Collaborative and payment data from the Michigan Value Collaborative between July 2012 and April 2015. We evaluated colorectal resections initiated with open and minimally invasive approaches, and compared reported risk-adjusted and price-standardized 30-day episode payments and their components. We identified 1061 open, 1604 laparoscopic, and 275 robotic colorectal resections. Adjusted episode payments were significantly higher for open operations than for minimally invasive procedures completed without conversion ($19,489 vs. $15,518, p < 0.001). The conversion rate was significantly higher with laparoscopic than robotic operations (15.1 vs. 7.6%, p < 0.001). Adjusted episode payments for minimally invasive operations converted to open were significantly higher than for those completed by minimally invasive approaches ($18,098 vs. $15,518, p < 0.001). Payments for operations completed robotically were greater than those completed laparoscopically ($16,949 vs. $15,250, p < 0.001), but the difference was substantially decreased when conversion to open cases was included ($16,939 vs. $15,699, p = 0.041). Episode payments for open colorectal surgery exceed both laparoscopic and robotic minimally invasive options. Conversion to open surgery significantly increases the payments associated with minimally invasive colorectal surgery. Because conversion rates in robotic colorectal operations are half of those in laparoscopy, the excess expenditures attributable to robotics are attenuated by consideration of the cost of conversions.

Cost-Effectiveness Analysis of Fosfomycin for Treatment of Uncomplicated Urinary Tract Infections in Ontario

PubMed Central

Dahan, Sybil; Iliza, Ange Christelle; LeLorier, Jacques

2017-01-01

Background and Objective. Bacterial resistance to antibiotics traditionally used to treat uncomplicated urinary tract infections (uUTIs) is rising in Canada. We compared the cost-per-patient in Ontario of including fosfomycin (an antibiotic with a low resistance profile) as an option for first-line empirical treatment of uUTIs with current cost of treatment with sulfonamides, fluoroquinolones, and nitrofurantoin. Methods. A decision-tree model was used to perform a cost-minimization analysis. All possible outcomes of a uUTI caused by bacterial species treated with either sulfonamides, fluoroquinolones, nitrofurantoin, or fosfomycin were included. Results. In the base case analysis, the cost-per-patient for treating uUTI with fosfomycin was $105.12. This is similar to the cost-per-patient for each of the other currently reimbursed antibiotics (e.g., $96.19 for sulfonamides, $98.85 for fluoroquinolones, and $99.09 for nitrofurantoins). The weighted average cost-per-patient for treating uUTI was not substantially elevated with the inclusion of fosfomycin in the treatment landscape ($98.41 versus $98.29 with and without fosfomycin, resp.). The sensitivity analyses revealed that most (88.34%) of the potential variation in cost was associated with the probability of progressing to pyelonephritis and hospitalization for pyelonephritis. Conclusion. Fosfomycin in addition to being a safe and effective agent to treat uUTI has a low resistance profile, offers a single-dose treatment administration, and is similar in cost to other reimbursed antibiotics. PMID:28316632

Quality and Cost in Thoracic Surgery.

PubMed

Medbery, Rachel L; Force, Seth D

2017-08-01

The value of health care is defined as health outcomes (quality) achieved per dollars spent (cost). The current national health care landscape is focused on minimizing spending while optimizing patient outcomes. With the introduction of minimally invasive thoracic surgery, there has been concern about added cost relative to improved outcomes. Moreover, differences in postoperative hospital care further drive patient outcomes and health care costs. This article presents a comprehensive literature review on quality and cost in thoracic surgery and aims to investigate current challenges with regard to achieving the greatest value for our patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost and performance model for redox flow batteries

NASA Astrophysics Data System (ADS)

Viswanathan, Vilayanur; Crawford, Alasdair; Stephenson, David; Kim, Soowhan; Wang, Wei; Li, Bin; Coffey, Greg; Thomsen, Ed; Graff, Gordon; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

2014-02-01

A cost model is developed for all vanadium and iron-vanadium redox flow batteries. Electrochemical performance modeling is done to estimate stack performance at various power densities as a function of state of charge and operating conditions. This is supplemented with a shunt current model and a pumping loss model to estimate actual system efficiency. The operating parameters such as power density, flow rates and design parameters such as electrode aspect ratio and flow frame channel dimensions are adjusted to maximize efficiency and minimize capital costs. Detailed cost estimates are obtained from various vendors to calculate cost estimates for present, near-term and optimistic scenarios. The most cost-effective chemistries with optimum operating conditions for power or energy intensive applications are determined, providing a roadmap for battery management systems development for redox flow batteries. The main drivers for cost reduction for various chemistries are identified as a function of the energy to power ratio of the storage system. Levelized cost analysis further guide suitability of various chemistries for different applications.

Process Mining-Based Method of Designing and Optimizing the Layouts of Emergency Departments in Hospitals.

PubMed

Rismanchian, Farhood; Lee, Young Hoon

2017-07-01

This article proposes an approach to help designers analyze complex care processes and identify the optimal layout of an emergency department (ED) considering several objectives simultaneously. These objectives include minimizing the distances traveled by patients, maximizing design preferences, and minimizing the relocation costs. Rising demand for healthcare services leads to increasing demand for new hospital buildings as well as renovating existing ones. Operations management techniques have been successfully applied in both manufacturing and service industries to design more efficient layouts. However, high complexity of healthcare processes makes it challenging to apply these techniques in healthcare environments. Process mining techniques were applied to address the problem of complexity and to enhance healthcare process analysis. Process-related information, such as information about the clinical pathways, was extracted from the information system of an ED. A goal programming approach was then employed to find a single layout that would simultaneously satisfy several objectives. The layout identified using the proposed method improved the distances traveled by noncritical and critical patients by 42.2% and 47.6%, respectively, and minimized the relocation costs. This study has shown that an efficient placement of the clinical units yields remarkable improvements in the distances traveled by patients.

A cost-function approach to rival penalized competitive learning (RPCL).

PubMed

Ma, Jinwen; Wang, Taijun

2006-08-01

Rival penalized competitive learning (RPCL) has been shown to be a useful tool for clustering on a set of sample data in which the number of clusters is unknown. However, the RPCL algorithm was proposed heuristically and is still in lack of a mathematical theory to describe its convergence behavior. In order to solve the convergence problem, we investigate it via a cost-function approach. By theoretical analysis, we prove that a general form of RPCL, called distance-sensitive RPCL (DSRPCL), is associated with the minimization of a cost function on the weight vectors of a competitive learning network. As a DSRPCL process decreases the cost to a local minimum, a number of weight vectors eventually fall into a hypersphere surrounding the sample data, while the other weight vectors diverge to infinity. Moreover, it is shown by the theoretical analysis and simulation experiments that if the cost reduces into the global minimum, a correct number of weight vectors is automatically selected and located around the centers of the actual clusters, respectively. Finally, we apply the DSRPCL algorithms to unsupervised color image segmentation and classification of the wine data.

Minimizing the health and climate impacts of emissions from heavy-duty public transportation bus fleets through operational optimization.

PubMed

Gouge, Brian; Dowlatabadi, Hadi; Ries, Francis J

2013-04-16

In contrast to capital control strategies (i.e., investments in new technology), the potential of operational control strategies (e.g., vehicle scheduling optimization) to reduce the health and climate impacts of the emissions from public transportation bus fleets has not been widely considered. This case study demonstrates that heterogeneity in the emission levels of different bus technologies and the exposure potential of bus routes can be exploited though optimization (e.g., how vehicles are assigned to routes) to minimize these impacts as well as operating costs. The magnitude of the benefits of the optimization depend on the specific transit system and region. Health impacts were found to be particularly sensitive to different vehicle assignments and ranged from worst to best case assignment by more than a factor of 2, suggesting there is significant potential to reduce health impacts. Trade-offs between climate, health, and cost objectives were also found. Transit agencies that do not consider these objectives in an integrated framework and, for example, optimize for costs and/or climate impacts alone, risk inadvertently increasing health impacts by as much as 49%. Cost-benefit analysis was used to evaluate trade-offs between objectives, but large uncertainties make identifying an optimal solution challenging.

Decoding Problem Gamblers' Signals: A Decision Model for Casino Enterprises.

PubMed

Ifrim, Sandra

2015-12-01

The aim of the present study is to offer a validated decision model for casino enterprises. The model enables those users to perform early detection of problem gamblers and fulfill their ethical duty of social cost minimization. To this end, the interpretation of casino customers' nonverbal communication is understood as a signal-processing problem. Indicators of problem gambling recommended by Delfabbro et al. (Identifying problem gamblers in gambling venues: final report, 2007) are combined with Viterbi algorithm into an interdisciplinary model that helps decoding signals emitted by casino customers. Model output consists of a historical path of mental states and cumulated social costs associated with a particular client. Groups of problem and non-problem gamblers were simulated to investigate the model's diagnostic capability and its cost minimization ability. Each group consisted of 26 subjects and was subsequently enlarged to 100 subjects. In approximately 95% of the cases, mental states were correctly decoded for problem gamblers. Statistical analysis using planned contrasts revealed that the model is relatively robust to the suppression of signals performed by casino clientele facing gambling problems as well as to misjudgments made by staff regarding the clients' mental states. Only if the last mentioned source of error occurs in a very pronounced manner, i.e. judgment is extremely faulty, cumulated social costs might be distorted.

A concept analysis of optimality in perinatal health.

PubMed

Kennedy, Holly Powell

2006-01-01

This analysis was conducted to describe the concept of optimality and its appropriateness for perinatal health care. The concept was identified in 24 scientific disciplines. Across all disciplines, the universal definition of optimality is the robust, efficient, and cost-effective achievement of best possible outcomes within a rule-governed framework. Optimality, specifically defined for perinatal health care, is the maximal perinatal outcome with minimal intervention placed against the context of the woman's social, medical, and obstetric history.

An economic evaluation of highly purified HMG and recombinant FSH based on a large randomized trial.

PubMed

Wechowski, Jaroslaw; Connolly, Mark; McEwan, Philip; Kennedy, Richard

2007-11-01

Public funding for IVF is increasingly being challenged by health authorities in an attempt to minimize health service costs. In light of treatment rationing, the need to consider costs in relation to outcomes is paramount. To assess the cost implications of gonadotrophin treatment options, an economic evaluation comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) has been conducted. The analysis is based on individual patient data from a large randomized controlled trial (n = 731) in a long agonist IVF protocol. The economic evaluation uses a discrete event simulation model to assess treatment costs in relation to live births for both treatments based on published UK costs. After one cycle the mean costs per IVF treatment for HP-HMG and rFSH were pound2396 (95% CI pound2383-2414) and pound2633 ( pound2615-2652), respectively. The average cost-saving of pound237 per IVF cycle using HP-HMG allows one additional cycle to be delivered for every 10 cycles. With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound8893 compared with pound11,741 for rFSH (P < 0.001). The cost-saving potential of HP-HMG in IVF was still apparent after varying critical cost parameters in the probabilistic sensitivity analysis.

Coronary artery bypass grafting with minimal versus conventional extracorporeal circulation; an economic analysis.

PubMed

Anastasiadis, K; Fragoulakis, V; Antonitsis, P; Maniadakis, N

2013-10-15

This study aims to develop a methodological framework for the comparative economic evaluation between Minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) in patients undergoing coronary artery bypass grafting (CABG) in different healthcare systems. Moreover, we evaluate the cost-effectiveness ratio of alternative comparators in the healthcare setting of Greece, Germany, the Netherlands and Switzerland. The effectiveness data utilized were derived from a recent meta-analysis which incorporated 24 randomized clinical trials. Total therapy cost per patient reflects all resources expensed in delivery of therapy and the management of any adverse events, including drugs, diagnostics tests, materials, devices, blood units, the utilization of operating theaters, intensive care units, and wards. Perioperative mortality was used as the primary health outcome to estimate life years gained in treatment arms. Bias-corrected uncertainty intervals were calculated using the percentile method of non-parametric Monte-Carlo simulation. The MECC circuit was more expensive than CECC, with a difference ranging from €180 to €600 depending on the country. However, in terms of total therapy cost per patient the comparison favored MECC in all countries. Specifically it was associated with a reduction of €635 in Greece, €297 in Germany, €1590 in the Netherlands and €375 in Switzerland. In terms of effectiveness, the total life-years gained were slightly higher in favor of MECC. Surgery with MECC may be dominant (lower cost and higher effectiveness) compared to CECC in coronary revascularization procedures and therefore it represents an attractive new option relative to conventional extracorporeal circulation for CABG. © 2013.

Minimizing the regrets of long-term urban floodplain management decisions under deeply uncertain climate change

NASA Astrophysics Data System (ADS)

Hecht, J. S.; Kirshen, P. H.; Vogel, R. M.

2016-12-01

Making long-term floodplain management decisions under uncertain climate change is a major urban planning challenge of the 21stcentury. To support these efforts, we introduce a screening-level optimization model that identifies adaptation portfolios by minimizing the regrets associated with their flood-control and damage costs under different climate change trajectories that are deeply uncertain, i.e. have probabilities that cannot be specified plausibly. This mixed integer program explicitly considers the coupled damage-reduction impacts of different floodwall designs and property-scale investments (first-floor elevation, wet floodproofing of basements, permanent retreat and insurance), recommends implementation schedules, and assesses impacts to stakeholders residing in three types of homes. An application to a stylized municipality illuminates many nonlinear system dynamics stemming from large fixed capital costs, infrastructure design thresholds, and discharge-depth-damage relationships. If stakeholders tolerate mild damage, floodwalls that fully protect a community from large design events are less cost-effective than portfolios featuring both smaller floodwalls and property-scale measures. Potential losses of property tax revenue from permanent retreat motivate municipal property-tax initiatives for adaptation financing. Yet, insurance incentives for first-floor elevation may discourage locally financed floodwalls, in turn making lower-income residents more vulnerable to severe flooding. A budget constraint analysis underscores the benefits of flexible floodwall designs with low incremental expansion costs while near-optimal solutions demonstrate the scheduling flexibility of many property-scale measures. Finally, an equity analysis shows the importance of evaluating the overpayment and under-design regrets of recommended adaptation portfolios for each stakeholder and contrasts them to single-scenario model results.

Assessing the Quality of Economic Evaluations of FDA Novel Drug Approvals: A Systematic Review.

PubMed

Woersching, Alex L; Borrego, Matthew E; Raisch, Dennis W

2016-12-01

To systematically review and assess the quality of the novel drugs' economic evaluation literature in print during the drugs' early commercial availability following US regulatory approval. MEDLINE and the United Kingdom National Health Service Economic Evaluation Database were searched from 1946 through December 2011 for economic evaluations of the 50 novel drugs approved by the FDA in 2008 and 2009. The inclusion criteria were English-language, peer-reviewed, original economic evaluations (cost-utility, cost-effectiveness, cost-minimization, and cost-benefit analyses). We extracted and analyzed data from 36 articles considering 19 of the 50 drugs. Two reviewers assessed each publication's quality using the Quality of Health Economic Studies (QHES) instrument and summarized study quality on a 100-point scale. Study quality had a mean of 70.0 ± 16.2 QHES points. The only study characteristics associated with QHES score (with P < 0.05) were having used modeling or advanced statistics, 75.1 versus 61.9 without; using quality-adjusted life years as an outcome, 75.9 versus 64.7 without; and cost-utility versus cost-minimization analysis, 75.9 versus 58.7. Studies most often satisfied quality aspects about stating study design choices and least often satisfied aspects about justifying design choices. The reviewed literature considered a minority of the 2008-2009 novel drugs and had mixed study quality. Cost-effectiveness stakeholders might benefit from efforts to improve the quality and quantity of literature examining novel drugs. Editors and reviewers may support quality improvement by stringently imposing economic evaluation guidelines about justifying study design choices. © The Author(s) 2016.

The economic impact of assisted reproductive technology: a review of selected developed countries.

PubMed

Chambers, Georgina M; Sullivan, Elizabeth A; Ishihara, Osamu; Chapman, Michael G; Adamson, G David

2009-06-01

To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.

Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis

PubMed Central

Rampersaud, Y. Raja; Gray, Randolph; Lewis, Steven J.; Massicotte, Eric M.; Fehlings, Michael G.

2011-01-01

Background The utility and cost of minimally invasive surgical (MIS) fusion remain controversial. The primary objective of this study was to compare the direct economic impact of 1- and 2-level fusion for grade I or II degenerative or isthmic spondylolisthesis via an MIS technique compared with conventional open posterior decompression and fusion. Methods A retrospective cohort study was performed by use of prospective data from 78 consecutive patients (37 with MIS technique by 1 surgeon and 41 with open technique by 3 surgeons). Independent review of demographic, intraoperative, and acute postoperative data was performed. Oswestry disability index (ODI) and Short Form 36 (SF-36) values were prospectively collected preoperatively and at 1 year postoperatively. Cost-utility analysis was performed by use of in-hospital micro-costing data (operating room, nursing, imaging, laboratories, pharmacy, and allied health cost) and change in health utility index (SF-6D) at 1 year. Results The groups were comparable in terms of age, sex, preoperative hemoglobin, comorbidities, and body mass index. Groups significantly differed (P < .01) regarding baseline ODI and SF-6D scores, as well as number of 2-level fusions (MIS, 12; open, 20) and number of interbody cages (MIS, 45; open, 14). Blood loss (200 mL vs 798 mL), transfusions (0% vs 17%), and length of stay (LOS) (6.1 days vs 8.4 days) were significantly (P < .01) lower in the MIS group. Complications were also fewer in the MIS group (4 vs 12, P < .02). The mean cost of an open fusion was 1.28 times greater than that of an MIS fusion (P = .001). Both groups had significant improvement in 1-year outcome. The changes in ODI and SF-6D scores were not statistically different between groups. Multivariate regression analysis showed that LOS and number of levels fused were independent predictors of cost. Age and MIS were the only predictors of LOS. Baseline outcomes and MIS were predictors of 1-year outcome. Conclusion MIS posterior fusion for spondylolisthesis does reduce blood loss, transfusion requirements, and LOS. Both techniques provided substantial clinical improvements at 1 year. The cost utility of the MIS technique was considered comparable to that of the open technique. Level of Evidence Level III. PMID:25802665

Electro-Microfluidic Packaging

NASA Astrophysics Data System (ADS)

Benavides, G. L.; Galambos, P. C.

2002-06-01

There are many examples of electro-microfluidic products that require cost effective packaging solutions. Industry has responded to a demand for products such as drop ejectors, chemical sensors, and biological sensors. Drop ejectors have consumer applications such as ink jet printing and scientific applications such as patterning self-assembled monolayers or ejecting picoliters of expensive analytes/reagents for chemical analysis. Drop ejectors can be used to perform chemical analysis, combinatorial chemistry, drug manufacture, drug discovery, drug delivery, and DNA sequencing. Chemical and biological micro-sensors can sniff the ambient environment for traces of dangerous materials such as explosives, toxins, or pathogens. Other biological sensors can be used to improve world health by providing timely diagnostics and applying corrective measures to the human body. Electro-microfluidic packaging can easily represent over fifty percent of the product cost and, as with Integrated Circuits (IC), the industry should evolve to standard packaging solutions. Standard packaging schemes will minimize cost and bring products to market sooner.

Financial analysis of biogas utilization : input cattle, pig feces and coffee waste in Karo, Indonesia

NASA Astrophysics Data System (ADS)

Ginting, N.; Zuhri, F.; Hasnudi; Mirwandhono, E.; Sembiring, I.; Daulay, A. H.

2018-02-01

The community's need for renewable energy was very urgent. In addition, efforts to preserve the environment from waste caused biogas technology feasible to apply. This study aims to provide biogas technology with minimal cost and utilize agricultural waste that were coffee and livestock waste. The study was conducted from July to October 2016. The theoretical and empirical methods used in this study were included data from officials resources, field survey on 16 biogas locations, focus group discussion and interview with stake holders. Data were tabulated by Excel Program which then were analysed by SAS. Parameters were included Production Cost, Production Result, Profit Loss Analysis, Revenue Cost Ratio (R/C Ratio), Return On Investment (ROI), Net B/C, and IRR. The result of this research showed that the application of bioplastic gas with cow dung and coffee waste as bioplasticgas input cause the best results.

Technological Minimalism: A Cost-Effective Alternative for Course Design and Development.

ERIC Educational Resources Information Center

Lorenzo, George

2001-01-01

Discusses the use of minimum levels of technology, or technological minimalism, for Web-based multimedia course content. Highlights include cost effectiveness; problems with video streaming, the use of XML for Web pages, and Flash and Java applets; listservs instead of proprietary software; and proper faculty training. (LRW)

Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1-a cost-effectiveness analysis alongside a randomized controlled trial.

PubMed

Barnhoorn, Karlijn; Staal, J Bart; van Dongen, Robert Tm; Frölke, Jan Paul M; Klomp, Frank P; van de Meent, Henk; Adang, Eddy; Nijhuis-van der Sanden, Maria Wg

2018-06-01

To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis. Randomized controlled trial with 9 months follow-up. Patients were recruited from hospitals and general practitioners in the region around a university hospital. A total of 56 patients, 45 (80.4%) female, were randomized. About 4 patients in the intervention and 11 patients in the conventional group switched groups. The mean (SD) age was 44.3 (16.6) years, and in 37 (66.1%) patients, the upper extremity was affected. Patients received either Pain Exposure Physical Therapy (maximum of five sessions), or conventional treatment conforming with the Dutch multidisciplinary guideline. For the economic evaluation difference between the groups in health-related quality of life (quality-adjusted life years (QALYs)), and the clinical outcomes Impairment level Sum Score-Restricted Version and Pain Disability was determined based on the intention-to-treat analysis as well as differences in both healthcare-related costs and travel expenses. Cost-effectiveness planes were constructed using bootstrapping to compare effects and costs. No significant effects were found for QALYs (mean difference = -0.02; 95% confidence interval (CI) -0.10 to 0.04) and clinical outcomes. A cost minimization analysis showed a significant difference in costs between groups. The conventional treatment was 64% more expensive than the Pain Exposure Physical Therapy. This economic analysis shows that Pain Exposure Physical Therapy compared to conventional treatment is cost-effective.

Central coast designs: The Eightball Express. Taking off with convention, cruising with improvements and landing with absolute success

NASA Technical Reports Server (NTRS)

Davis, Ryan Edwin; Dawson, Anne Marie; Fecht, Paul Hans; Fry, Roman Zyabash; Vantriet, Robert; Macabantad, Dominique Dujale; Miller, Robert Glenn; Perez, Gustavo, Jr.; Weise, Timothy Michael

1994-01-01

The airline industry is very competitive, resulting in most U.S. and many international airlines being unprofitable. Because of this competition the airlines have been engaging in fare wars (which reduce revenue generated by transporting passengers) while inflation has increased. This situation of course is not developing revenue for the airlines. To revive the airlines to profitability, the difference between revenue received and airline operational cost must be improved. To solve these extreme conditions, the Eightball Express was designed with the main philosophy of developing an aircraft with a low direct operating cost and acquisition cost. Central Coast Designs' (CCD) aircraft utilizes primarily aluminum in the structure to minimize manufacturing cost, supercritical airfoil sections to minimize drag, and fuel efficient engines to minimize fuel burn. Furthermore, the aircraft was designed using Total Quality Management and Integrated Product Development to minimize development and manufacturing costs. Using these primary cost reduction techniques, the Eightball Express was designed to meet the Lockheed/AIAA Request for Proposal (RFP) requirements of a low cost, 153 passenger, 3000 nm. range transport. The Eightball Express is able to takeoff on less than a 7000 ft. runway, cruise at Mach 0.82 at an altitude of 36,000 ft. for a range of 3,000 nm., and lands on a 5,000 ft. runway. lt is able to perform this mission at a direct operating cost of 3.51 cents/available seat mile in 1992 dollars while the acquisition cost is only $28 million in 1992 dollars. By utilizing and improving on proven technologies, CCD has produced an efficient low cost commercial transport for the future.

Mathematical model for dynamic cell formation in fast fashion apparel manufacturing stage

NASA Astrophysics Data System (ADS)

Perera, Gayathri; Ratnayake, Vijitha

2018-05-01

This paper presents a mathematical programming model for dynamic cell formation to minimize changeover-related costs (i.e., machine relocation costs and machine setup cost) and inter-cell material handling cost to cope with the volatile production environments in apparel manufacturing industry. The model is formulated through findings of a comprehensive literature review. Developed model is validated based on data collected from three different factories in apparel industry, manufacturing fast fashion products. A program code is developed using Lingo 16.0 software package to generate optimal cells for developed model and to determine the possible cost-saving percentage when the existing layouts used in three factories are replaced by generated optimal cells. The optimal cells generated by developed mathematical model result in significant cost saving when compared with existing product layouts used in production/assembly department of selected factories in apparel industry. The developed model can be considered as effective in minimizing the considered cost terms in dynamic production environment of fast fashion apparel manufacturing industry. Findings of this paper can be used for further researches on minimizing the changeover-related costs in fast fashion apparel production stage.

A perverse quality incentive in surgery: implications of reimbursing surgeons less for doing laparoscopic surgery.

PubMed

Fader, Amanda N; Xu, Tim; Dunkin, Brian J; Makary, Martin A

2016-11-01

Surgery is one of the highest priced services in health care, and complications from surgery can be serious and costly. Recently, advances in surgical techniques have allowed surgeons to perform many common operations using minimally invasive methods that result in fewer complications. Despite this, the rates of open surgery remain high across multiple surgical disciplines. This is an expert commentary and review of the contemporary literature regarding minimally invasive surgery practices nationwide, the benefits of less invasive approaches, and how minimally invasive compared with open procedures are differentially reimbursed in the United States. We explore the incentive of the current surgeon reimbursement fee schedule and its potential implications. A surgeon's preference to perform minimally invasive compared with open surgery remains highly variable in the U.S., even after adjustment for patient comorbidities and surgical complexity. Nationwide administrative claims data across several surgical disciplines demonstrates that minimally invasive surgery utilization in place of open surgery is associated with reduced adverse events and cost savings. Reducing surgical complications by increasing adoption of minimally invasive operations has significant cost implications for health care. However, current U.S. payment structures may perversely incentivize open surgery and financially reward physicians who do not necessarily embrace newer or best minimally invasive surgery practices. Utilization of minimally invasive surgery varies considerably in the U.S., representing one of the greatest disparities in health care. Existing physician payment models must translate the growing body of research in surgical care into physician-level rewards for quality, including choice of operation. Promoting safe surgery should be an important component of a strong, value-based healthcare system. Resolving the potentially perverse incentives in paying for surgical approaches may help address disparities in surgical care, reduce the prevalent problem of variation, and help contain health care costs.

Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries.

PubMed

Massad, Eduardo; Behrens, Ben C; Coutinho, Francisco A B; Behrens, Ronald H

2011-05-17

In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used. Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational. The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission. The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

THREAT ENSEMBLE VULNERABILITY ASSESSMENT ...

EPA Pesticide Factsheets

software and manual TEVA-SPOT is used by water utilities to optimize the number and location of contamination detection sensors so that economic and/or public health consequences are minimized. TEVA-SPOT is interactive, allowing a user to specify the minimization objective (e.g., the number of people exposed, the time to detection, or the extent of pipe length contaminated). It also allows a user to specify constraints. For example, a TEVA-SPOT user can employ expert knowledge during the design process by identifying either existing or unfeasible sensor locations. Installation and maintenance costs for sensor placement can also be factored into the analysis. Python and Java are required to run TEVA-SPOT

The Effect of Mission Location on Mission Costs and Equivalent System Mass

NASA Technical Reports Server (NTRS)

Fisher, John W.; Levri, Julie A.; Jones, Harry W.

2003-01-01

Equivalent System Mass (ESM) is used by the Advanced Life Support (ALS) community to quantify mission costs of technologies for space applications (Drysdale et al, 1999, Levri et al, 2000). Mass is used as a cost measure because the mass of an object determines propulsion (acceleration) cost (i.e. amount of fuel needed), and costs relating to propulsion dominate mission cost. Mission location drives mission cost because acceleration is typically required to initiate and complete a change in location. Total mission costs may be reduced by minimizing the mass of materials that must be propelled to each distinct location. In order to minimize fuel requirements for missions beyond low-Earth orbit (LEO), the hardware and astronauts may not all go to the same location. For example, on a Lunar or Mars mission, some of the hardware or astronauts may stay in orbit while the rest of the hardware and astronauts descend to the planetary surface. In addition, there may be disposal of waste or used hardware at various mission locations to avoid propulsion of mass that is no longer needed in the mission. This paper demonstrates how using location factors in the calculation of ESM can account for the effects of various acceleration events and can improve the accuracy and value of the ESM metric to mission planners. Even a mission with one location can benefit from location factor analysis if the alternative technologies under consideration consume resources at different rates. For example, a mission that regenerates resources will have a relatively constant mass compared to one that uses consumables and vents/discards mass along the way. This paper shows examples of how location factors can affect ESM calculations and how the inclusion of location factors can change the relative value of technologies being considered for development.

Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting?

PubMed

Mallett, Ross; Bakker, Edward; Burton, Maria

2014-12-01

The aim of the present study was to establish if physiotherapy self-referral (SR) is viable, cost effective and beneficial to musculoskeletal outpatients in a primary care setting. In an urban National Health Service (NHS) primary care physiotherapy service, waiting times, attendance rates and treatment ratios (thus, episode-of-care costs) were deemed unsustainable. The introduction of 'Any Qualified Provider' is imminent and will drive NHS physiotherapy services to compete directly with private counterparts. Current literature, healthcare policy and the Chartered Society of Physiotherapy strongly advocate SR to promote value for money and improve the patient experience. A repeated measure prospective cohort study introduced an SR pathway parallel to existing general practice (GP) referrals and compared costs, attendance and data relating to the patient experience across groups. SR referral groups were found to have a higher proportion of female patients presenting with acute conditions. Cost minimization analysis indicated an average 32.3% reduction in episode-of-care cost with an SR-initiated intervention. An estimated cost minimization of between £84,387.80 and £124,472.06 was calculated if SR were to be expanded service-wide. SR referral reduced waiting times and improved patient satisfaction relating to waiting times and communication compared with traditional pathways. The results of the present study showed that the introduction of the described SR pathway was feasible, cost-effective and offered comparable care. Certain aspects of the SR patient experience compared more favourably than those studied in traditional GP referral routes. They also added to an existing body of evidence supporting SR with a variety of administrative processes in various socioeconomic settings. Copyright © 2014 John Wiley & Sons, Ltd.

Multi-level optimization of a beam-like space truss utilizing a continuum model

NASA Technical Reports Server (NTRS)

Yates, K.; Gurdal, Z.; Thangjitham, S.

1992-01-01

A continuous beam model is developed for approximate analysis of a large, slender, beam-like truss. The model is incorporated in a multi-level optimization scheme for the weight minimization of such trusses. This scheme is tested against traditional optimization procedures for savings in computational cost. Results from both optimization methods are presented for comparison.

Project To Design a Marketing Plan for Promoting Educators' Awareness of and Access to ERIC Products. Proposed Marketing Plan.

ERIC Educational Resources Information Center

Contemporary Associates, Inc., Washington, DC.

The proposed strategy, which is designed to maximize the effectiveness and minimize the costs of marketing the Information Analysis Products (IAPs) produced by the 16 ERIC Clearinghouses, is based on a study of the concept of centralized versus decentralized ordering of selected ERIC products. The experiment measured four variables--postage,…

Analysis of soy flour/phenol-formaldehyde adhesives for bonding wood

Treesearch

Linda Lorenz; Charles R. Frihart; James M. Wescott

2005-01-01

The desire to make more environmentally friendly and lower-cost bonded wood products has led to an interest in replacing some phenol and formaldehyde in wood adhe- sives with soybean flour. It is important to develop tests that relate resin production variables to resin properties before and after wood bonding. The protein needs to be denatured, with minimal hydrolysis...

Multigeneration data migration from legacy systems

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Liu, Brent J.; Kho, Hwa T.; Tao, Wenchao; Wang, Cun; McCoy, J. Michael

2003-05-01

The migration of image data from different generations of legacy archive systems represents a technical challenge and in incremental cost in transitions to newer generations of PACS. UCLA medical center has elected to completely replace the existing PACS infrastructure encompassing several generations of legacy systems by a new commercial system providing enterprise-wide image management and communication. One of the most challenging parts of the project was the migration of large volumes of legacy images into the new system. Planning of the migration required the development of specialized software and hardware, and included different phases of data mediation from existing databases to the new PACS database prior to the migration of the image data. The project plan included a detailed analysis of resources and cost of data migration to optimize the process and minimize the delay of a hybrid operation where the legacy systems need to remain operational. Our analysis and project planning showed that the data migration represents the most critical path in the process of PACS renewal. Careful planning and optimization of the project timeline and resources allocated is critical to minimize the financial impact and the time delays that such migrations can impose on the implementation plan.

A holistic framework for design of cost-effective minimum water utilization network.

PubMed

Wan Alwi, S R; Manan, Z A; Samingin, M H; Misran, N

2008-07-01

Water pinch analysis (WPA) is a well-established tool for the design of a maximum water recovery (MWR) network. MWR, which is primarily concerned with water recovery and regeneration, only partly addresses water minimization problem. Strictly speaking, WPA can only lead to maximum water recovery targets as opposed to the minimum water targets as widely claimed by researchers over the years. The minimum water targets can be achieved when all water minimization options including elimination, reduction, reuse/recycling, outsourcing and regeneration have been holistically applied. Even though WPA has been well established for synthesis of MWR network, research towards holistic water minimization has lagged behind. This paper describes a new holistic framework for designing a cost-effective minimum water network (CEMWN) for industry and urban systems. The framework consists of five key steps, i.e. (1) Specify the limiting water data, (2) Determine MWR targets, (3) Screen process changes using water management hierarchy (WMH), (4) Apply Systematic Hierarchical Approach for Resilient Process Screening (SHARPS) strategy, and (5) Design water network. Three key contributions have emerged from this work. First is a hierarchical approach for systematic screening of process changes guided by the WMH. Second is a set of four new heuristics for implementing process changes that considers the interactions among process changes options as well as among equipment and the implications of applying each process change on utility targets. Third is the SHARPS cost-screening technique to customize process changes and ultimately generate a minimum water utilization network that is cost-effective and affordable. The CEMWN holistic framework has been successfully implemented on semiconductor and mosque case studies and yielded results within the designer payback period criterion.

A Computational Approach to Characterizing the Impact of Social Influence on Individuals’ Vaccination Decision Making

PubMed Central

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals’ decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals’ initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the effectiveness of a voluntary vaccination program. PMID:23585835

A computational approach to characterizing the impact of social influence on individuals' vaccination decision making.

PubMed

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals' decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals' initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the effectiveness of a voluntary vaccination program.

Neutral buoyancy is optimal to minimize the cost of transport in horizontally swimming seals

PubMed Central

Sato, Katsufumi; Aoki, Kagari; Watanabe, Yuuki Y.; Miller, Patrick J. O.

2013-01-01

Flying and terrestrial animals should spend energy to move while supporting their weight against gravity. On the other hand, supported by buoyancy, aquatic animals can minimize the energy cost for supporting their body weight and neutral buoyancy has been considered advantageous for aquatic animals. However, some studies suggested that aquatic animals might use non-neutral buoyancy for gliding and thereby save energy cost for locomotion. We manipulated the body density of seals using detachable weights and floats, and compared stroke efforts of horizontally swimming seals under natural conditions using animal-borne recorders. The results indicated that seals had smaller stroke efforts to swim a given speed when they were closer to neutral buoyancy. We conclude that neutral buoyancy is likely the best body density to minimize the cost of transport in horizontal swimming by seals. PMID:23857645

Neutral buoyancy is optimal to minimize the cost of transport in horizontally swimming seals.

PubMed

Sato, Katsufumi; Aoki, Kagari; Watanabe, Yuuki Y; Miller, Patrick J O

2013-01-01

Flying and terrestrial animals should spend energy to move while supporting their weight against gravity. On the other hand, supported by buoyancy, aquatic animals can minimize the energy cost for supporting their body weight and neutral buoyancy has been considered advantageous for aquatic animals. However, some studies suggested that aquatic animals might use non-neutral buoyancy for gliding and thereby save energy cost for locomotion. We manipulated the body density of seals using detachable weights and floats, and compared stroke efforts of horizontally swimming seals under natural conditions using animal-borne recorders. The results indicated that seals had smaller stroke efforts to swim a given speed when they were closer to neutral buoyancy. We conclude that neutral buoyancy is likely the best body density to minimize the cost of transport in horizontal swimming by seals.

Cost analysis of minimally invasive hysterectomy vs open approach performed by a single surgeon in an Italian center.

PubMed

Pellegrino, Antonio; Damiani, Gianluca Raffaello; Fachechi, Giorgio; Corso, Silvia; Pirovano, Cecilia; Trio, Claudia; Villa, Mario; Turoli, Daniela; Youssef, Aly

2017-06-01

Despite the rapid uptake of robotic surgery, the effectiveness of robotically assisted hysterectomy (RAH) remains uncertain, due to the costs widely variable. Observed the different related costs of robotic procedures, in different countries, we performed a detailed economic analysis of the cost of RAH compared with total laparoscopic (TLH) and open hysterectomy (OH). The three surgical routes were matched according to age, BMI, and comorbidities. Hysterectomy costs were collected prospectively from September 2014 to September 2015. Direct costs were determined by examining the overall medical pathway for each type of intervention. Surgical procedure cost for RAH was €3598 compared with €912 for TLH and €1094 for OH. The cost of the robot-specific supplies was €2705 per intervention. When considering overall medical surgical care, the patient treatment average cost of a RAH was €4695 with a hospital stay (HS) of 2 days (range 2-4) compared with €2053 for TLH and €2846 for OH. The main driver of additional costs is disposable instruments of the robot, which is not compensated by the hospital room costs and by an experienced team staff. Implementation of strategies to reduce the cost of robotic instrumentation is due. No significant cost difference among the three procedures was observed; however, despite the optimal operative time, the experienced, surgeon and the lower HS, RAH resulted 2, 3 times and 1, 6 times more expensive in our institution than TLH and OH, respectively.

Cost Analysis When Open Surgeons Perform Minimally Invasive Hysterectomy

PubMed Central

Kantartzis, Kelly L.; Ahn, Ki Hoon; Bonidie, Michael J.; Lee, Ted

2014-01-01

Background and Objective: The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Methods: Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. Results: A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P < .001). By cost subcategory, laparoscopic hysterectomy was lower than robotic hysterectomy in 6 and higher in 1. When performing robotic hysterectomy, open and robotic surgeon costs were similar. With laparoscopic hysterectomy, open surgeons had higher costs than laparoscopic surgeons for 1 of 2 statistical transformations (P = .007). Open surgeons had lower costs performing laparoscopic hysterectomy than robotic hysterectomy with robotic maintenance and depreciation included (P < .001) but similar costs if these variables were excluded. Conclusion: Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy. PMID:25489215

Optimal Sizing of Energy Storage for Community Microgrids Considering Building Thermal Dynamics

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

Liu, Guodong; Li, Zhi; Starke, Michael R.

This paper proposes an optimization model for the optimal sizing of energy storage in community microgrids considering the building thermal dynamics and customer comfort preference. The proposed model minimizes the annualized cost of the community microgrid, including energy storage investment, purchased energy cost, demand charge, energy storage degradation cost, voluntary load shedding cost and the cost associated with customer discomfort due to room temperature deviation. The decision variables are the power and energy capacity of invested energy storage. In particular, we assume the heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently by the microgrid central controller while maintainingmore » the indoor temperature in the comfort range set by customers. For this purpose, the detailed thermal dynamic characteristics of buildings have been integrated into the optimization model. Numerical simulation shows significant cost reduction by the proposed model. The impacts of various costs on the optimal solution are investigated by sensitivity analysis.« less

An optimal policy for a single-vendor and a single-buyer integrated system with setup cost reduction and process-quality improvement

NASA Astrophysics Data System (ADS)

Shu, Hui; Zhou, Xideng

2014-05-01

The single-vendor single-buyer integrated production inventory system has been an object of study for a long time, but little is known about the effect of investing in reducing setup cost reduction and process-quality improvement for an integrated inventory system in which the products are sold with free minimal repair warranty. The purpose of this article is to minimise the integrated cost by optimising simultaneously the number of shipments and the shipment quantity, the setup cost, and the process quality. An efficient algorithm procedure is proposed for determining the optimal decision variables. A numerical example is presented to illustrate the results of the proposed models graphically. Sensitivity analysis of the model with respect to key parameters of the system is carried out. The paper shows that the proposed integrated model can result in significant savings in the integrated cost.

The Development of Patient Scheduling Groups for an Effective Appointment System

PubMed Central

2016-01-01

Summary Background Patient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost. Objectives This study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility. Methods The proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost. Results The cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one. Conclusions This study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed. PMID:27081406

Structural tailoring of advanced turboprops

NASA Technical Reports Server (NTRS)

Brown, K. W.; Hopkins, Dale A.

1988-01-01

The Structural Tailoring of Advanced Turboprops (STAT) computer program was developed to perform numerical optimization on highly swept propfan blades. The optimization procedure seeks to minimize an objective function defined as either: (1) direct operating cost of full scale blade or, (2) aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analysis system includes an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution forced response life prediction capability. STAT includes all relevant propfan design constraints.

Kiovig for primary immunodeficiency: reduced infusion and decreased costs per infusion.

PubMed

Connolly, Mark; Simoens, Steven

2011-09-01

Kiovig is a ready-to-use 10% liquid immunoglobulin preparation that is medically indicated for the treatment of primary immunodeficiency. This study aims to conduct an economic evaluation which compares the intravenous immunoglobulin (IVIg) preparations Kiovig, Multigam, and Sandoglobulin from the Belgian societal perspective. As three prospective studies have observed no difference in outcomes, a cost-minimization analysis is considered appropriate to evaluate differences in treatment costs that can arise from IVIgs. A decision-analytic model simulated treatment costs attributed to one infusion. Resource use data were derived from a Dutch costing study. Cost items included immunoglobulin costs, pharmacy administration and nursing costs, mini-forfait for hospital infusion, costs of adverse events, and lost productivity with 2009 as base year. Cost data were identified from published sources and Belgian hospital administrators. A probabilistic sensitivity analysis explored the impact of parameter uncertainty on cost results. Costs per infusion cycle in adult primary immunodeficiency patients were €1,046 (95% confidence interval: €1,006-1,093) with Kiovig; €1,102 (€1,064-1,147) with Multigam; and €1,147 (€1,108-1,193) with Sandoglobulin. The average cost savings per infusion with Kiovig as compared to Multigam and Sandoglobulin amounted to €56 and €101 per infusion. In conclusion, treatment costs with Kiovig were shown to be lower as compared to other IVIgs in Belgium. Reduced costs per infusion were attributed to lower costs associated with treating adverse events and the opportunity cost of nursing time and time off work for working adults. Copyright © 2011 Elsevier B.V. All rights reserved.

Design of a Low Cost Short Takeoff-vertical Landing Export Fighter/attack Aircraft

NASA Technical Reports Server (NTRS)

Belcher, Anne; Bodeker, Dan, III; Miu, Steve; Petro, Laura; Senf, Cary Taylor; Woeltjen, Donald

1990-01-01

The design of a supersonic short takeoff and vertical landing (STOVL) aircraft is presented that is suitable for export. An advanced four poster, low bypass turbofan engine is to be used for propulsion. Preliminary aerodynamic analysis is presented covering a determination of CD versus CL, CD versus Mach number, as well as best cruise Mach number and altitude. Component locations are presented and center of gravity determined. Cost minimization is achieved through the use of developed subsystems and standard fabrication techniques using nonexotic materials. Conclusions regarding the viability of the STOVL design are presented.

Cost-Effectiveness Analysis of the Self-Management Program for Thai Patients with Metabolic Syndrome.

PubMed

Sakulsupsiri, Anut; Sakthong, Phantipa; Winit-Watjana, Win

2016-05-01

Lifestyle modification programs are partly evaluated for their usefulness. This study aimed to assess the cost-effectiveness and healthy lifestyle persistence of a self-management program (SMP) for patients with metabolic syndrome (MetS) in Thai health care settings. A cost-effectiveness analysis was performed on the basis of an intervention study of 90 patients with MetS randomly allocated to the SMP and control groups. A Markov model with the Difference-in-Difference method was used to predict the lifetime costs from a societal perspective and quality-adjusted life-years (QALYs), of which 95% confidence intervals (CIs) were estimated by bootstrapping. The cost-effectiveness analysis, along with healthy lifestyle persistence, was performed using the discount rate of 3% per annum. Parameter uncertainties were identified using one-way and probabilistic sensitivity analyses. The lifetime costs tended to decrease in both groups. The SMP could save lifetime costs (-2310 baht; 95% CI -5960 to 1400) and gain QALYs (0.0098; 95% CI -0.0003 to 0.0190), compared with ordinary care. The probability of cost-effectiveness was 99.4% from the Monte-Carlo simulation, and the program was deemed cost-effective at dropout rates below 69% per year as determined by the threshold of 160,000 baht per QALY gained. The cost of macrovascular complications was the most influencing variable for the overall incremental cost-effectiveness ratio. The SMP provided by the health care settings is marginally cost-effective, and the persistence results support the implementation of the program to minimize the complications and economic burden of patients with MetS. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis.

PubMed

Corso, C; Gomez, X; Sanabria, A; Vega, V; Dominguez, L C; Osorio, C

2014-01-01

Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. In a deterministic analysis, the cost, utility and cost-utility ratio was COP $12.981.801, 44.5 and COP $291.310 for total thyroidectomy and COP $14.309.889, 42.0 and $340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -$535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective. Under a common range of complications, and considering the patient's preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Flat-plate photovoltaic array design optimization

NASA Technical Reports Server (NTRS)

Ross, R. G., Jr.

1980-01-01

An analysis is presented which integrates the results of specific studies in the areas of photovoltaic structural design optimization, optimization of array series/parallel circuit design, thermal design optimization, and optimization of environmental protection features. The analysis is based on minimizing the total photovoltaic system life-cycle energy cost including repair and replacement of failed cells and modules. This approach is shown to be a useful technique for array optimization, particularly when time-dependent parameters such as array degradation and maintenance are involved.

Spatial Optimization of Future Urban Development with Regards to Climate Risk and Sustainability Objectives.

PubMed

Caparros-Midwood, Daniel; Barr, Stuart; Dawson, Richard

2017-11-01

Future development in cities needs to manage increasing populations, climate-related risks, and sustainable development objectives such as reducing greenhouse gas emissions. Planners therefore face a challenge of multidimensional, spatial optimization in order to balance potential tradeoffs and maximize synergies between risks and other objectives. To address this, a spatial optimization framework has been developed. This uses a spatially implemented genetic algorithm to generate a set of Pareto-optimal results that provide planners with the best set of trade-off spatial plans for six risk and sustainability objectives: (i) minimize heat risks, (ii) minimize flooding risks, (iii) minimize transport travel costs to minimize associated emissions, (iv) maximize brownfield development, (v) minimize urban sprawl, and (vi) prevent development of greenspace. The framework is applied to Greater London (U.K.) and shown to generate spatial development strategies that are optimal for specific objectives and differ significantly from the existing development strategies. In addition, the analysis reveals tradeoffs between different risks as well as between risk and sustainability objectives. While increases in heat or flood risk can be avoided, there are no strategies that do not increase at least one of these. Tradeoffs between risk and other sustainability objectives can be more severe, for example, minimizing heat risk is only possible if future development is allowed to sprawl significantly. The results highlight the importance of spatial structure in modulating risks and other sustainability objectives. However, not all planning objectives are suited to quantified optimization and so the results should form part of an evidence base to improve the delivery of risk and sustainability management in future urban development. © 2017 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections

PubMed Central

Patel, Twisha S.; Kaakeh, Rola; Nagel, Jerod L.; Newton, Duane W.

2016-01-01

ABSTRACT Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. PMID:27795335

[A future image of clinical inspection from health economics].

PubMed

Kakihara, Hiroaki

2006-06-01

Do you let medical costs increase in proportion to the growth rate of GDP? A way of thinking of the Council on Economic and Fiscal Policy. Should we exclude public medical insurance? It is not a problem, it is an absolute sum if you are effective. If there is no insurance, and individuals pay the total amount, there is no problem, but it is impossible. Economic development will cease if there is no insurance. As medical personnel, to offer good medical care with an appropriate cost. An appeal to the nation is necessary. Economic technical evaluation to identify a cheap method for each clinical inspection. Does medical insurance have a deficit? I. Japanese Health insurance system. (1) Health insurance union. When you look at the contribution money, it is originally 2,479,800,000,000 yen, with premium income and a profit of 45%. (2) Government management health insurance. When you look at the contribution money, it is originally 2,163,300,000,000 yen, with premium income and a profit of 36%. (1) + (2) Employed insurance meter. (3) Mutual aid. (4) National Health Insurance. II. A clinical economic method. III. Expense of medical care and its effect. A. Expense. B. A medical economic technical evaluation method. 1. Cost-effectiveness analysis CEA. 2. Cost utility analysis CUA. 3. Cost-benefit analysis CBA. 4. Expense minimization analysis.

A required course in the development, implementation, and evaluation of clinical pharmacy services.

PubMed

Skomo, Monica L; Kamal, Khalid M; Berdine, Hildegarde J

2008-10-15

To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care.

A Required Course in the Development, Implementation, and Evaluation of Clinical Pharmacy Services

PubMed Central

Kamal, Khalid M.; Berdine, Hildegarde J.

2008-01-01

Objective To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Design Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. Assessment One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. Conclusion The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care. PMID:19214263

An open-source and low-cost monitoring system for precision enology.

PubMed

Di Gennaro, Salvatore Filippo; Matese, Alessandro; Mancin, Mirko; Primicerio, Jacopo; Palliotti, Alberto

2014-12-05

Winemaking is a dynamic process, where microbiological and chemical effects may strongly differentiate products from the same vineyard and even between wine vats. This high variability means an increase in work in terms of control and process management. The winemaking process therefore requires a site-specific approach in order to optimize cellar practices and quality management, suggesting a new concept of winemaking, identified as Precision Enology. The Institute of Biometeorology of the Italian National Research Council has developed a wireless monitoring system, consisting of a series of nodes integrated in barrel bungs with sensors for the measurement of wine physical and chemical parameters in the barrel. This paper describes an open-source evolution of the preliminary prototype, using Arduino-based technology. Results have shown good performance in terms of data transmission and accuracy, minimal size and power consumption. The system has been designed to create a low-cost product, which allows a remote and real-time control of wine evolution in each barrel, minimizing costs and time for sampling and laboratory analysis. The possibility of integrating any kind of sensors makes the system a flexible tool that can satisfy various monitoring needs.

Design optimization of a fuzzy distributed generation (DG) system with multiple renewable energy sources

NASA Astrophysics Data System (ADS)

Ganesan, T.; Elamvazuthi, I.; Shaari, Ku Zilati Ku; Vasant, P.

2012-09-01

The global rise in energy demands brings major obstacles to many energy organizations in providing adequate energy supply. Hence, many techniques to generate cost effective, reliable and environmentally friendly alternative energy source are being explored. One such method is the integration of photovoltaic cells, wind turbine generators and fuel-based generators, included with storage batteries. This sort of power systems are known as distributed generation (DG) power system. However, the application of DG power systems raise certain issues such as cost effectiveness, environmental impact and reliability. The modelling as well as the optimization of this DG power system was successfully performed in the previous work using Particle Swarm Optimization (PSO). The central idea of that work was to minimize cost, minimize emissions and maximize reliability (multi-objective (MO) setting) with respect to the power balance and design requirements. In this work, we introduce a fuzzy model that takes into account the uncertain nature of certain variables in the DG system which are dependent on the weather conditions (such as; the insolation and wind speed profiles). The MO optimization in a fuzzy environment was performed by applying the Hopfield Recurrent Neural Network (HNN). Analysis on the optimized results was then carried out.

Combined EDL-Mobility Planning for Planetary Missions

NASA Technical Reports Server (NTRS)

Kuwata, Yoshiaki; Balaram, Bob

2011-01-01

This paper presents an analysis framework for planetary missions that have coupled mobility and EDL (Entry-Descent-Landing) systems. Traditional systems engineering approaches to mobility missions such as MERs (Mars Exploration Rovers) and MSL (Mars Science Laboratory) independently study the EDL system and the mobility system, and does not perform explicit trade-off between them or risk minimization of the overall system. A major challenge is that EDL operation is inherently uncertain and its analysis results such as landing footprint are described using PDF (Probability Density Function). The proposed approach first builds a mobility cost-to-go map that encodes the driving cost of any point on the map to a science target location. The cost could include variety of metrics such as traverse distance, time, wheel rotation on soft soil, and closeness to hazards. It then convolves the mobility cost-to-go map with the landing PDF given by the EDL system, which provides a histogram of driving cost, which can be used to evaluate the overall risk of the mission. By capturing the coupling between EDL and mobility explicitly, this analysis framework enables quantitative tradeoff between EDL and mobility system performance, as well as the characterization of risks in a statistical way. The simulation results are presented with a realistic Mars terrain data

Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control.

PubMed

Kulchaitanaroaj, Puttarin; Brooks, John M; Ardery, Gail; Newman, Dana; Carter, Barry L

2012-08-01

To compare costs associated with a physician-pharmacist collaborative intervention with costs of usual care. Cost analysis using health care utilization and outcome data from two prospective, cluster-randomized, controlled clinical trials. Eleven community-based medical offices. A total of 496 patients with hypertension; 244 were in the usual care (control) group and 252 were in the intervention group. To compare the costs, we combined cost data from the two trials. Total costs included costs of provider time, laboratory tests, and antihypertensive drugs. Provider time was calculated based on an online survey of intervention pharmacists and the National Ambulatory Medical Care Survey. Cost parameters were taken from the Bureau of Labor Statistics for average wage rates, the Medicare laboratory fee schedule, and a publicly available Web site for drug prices. Total costs were adjusted for patient characteristics. Adjusted total costs were $774.90 in the intervention group and $445.75 in the control group (difference $329.16, p<0.001). In a sensitivity analysis, the difference in adjusted total costs between the two groups ranged from $224.27-515.56. The intervention cost required to have one additional patient achieve blood pressure control within 6 months was $1338.05, determined by the difference in costs divided by the difference in hypertension control rates between the groups ($329.16/24.6%). The cost over 6 months to lower systolic and diastolic blood pressure 1 mm Hg was $36.25 and $94.32, respectively. The physician-pharmacist collaborative intervention increased not only blood pressure control but also the cost of care. Additional research, such as a cost-benefit or a cost-minimization analysis, is needed to assess whether financial savings related to reduced morbidity and mortality achieved from better blood pressure control outweigh the cost of the intervention. © 2012 Pharmacotherapy Publications, Inc. All rights reserved.

Nuclear Waste Management under Approaching Disaster: A Comparison of Decommissioning Strategies for the German Repository Asse II.

PubMed

Ilg, Patrick; Gabbert, Silke; Weikard, Hans-Peter

2017-07-01

This article compares different strategies for handling low- and medium-level nuclear waste buried in a retired potassium mine in Germany (Asse II) that faces significant risk of uncontrollable brine intrusion and, hence, long-term groundwater contamination. We survey the policy process that has resulted in the identification of three possible so-called decommissioning options: complete backfilling, relocation of the waste to deeper levels in the mine, and retrieval. The selection of a decommissioning strategy must compare expected investment costs with expected social damage costs (economic, environmental, and health damage costs) caused by flooding and subsequent groundwater contamination. We apply a cost minimization approach that accounts for the uncertainty regarding the stability of the rock formation and the risk of an uncontrollable brine intrusion. Since economic and health impacts stretch out into the far future, we examine the impact of different discounting methods and rates. Due to parameter uncertainty, we conduct a sensitivity analysis concerning key assumptions. We find that retrieval, the currently preferred option by policymakers, has the lowest expected social damage costs for low discount rates. However, this advantage is overcompensated by higher expected investment costs. Considering all costs, backfilling is the best option for all discounting scenarios considered. © 2016 Society for Risk Analysis.

Renal Mass Biopsy to Guide Treatment Decisions for Small Incidental Renal Tumors: A Cost-effectiveness Analysis1

PubMed Central

Gervais, Debra A.; Hartman, Rebecca I.; Harisinghani, Mukesh G.; Feldman, Adam S.; Mueller, Peter R.; Gazelle, G. Scott

2010-01-01

Purpose: To evaluate the effectiveness, cost, and cost-effectiveness of using renal mass biopsy to guide treatment decisions for small incidentally detected renal tumors. Materials and Methods: A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for patients with small (≤4-cm) renal tumors. Two strategies were compared: renal mass biopsy to triage patients to surgery or imaging surveillance and empiric nephron-sparing surgery. The model incorporated biopsy performance, the probability of track seeding with malignant cells, the prevalence and growth of benign and malignant tumors, treatment effectiveness and costs, and patient outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference under a willingness-to-pay threshold of $75 000 per quality-adjusted life-year (QALY). Effects of changes in key parameters on strategy preference were evaluated in sensitivity analysis. Results: Under base-case assumptions, the biopsy strategy yielded a minimally greater quality-adjusted life expectancy (4 days) than did empiric surgery at a lower lifetime cost ($3466), dominating surgery from a cost-effectiveness perspective. Over the majority of parameter ranges tested in one-way sensitivity analysis, the biopsy strategy dominated surgery or was cost-effective relative to surgery based on a $75 000-per-QALY willingness-to-pay threshold. In two-way sensitivity analysis, surgery yielded greater life expectancy when the prevalence of malignancy and propensity for biopsy-negative cancers to metastasize were both higher than expected or when the sensitivity and specificity of biopsy were both lower than expected. Conclusion: The use of biopsy to guide treatment decisions for small incidentally detected renal tumors is cost-effective and can prevent unnecessary surgery in many cases. © RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10092013/-/DC1 PMID:20720070

Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis.

PubMed

Bogavac-Stanojević, Natasa; Dopsaj, Violeta; Jelić-Ivanović, Zorana; Lakić, Dragana; Vasić, Dragan; Petrova, Guenka

2013-01-01

We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.

Decision Modeling Framework to Minimize Arrival Delays from Ground Delay Programs

NASA Astrophysics Data System (ADS)

Mohleji, Nandita

Convective weather and other constraints create uncertainty in air transportation, leading to costly delays. A Ground Delay Program (GDP) is a strategy to mitigate these effects. Systematic decision support can increase GDP efficacy, reduce delays, and minimize direct operating costs. In this study, a decision analysis (DA) model is constructed by combining a decision tree and Bayesian belief network. Through a study of three New York region airports, the DA model demonstrates that larger GDP scopes that include more flights in the program, along with longer lead times that provide stakeholders greater notice of a pending program, trigger the fewest average arrival delays. These findings are demonstrated to result in a savings of up to $1,850 per flight. Furthermore, when convective weather is predicted, forecast weather confidences remain the same level or greater at least 70% of the time, supporting more strategic decision making. The DA model thus enables quantification of uncertainties and insights on causal relationships, providing support for future GDP decisions.

Current concepts in clinical research: web-based, automated, arthroscopic surgery prospective database registry.

PubMed

Lubowitz, James H; Smith, Patrick A

2012-03-01

In 2011, postsurgical patient outcome data may be compiled in a research registry, allowing comparative-effectiveness research and cost-effectiveness analysis by use of Health Insurance Portability and Accountability Act-compliant, institutional review board-approved, Food and Drug Administration-approved, remote, Web-based data collection systems. Computerized automation minimizes cost and minimizes surgeon time demand. A research registry can be a powerful tool to observe and understand variations in treatment and outcomes, to examine factors that influence prognosis and quality of life, to describe care patterns, to assess effectiveness, to monitor safety, and to change provider practice through feedback of data. Registry of validated, prospective outcome data is required for arthroscopic and related researchers and the public to advocate with governments and health payers. The goal is to develop evidence-based data to determine the best methods for treating patients. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Global agriculture and carbon trade-offs

PubMed Central

Johnson, Justin Andrew; Runge, Carlisle Ford; Senauer, Benjamin; Foley, Jonathan; Polasky, Stephen

2014-01-01

Feeding a growing and increasingly affluent world will require expanded agricultural production, which may require converting grasslands and forests into cropland. Such conversions can reduce carbon storage, habitat provision, and other ecosystem services, presenting difficult societal trade-offs. In this paper, we use spatially explicit data on agricultural productivity and carbon storage in a global analysis to find where agricultural extensification should occur to meet growing demand while minimizing carbon emissions from land use change. Selective extensification saves ∼6 billion metric tons of carbon compared with a business-as-usual approach, with a value of approximately $1 trillion (2012 US dollars) using recent estimates of the social cost of carbon. This type of spatially explicit geospatial analysis can be expanded to include other ecosystem services and other industries to analyze how to minimize conflicts between economic development and environmental sustainability. PMID:25114254

Global agriculture and carbon trade-offs.

PubMed

Johnson, Justin Andrew; Runge, Carlisle Ford; Senauer, Benjamin; Foley, Jonathan; Polasky, Stephen

2014-08-26

Feeding a growing and increasingly affluent world will require expanded agricultural production, which may require converting grasslands and forests into cropland. Such conversions can reduce carbon storage, habitat provision, and other ecosystem services, presenting difficult societal trade-offs. In this paper, we use spatially explicit data on agricultural productivity and carbon storage in a global analysis to find where agricultural extensification should occur to meet growing demand while minimizing carbon emissions from land use change. Selective extensification saves ∼ 6 billion metric tons of carbon compared with a business-as-usual approach, with a value of approximately $1 trillion (2012 US dollars) using recent estimates of the social cost of carbon. This type of spatially explicit geospatial analysis can be expanded to include other ecosystem services and other industries to analyze how to minimize conflicts between economic development and environmental sustainability.

Integration of decentralized torrefaction with centralized catalytic pyrolysis to produce green aromatics from coffee grounds.

PubMed

Chai, Li; Saffron, Christopher M; Yang, Yi; Zhang, Zhongyu; Munro, Robert W; Kriegel, Robert M

2016-02-01

The aim of this work was to integrate decentralized torrefaction with centralized catalytic pyrolysis to convert coffee grounds into the green aromatic precursors of terephthalic acid, namely benzene, toluene, ethylbenzene, and xylenes (BTEX). An economic analysis of this bioproduct system was conducted to examine BTEX yields, biomass costs and their sensitivities. Model predictions were verified experimentally using pyrolysis GC/MS to quantify BTEX yields for raw and torrefied biomass. The production cost was minimized when the torrefier temperature and residence time were 239°C and 34min, respectively. This optimization study found conditions that justify torrefaction as a pretreatment for making BTEX, provided that starting feedstock costs are below $58 per tonne. Copyright © 2015. Published by Elsevier Ltd.

Biodiesel production process from microalgae oil by waste heat recovery and process integration.

PubMed

Song, Chunfeng; Chen, Guanyi; Ji, Na; Liu, Qingling; Kansha, Yasuki; Tsutsumi, Atsushi

2015-10-01

In this work, the optimization of microalgae oil (MO) based biodiesel production process is carried out by waste heat recovery and process integration. The exergy analysis of each heat exchanger presented an efficient heat coupling between hot and cold streams, thus minimizing the total exergy destruction. Simulation results showed that the unit production cost of optimized process is 0.592$/L biodiesel, and approximately 0.172$/L biodiesel can be avoided by heat integration. Although the capital cost of the optimized biodiesel production process increased 32.5% and 23.5% compared to the reference cases, the operational cost can be reduced by approximately 22.5% and 41.6%. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry.

PubMed

Moschetti, Karine; Petersen, Steffen E; Pilz, Guenter; Kwong, Raymond Y; Wasserfallen, Jean-Blaise; Lombardi, Massimo; Korosoglou, Grigorios; Van Rossum, Albert C; Bruder, Oliver; Mahrholdt, Heiko; Schwitter, Juerg

2016-01-11

Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50% stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50% stenoses. To calculate the proportion of patients with ≥50% stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Revascularizations were performed in 6.2%, 4.5%, and 12.9% of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3%, 1.1%, and 1.5%, respectively. The CMR + CXA-strategy reduced costs by 14%, 34%, 27%, and 24% in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59%, 52%, 61% and 71%, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3%), intermediate in the US and Swiss (11.6% and 12.8%, respectively), and remained substantial in the UK (18.9%) systems. Sensitivity analyses proved the robustness of results. A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.

Space shuttle low cost/risk avionics study

NASA Technical Reports Server (NTRS)

1971-01-01

All work breakdown structure elements containing any avionics related effort were examined for pricing the life cycle costs. The analytical, testing, and integration efforts are included for the basic onboard avionics and electrical power systems. The design and procurement of special test equipment and maintenance and repair equipment are considered. Program management associated with these efforts is described. Flight test spares and labor and materials associated with the operations and maintenance of the avionics systems throughout the horizontal flight test are examined. It was determined that cost savings can be achieved by using existing hardware, maximizing orbiter-booster commonality, specifying new equipments to MIL quality standards, basing redundancy on cost effective analysis, minimizing software complexity and reducing cross strapping and computer-managed functions, utilizing compilers and floating point computers, and evolving the design as dictated by the horizontal flight test schedules.

Cost Optimization Model for Business Applications in Virtualized Grid Environments

NASA Astrophysics Data System (ADS)

Strebel, Jörg

The advent of Grid computing gives enterprises an ever increasing choice of computing options, yet research has so far hardly addressed the problem of mixing the different computing options in a cost-minimal fashion. The following paper presents a comprehensive cost model and a mixed integer optimization model which can be used to minimize the IT expenditures of an enterprise and help in decision-making when to outsource certain business software applications. A sample scenario is analyzed and promising cost savings are demonstrated. Possible applications of the model to future research questions are outlined.

Drug waste minimization as an effective strategy of cost-containment in Oncology

PubMed Central

2014-01-01

Background Sustainability of cancer care is a crucial issue for health care systems worldwide, even more during a time of economic recession. Low-cost measures are highly desirable to contain and reduce expenditures without impairing the quality of care. In this paper we aim to demonstrate the efficacy of drug waste minimization in reducing drug-related costs and its importance as a structural measure in health care management. Methods We first recorded intravenous cancer drugs prescription and amount of drug waste at the Oncology Department of Udine, Italy. Than we developed and applied a protocol for drug waste minimization based on per-pathology/per-drug scheduling of chemotherapies and pre-planned rounding of dosages. Results Before the protocol, drug wastage accounted for 8,3% of the Department annual drug expenditure. Over 70% of these costs were attributable to six drugs (cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab) that we named ‘hot drugs’. Since the protocol introduction, we observed a 45% reduction in the drug waste expenditure. This benefit was confirmed in the following years and drug waste minimazion was able to limit the impact of new pricely drugs on the Department expenditures. Conclusions Facing current budgetary constraints, the application of a drug waste minimization model is effective in drug cost containment and may produce durable benefits. PMID:24507545

Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities.

PubMed

Patel, Shraddha P; Pena, Margarita E; Babcock, Charlene Irvin

2015-01-01

The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die. To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care. A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal. The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD. Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis.

PubMed

Beyer, Sebastian E; Hunink, Myriam G; Schöberl, Florian; von Baumgarten, Louisa; Petersen, Steffen E; Dichgans, Martin; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F; Sommer, Wieland H

2015-07-01

This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80,000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values. In the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80,000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80,000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ≤0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy. Our results suggest that CTA in patients with possible basilar artery occlusion is cost-effective. © 2015 The Authors.

Biosimilar medicines and cost-effectiveness

PubMed Central

Simoens, Steven

2011-01-01

Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical), the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events) and effectiveness of a biosimilar, the cost-effectiveness of a biosimilar needs to be calculated at multiple time points throughout the life cycle of the product. PMID:21935330

The complex interface between economy and healthcare: An introductory overview for clinicians.

PubMed

Ottolini, Federica Liliana; Buggio, Laura; Somigliana, Edgardo; Vercellini, Paolo

2016-12-01

In a period of generalized economic crisis, it seems particularly appropriate to try to manage a continuing growing sector such as healthcare in the best possible way. The crucial aim of optimization of available healthcare resources is obtaining the maximum possible benefit with the minimum expenditure. This has important social implications, whether individual citizens or tax-funded national health services eventually have to pay the bill. The keyword here is efficiency, which means either, maximizing the benefit from a fixed sum of money, or minimizing the resources required for a defined benefit. In order to achieve these objectives, economic evaluation is a helpful tool. Five different types of economic evaluation exist in the health-care field: cost-minimization, cost-benefit, cost-consequences, cost-effectiveness and cost-utility analysis. The objective of this narrative review is to provide an overview of the principal methods used for economic evaluation in healthcare. Economic evaluation represents a starting point for the allocation of resources, the decision of the valuable investments and the division of budgets across different health programs. Moreover, economic evaluation allows the comparison of different procedures in terms of quality of life and life expectancy, bearing in mind that cost-effectiveness is only one of multiple facets in the decision making-process. Economic evaluation is important to critically evaluate clinical interventions and ensure that we are implementing the most cost-effective management protocols. Clinicians are called to fulfill the complex task of optimizing the use of resources, and, at the same time, improving the quality of healthcare assistance. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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

PubMed

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

2013-04-01

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

Access Based Cost Estimation for Beddown Analysis

DTIC Science & Technology

2006-03-23

logic. This research expands upon the existing research by using Visual Basic for Applications ( VBA ) to further customize and streamline the...methods with the use of VBA . Calculations are completed in either underlying Form VBA code or through global modules accessible throughout the...query and SQL referencing. Attempts were made where possible to align data structures with possible external sources to minimize import errors and

Development of standardized specifications for silicon solar cells

NASA Technical Reports Server (NTRS)

Scott-Monck, J. A.

1977-01-01

A space silicon solar cell assembly (cell and coverglass) specification aimed at standardizing the diverse requirements of current cell or assembly specifications was developed. This specification was designed to minimize both the procurement and manufacturing costs for space qualified silicon solar cell assembilies. In addition, an impact analysis estimating the technological and economic effects of employing a standardized space silicon solar cell assembly was performed.

An analysis of wildfire prevention

NASA Technical Reports Server (NTRS)

Heineke, J. M.; Weissenberger, S.

1974-01-01

A model of the production of wildfire ignitions and damages is developed and used to determine wildland activity-regulation decisions, which minimize total expected cost-plus-loss due to wildfires. In this context, the implications of various policy decisions are considered. The resulting decision rules take a form that makes it possible for existing wildfire management agencies to readily adopt them upon collection of the required data.

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

PubMed

Kulkarni, Arvind Gopalrao; Patel, Ravish Shammi; Dutta, Shumayou

2016-12-01

Retrospective review of prospectively collected data. To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.

The goal of value-based medicine analyses: comparability. The case for neovascular macular degeneration.

PubMed

Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds.

THE GOAL OF VALUE-BASED MEDICINE ANALYSES: COMPARABILITY. THE CASE FOR NEOVASCULAR MACULAR DEGENERATION

PubMed Central

Brown, Gary C.; Brown, Melissa M.; Brown, Heidi C.; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

Purpose To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). Methods A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Results Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. Conclusions The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds. PMID:18427606

Reactive Power Pricing Model Considering the Randomness of Wind Power Output

NASA Astrophysics Data System (ADS)

Dai, Zhong; Wu, Zhou

2018-01-01

With the increase of wind power capacity integrated into grid, the influence of the randomness of wind power output on the reactive power distribution of grid is gradually highlighted. Meanwhile, the power market reform puts forward higher requirements for reasonable pricing of reactive power service. Based on it, the article combined the optimal power flow model considering wind power randomness with integrated cost allocation method to price reactive power. Meanwhile, considering the advantages and disadvantages of the present cost allocation method and marginal cost pricing, an integrated cost allocation method based on optimal power flow tracing is proposed. The model realized the optimal power flow distribution of reactive power with the minimal integrated cost and wind power integration, under the premise of guaranteeing the balance of reactive power pricing. Finally, through the analysis of multi-scenario calculation examples and the stochastic simulation of wind power outputs, the article compared the results of the model pricing and the marginal cost pricing, which proved that the model is accurate and effective.

Integrated strategic and tactical biomass-biofuel supply chain optimization.

PubMed

Lin, Tao; Rodríguez, Luis F; Shastri, Yogendra N; Hansen, Alan C; Ting, K C

2014-03-01

To ensure effective biomass feedstock provision for large-scale biofuel production, an integrated biomass supply chain optimization model was developed to minimize annual biomass-ethanol production costs by optimizing both strategic and tactical planning decisions simultaneously. The mixed integer linear programming model optimizes the activities range from biomass harvesting, packing, in-field transportation, stacking, transportation, preprocessing, and storage, to ethanol production and distribution. The numbers, locations, and capacities of facilities as well as biomass and ethanol distribution patterns are key strategic decisions; while biomass production, delivery, and operating schedules and inventory monitoring are key tactical decisions. The model was implemented to study Miscanthus-ethanol supply chain in Illinois. The base case results showed unit Miscanthus-ethanol production costs were $0.72L(-1) of ethanol. Biorefinery related costs accounts for 62% of the total costs, followed by biomass procurement costs. Sensitivity analysis showed that a 50% reduction in biomass yield would increase unit production costs by 11%. Copyright © 2014 Elsevier Ltd. All rights reserved.

Design study of wind turbines 50 kW to 3000 kW for electric utility applications. Volume 2: Analysis and design

NASA Technical Reports Server (NTRS)

1976-01-01

All possible overall system configurations, operating modes, and subsystem concepts for a wind turbine configuration for cost effective generation of electrical power were evaluated for both technical feasibility and compatibility with utility networks, as well as for economic attractiveness. A design optimization computer code was developed to determine the cost sensitivity of the various design features, and thus establish the configuration and design conditions that would minimize the generated energy costs. The preliminary designs of both a 500 kW unit and a 1500 kW unit operating in a 12 mph and 18 mph median wind speed respectively, were developed. The various design features and components evaluated are described, and the rationale employed to select the final design configuration is given. All pertinent technical performance data and component cost data is included. The costs of all major subassemblies are estimated and the resultant energy costs for both the 500 kW and 1500 kW units are calculated.

Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology.

PubMed

Pavan, Nicola; Autorino, Riccardo; Lee, Hak; Porpiglia, Francesco; Sun, Yinghao; Greco, Francesco; Jeff Chueh, S; Han, Deok Hyun; Cindolo, Luca; Ferro, Matteo; Chen, Xiang; Branco, Anibal; Fornara, Paolo; Liao, Chun-Hou; Miyajima, Akira; Kyriazis, Iason; Puglisi, Marco; Fiori, Cristian; Yang, Bo; Fei, Guo; Altieri, Vincenzo; Jeong, Byong Chang; Berardinelli, Francesco; Schips, Luigi; De Cobelli, Ottavio; Chen, Zhi; Haber, Georges-Pascal; He, Yao; Oya, Mototsugu; Liatsikos, Evangelos; Brandao, Luis; Challacombe, Benjamin; Kaouk, Jihad; Darweesh, Ithaar

2016-10-01

To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide. A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities. Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p < 0.001). European centers mostly adopted CL and ML techniques, whereas those from Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis. Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.

Analysis of fuel cell hybrid locomotives

NASA Astrophysics Data System (ADS)

Miller, Arnold R.; Peters, John; Smith, Brian E.; Velev, Omourtag A.

Led by Vehicle Projects LLC, an international industry-government consortium is developing a 109 t, 1.2 MW road-switcher locomotive for commercial and military railway applications. As part of the feasibility and conceptual-design analysis, a study has been made of the potential benefits of a hybrid power plant in which fuel cells comprise the prime mover and a battery or flywheel provides auxiliary power. The potential benefits of a hybrid power plant are: (i) enhancement of transient power and hence tractive effort; (ii) regenerative braking; (iii) reduction of capital cost. Generally, the tractive effort of a locomotive at low speed is limited by wheel adhesion and not by available power. Enhanced transient power is therefore unlikely to benefit a switcher locomotive, but could assist applications that require high acceleration, e.g. subway trains with all axles powered. In most cases, the value of regeneration in locomotives is minimal. For low-speed applications such as switchers, the available kinetic energy and the effectiveness of traction motors as generators are both minimal. For high-speed heavy applications such as freight, the ability of the auxiliary power device to absorb a significant portion of the available kinetic energy is low. Moreover, the hybrid power plant suffers a double efficiency penalty, namely, losses occur in both absorbing and then releasing energy from the auxiliary device, which result in a net storage efficiency of no more than 50% for present battery technology. Capital cost in some applications may be reduced. Based on an observed locomotive duty cycle, a cost model shows that a hybrid power plant for a switcher may indeed reduce capital cost. Offsetting this potential benefit are the increased complexity, weight and volume of the power plant, as well as 20-40% increased fuel consumption that results from lower efficiency. Based on this analysis, the consortium has decided to develop a pure fuel cell road-switcher locomotive, that is, not a hybrid.

Make or buy analysis model based on tolerance allocation to minimize manufacturing cost and fuzzy quality loss

NASA Astrophysics Data System (ADS)

Rosyidi, C. N.; Puspitoingrum, W.; Jauhari, W. A.; Suhardi, B.; Hamada, K.

2016-02-01

The specification of tolerances has a significant impact on the quality of product and final production cost. The company should carefully pay attention to the component or product tolerance so they can produce a good quality product at the lowest cost. Tolerance allocation has been widely used to solve problem in selecting particular process or supplier. But before merely getting into the selection process, the company must first make a plan to analyse whether the component must be made in house (make), to be purchased from a supplier (buy), or used the combination of both. This paper discusses an optimization model of process and supplier selection in order to minimize the manufacturing costs and the fuzzy quality loss. This model can also be used to determine the allocation of components to the selected processes or suppliers. Tolerance, process capability and production capacity are three important constraints that affect the decision. Fuzzy quality loss function is used in this paper to describe the semantic of the quality, in which the product quality level is divided into several grades. The implementation of the proposed model has been demonstrated by solving a numerical example problem that used a simple assembly product which consists of three components. The metaheuristic approach were implemented to OptQuest software from Oracle Crystal Ball in order to obtain the optimal solution of the numerical example.

[Pharmacoeconomic analysis of patients with acute exacerbation of chronic bronchitis treated with telithromycin or cefuroxime-axetil].

PubMed

Rubio-Terrés, C; Cots, J M; Domínguez-Gil, A; Herreras, A; Sánchez Gascón, F; Chang, J; Trilla, A

2004-11-01

A pharmacoeconomic analysis was done to compare the efficiency of two treatments in the acute exacerbation of chronic bronchitis: telithromycin and cefuroxime-axetil. Restrospective analysis, modeled through a decision tree. The effectiveness of the treatments was estimated through a randomized and double-blind clinical trial in which 800 mg/day (5 days) of telithromycin were compared with 1,000 mg/day (10 days) of cefuroxime-axetil in patients with acute exacerbation of chronic bronchitis (140 and 142 patients, respectively). Resources use was estimated from clinical trial and from Spanish data, and the unit costs through a health costs dabatase. The model was validated by a panel of Spanish clinical experts. Since the clinical trial was designed to demonstrate equivalence, there were no significant differences of effectiveness among both treatments (with a rate of clinical cure of 86.4% and 83.1%, respectively) which means that an analysis of costs minimization was done. In the average case, the average cost of the disease by patient was 174.83 Euros with telithromycin and 194.68 Euros with cefuroxime-axetil (a difference of 19.85 Euros). The results were maintained in the analysis of sensitivity, with favorable differences for telithromycin that ranged between 18.04 Euros and 22.25 Euros. With telithromycin up to 22 Euros by patient with acute exacerbation of chronic bronchitis could be saved, in comparison with cefuroxime-axetil.

Exergoeconomic analysis and optimization of an evaporator for a binary mixture of fluids in an organic Rankine cycle

NASA Astrophysics Data System (ADS)

Li, You-Rong; Du, Mei-Tang; Wang, Jian-Ning

2012-12-01

This paper focuses on the research of an evaporator with a binary mixture of organic working fluids in the organic Rankine cycle. Exergoeconomic analysis and performance optimization were performed based on the first and second laws of thermodynamics, and the exergoeconomic theory. The annual total cost per unit heat transfer rate was introduced as the objective function. In this model, the exergy loss cost caused by the heat transfer irreversibility and the capital cost were taken into account; however, the exergy loss due to the frictional pressure drops, heat dissipation to surroundings, and the flow imbalance were neglected. The variation laws of the annual total cost with respect to the number of transfer units and the temperature ratios were presented. Optimal design parameters that minimize the objective function had been obtained, and the effects of some important dimensionless parameters on the optimal performances had also been discussed for three types of evaporator flow arrangements. In addition, optimal design parameters of evaporators were compared with those of condensers.

Argonne National Laboratory Expedited Site Characterization: First International Symposium on Integrated Technical Approaches to Site Characterization - Proceedings Volume

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

NONE

1998-06-08

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

Aether: leveraging linear programming for optimal cloud computing in genomics.

PubMed

Luber, Jacob M; Tierney, Braden T; Cofer, Evan M; Patel, Chirag J; Kostic, Aleksandar D

2018-05-01

Across biology, we are seeing rapid developments in scale of data production without a corresponding increase in data analysis capabilities. Here, we present Aether (http://aether.kosticlab.org), an intuitive, easy-to-use, cost-effective and scalable framework that uses linear programming to optimally bid on and deploy combinations of underutilized cloud computing resources. Our approach simultaneously minimizes the cost of data analysis and provides an easy transition from users' existing HPC pipelines. Data utilized are available at https://pubs.broadinstitute.org/diabimmune and with EBI SRA accession ERP005989. Source code is available at (https://github.com/kosticlab/aether). Examples, documentation and a tutorial are available at http://aether.kosticlab.org. chirag_patel@hms.harvard.edu or aleksandar.kostic@joslin.harvard.edu. Supplementary data are available at Bioinformatics online.

Cost minimization analysis of low back pain claims data for chiropractic vs medicine in a managed care organization.

PubMed

Grieves, Brian; Menke, J Michael; Pursel, Kevin J

2009-01-01

A managed care organization (MCO) examined differences in allowed cost for managing low back pain by medical providers vs chiropractors in an integrated care environment. The purpose of this study is to provide a retrospective cost analysis of administrative data of chiropractic vs medical management of low back pain in a managed care setting. All patients with a low back pain-related diagnosis presenting for health care from January 2004 to June 2004 who were insured by an MCO in northeast Wisconsin were tracked. The cumulative health care costs incurred by this MCO during the 2-year period from January 2004 to December 2005 related to these back pain diagnoses were collected. Allowed costs of chiropractic treatment were 12% greater than medical primary care and 60% less per case than other types of medical care combined, on a per-case basis: median cost of medical primary care was $365.00, chiropractic care was $417.00, and medical nonprimary care was $669.00. This study of an MCO's low back pain allowed costs may be better redirected to primary care or chiropractic, given equivalent levels of case complexity. This study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.

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

PubMed

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

2017-03-01

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

The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis

PubMed Central

Axelrod, David; Schnitzler, Mark A.; Xiao, Huiling; Naik, Abhijit S.; Segev, Dorry L.; Dharnidharka, Vikas R.; Brennan, Daniel C.; Lentine, Krista L.

2017-01-01

Kidney transplantation has become more resource intensive as recipient complexity has increased and average donor quality has diminished over time. A national retrospective cohort study was performed to assess the impact of kidney donor and recipient characteristics on transplant center cost (exclusive of organ acquisition) and Medicare reimbursement. Data from the national transplant registry, University HealthSystem Consortium hospital costs, and Medicare payments for deceased donor (N=53,862) and living donor (N=36,715) transplants from 2002–2013 were linked and analyzed using multivariate linear regression modeling. Deceased donor kidney transplant costs were correlated with recipient (Expected Post Transplant Survival Score, degree of allosensitization, obesity, cause of renal failure) donor (age, cause of death, donation after cardiac death, terminal creatinine), and transplant (histocompatibility matching) characteristics. Living donor costs rose sharply with higher degrees of allosensitization, and were also associated with obesity, cause of renal failure, recipient work ability, and 0-ABDR mismatching. Analysis of Medicare payments for a subsample of 24,809 transplants demonstrated minimal correlation with patient and donor characteristics. In conclusion, the complexity in the landscape of kidney transplantation increases center costs, posing financial disincentives that may reduce organ utilization and limit access for higher risk populations. PMID:27565133

Depth of manual dismantling analysis: a cost-benefit approach.

PubMed

Achillas, Ch; Aidonis, D; Vlachokostas, Ch; Karagiannidis, A; Moussiopoulos, N; Loulos, V

2013-04-01

This paper presents a decision support tool for manufacturers and recyclers towards end-of-life strategies for waste electrical and electronic equipment. A mathematical formulation based on the cost benefit analysis concept is herein analytically described in order to determine the parts and/or components of an obsolete product that should be either non-destructively recovered for reuse or be recycled. The framework optimally determines the depth of disassembly for a given product, taking into account economic considerations. On this basis, it embeds all relevant cost elements to be included in the decision-making process, such as recovered materials and (depreciated) parts/components, labor costs, energy consumption, equipment depreciation, quality control and warehousing. This tool can be part of the strategic decision-making process in order to maximize profitability or minimize end-of-life management costs. A case study to demonstrate the models' applicability is presented for a typical electronic product in terms of structure and material composition. Taking into account the market values of the pilot product's components, the manual disassembly is proven profitable with the marginal revenues from recovered reusable materials to be estimated at 2.93-23.06 €, depending on the level of disassembly. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impact of uncertainty on cost-effectiveness analysis of medical strategies: the case of high-dose chemotherapy for breast cancer patients.

PubMed

Marino, Patricia; Siani, Carole; Roché, Henri; Moatti, Jean-Paul

2005-01-01

The object of this study was to determine, taking into account uncertainty on cost and outcome parameters, the cost-effectiveness of high-dose chemotherapy (HDC) compared with conventional chemotherapy for advanced breast cancer patients. An analysis was conducted for 300 patients included in a randomized clinical trial designed to evaluate the benefits, in terms of disease-free survival and overall survival, of adding a single course of HDC to a four-cycle conventional-dose chemotherapy for breast cancer patients with axillary lymph node invasion. Costs were estimated from a detailed observation of physical quantities consumed, and the Kaplan-Meier method was used to evaluate mean survival times. Incremental cost-effectiveness ratios were evaluated successively considering disease-free survival and overall survival outcomes. Handling of uncertainty consisted in construction of confidence intervals for these ratios, using the truncated Fieller method. The cost per disease-free life year gained was evaluated at 13,074 Euros, a value that seems to be acceptable to society. However, handling uncertainty shows that the upper bound of the confidence interval is around 38,000 Euros, which is nearly three times higher. Moreover, as no difference was demonstrated in overall survival between treatments, cost-effectiveness analysis, that is a cost minimization, indicated that the intensive treatment is a dominated strategy involving an extra cost of 7,400 Euros, for no added benefit. Adding a single course of HDC led to a clinical benefit in terms of disease-free survival for an additional cost that seems to be acceptable, considering the point estimate of the ratio. However, handling uncertainty indicates a maximum ratio for which conclusions have to be discussed.

Economic analysis comparing induction of labor and expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial).

PubMed

Vijgen, Sylvia M C; van der Ham, David P; Bijlenga, Denise; van Beek, Johannes J; Bloemenkamp, Kitty W M; Kwee, Anneke; Groenewout, Mariët; Kars, Michael M; Kuppens, Simone; Mantel, Gerald; Molkenboer, Jan F M; Mulder, Antonius L M; Nijhuis, Jan G; Pernet, Paula J M; Porath, Martina; Woiski, Mallory D; Weinans, Martin J N; van Wijngaarden, Wim J; Wildschut, Hajo I J; Akerboom, Bertina; Sikkema, J Marko; Willekes, Christine; Mol, Ben W J; Opmeer, Brent C

2014-04-01

To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). Economic analysis based on a randomized clinical trial. Obstetric departments of eight academic and 52 non-academic hospitals in the Netherlands. Women with PPROM near term who were not in labor 24 h after PPROM. A cost-minimization analysis was done from a health care provider perspective, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Primary health outcome was the incidence of neonatal sepsis. Direct medical costs were estimated from start of randomization to hospital discharge of mother and child. Induction of labor did not significantly reduce the probability of neonatal sepsis [2.6% vs. 4.1%, relative risk 0.64 (95% confidence interval 0.25-1.6)]. Mean costs per woman were €8094 for induction and €7340 for expectant management (difference €754; 95% confidence interval -335 to 1802). This difference predominantly originated in the postpartum period, where the mean costs were €5669 for induction vs. €4801 for expectant management. Delivery costs were higher in women allocated to induction than in women allocated to expectant management (€1777 vs. €1153 per woman). Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. In women with pregnancies complicated by PPROM near term, induction of labor does not reduce neonatal sepsis, whereas costs associated with this strategy are probably higher. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis

PubMed Central

Hui, Chi-Leung

2017-01-01

Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an (Q,r) inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights. PMID:29527283

Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis.

PubMed

Pan, An; Hui, Chi-Leung

2017-01-01

Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an ( Q , r ) inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights.

Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany.

PubMed

Zeidler, J; Mittendorf, T; Vahldiek, G; Zeidler, H; Merkesdal, S

2008-10-01

To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of euro2047 and euro1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were euro2067 (euro1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

Life cycle costing with a discount rate

NASA Technical Reports Server (NTRS)

Posner, E. C.

1978-01-01

This article studies life cycle costing for a capability needed for the indefinite future, and specifically investigates the dependence of optimal policies on the discount rate chosen. The two costs considered are reprocurement cost and maintenance and operations (M and O) cost. The procurement price is assumed known, and the M and O costs are assumed to be a known function, in fact, a non-decreasing function, of the time since last reprocurement. The problem is to choose the optimum reprocurement time so as to minimize the quotient of the total cost over a reprocurement period divided by the period. Or one could assume a discount rate and try to minimize the total discounted costs into the indefinite future. It is shown that the optimum policy in the presence of a small discount rate hardly depends on the discount rate at all, and leads to essentially the same policy as in the case in which discounting is not considered.

A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia.

PubMed

Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

2017-01-01

Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group ( p <0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN ( p =0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.

Computer analysis of railcar vibrations

NASA Technical Reports Server (NTRS)

Vlaminck, R. R.

1975-01-01

Computer models and techniques for calculating railcar vibrations are discussed along with criteria for vehicle ride optimization. The effect on vibration of car body structural dynamics, suspension system parameters, vehicle geometry, and wheel and rail excitation are presented. Ride quality vibration data collected on the state-of-the-art car and standard light rail vehicle is compared to computer predictions. The results show that computer analysis of the vehicle can be performed for relatively low cost in short periods of time. The analysis permits optimization of the design as it progresses and minimizes the possibility of excessive vibration on production vehicles.

An approximate methods approach to probabilistic structural analysis

NASA Technical Reports Server (NTRS)

Mcclung, R. C.; Millwater, H. R.; Wu, Y.-T.; Thacker, B. H.; Burnside, O. H.

1989-01-01

A probabilistic structural analysis method (PSAM) is described which makes an approximate calculation of the structural response of a system, including the associated probabilistic distributions, with minimal computation time and cost, based on a simplified representation of the geometry, loads, and material. The method employs the fast probability integration (FPI) algorithm of Wu and Wirsching. Typical solution strategies are illustrated by formulations for a representative critical component chosen from the Space Shuttle Main Engine (SSME) as part of a major NASA-sponsored program on PSAM. Typical results are presented to demonstrate the role of the methodology in engineering design and analysis.

Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room.

PubMed

Thiel, Cassandra L; Fiorin Carvalho, Rafaela; Hess, Lindsay; Tighe, Joelle; Laurence, Vincent; Bilec, Melissa M; Baratz, Mark

2017-11-01

The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis of the respective costs and waste generation of the 2 techniques. We created a "minimal" custom pack of disposable surgical supplies expressly for small hand surgery procedures and then measured the waste from 178 small hand surgeries performed using either the "minimal pack" or the "standard pack," depending on physician pack choice. Patients were also asked to complete a postoperative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t tests, and Fisher exact tests. As expected, WAHS with the minimal pack produced 0.3 kg (13%) less waste and cost $125 (55%) less in supplies per case than sedation & local with the standard pack. Pack size was found to be the driving factor in waste generation. Patients who underwent WAHS reported slightly greater pain and anxiety levels during their surgery, but also reported greater satisfaction with their anesthetic choice, which could be tied to the enthusiasm of the physician performing WAHS. Surgical waste and spending can be reduced by minimizing the materials brought into the operating room in disposable packs. WAHS, as a nascent technique, may provide an opportunity to drive sustainability by paring back what is considered necessary in these packs. Moreover, despite some initial anxiety, many patients report greater satisfaction with WAHS. All told, our study suggests a potentially broader role for WAHS, with its concomitant emphases on patient satisfaction and the efficient use of time and resources.

Distributed query plan generation using multiobjective genetic algorithm.

PubMed

Panicker, Shina; Kumar, T V Vijay

2014-01-01

A distributed query processing strategy, which is a key performance determinant in accessing distributed databases, aims to minimize the total query processing cost. One way to achieve this is by generating efficient distributed query plans that involve fewer sites for processing a query. In the case of distributed relational databases, the number of possible query plans increases exponentially with respect to the number of relations accessed by the query and the number of sites where these relations reside. Consequently, computing optimal distributed query plans becomes a complex problem. This distributed query plan generation (DQPG) problem has already been addressed using single objective genetic algorithm, where the objective is to minimize the total query processing cost comprising the local processing cost (LPC) and the site-to-site communication cost (CC). In this paper, this DQPG problem is formulated and solved as a biobjective optimization problem with the two objectives being minimize total LPC and minimize total CC. These objectives are simultaneously optimized using a multiobjective genetic algorithm NSGA-II. Experimental comparison of the proposed NSGA-II based DQPG algorithm with the single objective genetic algorithm shows that the former performs comparatively better and converges quickly towards optimal solutions for an observed crossover and mutation probability.

Distributed Query Plan Generation Using Multiobjective Genetic Algorithm

PubMed Central

Panicker, Shina; Vijay Kumar, T. V.

2014-01-01

A distributed query processing strategy, which is a key performance determinant in accessing distributed databases, aims to minimize the total query processing cost. One way to achieve this is by generating efficient distributed query plans that involve fewer sites for processing a query. In the case of distributed relational databases, the number of possible query plans increases exponentially with respect to the number of relations accessed by the query and the number of sites where these relations reside. Consequently, computing optimal distributed query plans becomes a complex problem. This distributed query plan generation (DQPG) problem has already been addressed using single objective genetic algorithm, where the objective is to minimize the total query processing cost comprising the local processing cost (LPC) and the site-to-site communication cost (CC). In this paper, this DQPG problem is formulated and solved as a biobjective optimization problem with the two objectives being minimize total LPC and minimize total CC. These objectives are simultaneously optimized using a multiobjective genetic algorithm NSGA-II. Experimental comparison of the proposed NSGA-II based DQPG algorithm with the single objective genetic algorithm shows that the former performs comparatively better and converges quickly towards optimal solutions for an observed crossover and mutation probability. PMID:24963513

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

PubMed

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

2016-12-01

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

Health economic evaluations in orthodontics: a systematic review

PubMed Central

Petrén, Sofia; Björnsson, Liselotte; Norlund, Anders; Bondemark, Lars

2016-01-01

Summary Background: Economic evaluation is assuming increasing importance as an integral component of health services research. Aim: To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. Materials/methods: The literature review was conducted in four steps, according to Goodman’s model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). Results: The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. Conclusion: This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes. There is currently insufficient evidence available about the health economics of orthodontic interventions. Further investigation is warranted. PMID:26070925

Health economic evaluations in orthodontics: a systematic review.

PubMed

Sollenius, Ola; Petrén, Sofia; Björnsson, Liselotte; Norlund, Anders; Bondemark, Lars

2016-06-01

Economic evaluation is assuming increasing importance as an integral component of health services research. To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. The literature review was conducted in four steps, according to Goodman's model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes. There is currently insufficient evidence available about the health economics of orthodontic interventions. Further investigation is warranted. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Early EEG for outcome prediction of postanoxic coma: prospective cohort study with cost-minimization analysis.

PubMed

Sondag, Lotte; Ruijter, Barry J; Tjepkema-Cloostermans, Marleen C; Beishuizen, Albertus; Bosch, Frank H; van Til, Janine A; van Putten, Michel J A M; Hofmeijer, Jeannette

2017-05-15

We recently showed that electroencephalography (EEG) patterns within the first 24 hours robustly contribute to multimodal prediction of poor or good neurological outcome of comatose patients after cardiac arrest. Here, we confirm these results and present a cost-minimization analysis. Early prognosis contributes to communication between doctors and family, and may prevent inappropriate treatment. A prospective cohort study including 430 subsequent comatose patients after cardiac arrest was conducted at intensive care units of two teaching hospitals. Continuous EEG was started within 12 hours after cardiac arrest and continued up to 3 days. EEG patterns were visually classified as unfavorable (isoelectric, low-voltage, or burst suppression with identical bursts) or favorable (continuous patterns) at 12 and 24 hours after cardiac arrest. Outcome at 6 months was classified as good (cerebral performance category (CPC) 1 or 2) or poor (CPC 3, 4, or 5). Predictive values of EEG measures and cost-consequences from a hospital perspective were investigated, assuming EEG-based decision- making about withdrawal of life-sustaining treatment in the case of a poor predicted outcome. Poor outcome occurred in 197 patients (51% of those included in the analyses). Unfavorable EEG patterns at 24 hours predicted a poor outcome with specificity of 100% (95% CI 98-100%) and sensitivity of 29% (95% CI 22-36%). Favorable patterns at 12 hours predicted good outcome with specificity of 88% (95% CI 81-93%) and sensitivity of 51% (95% CI 42-60%). Treatment withdrawal based on an unfavorable EEG pattern at 24 hours resulted in a reduced mean ICU length of stay without increased mortality in the long term. This gave small cost reductions, depending on the timing of withdrawal. Early EEG contributes to reliable prediction of good or poor outcome of postanoxic coma and may lead to reduced length of ICU stay. In turn, this may bring small cost reductions.

a Multi Objective Model for Optimization of a Green Supply Chain Network

NASA Astrophysics Data System (ADS)

Paksoy, Turan; Özceylan, Eren; Weber, Gerhard-Wilhelm

2010-06-01

This study develops a model of a closed-loop supply chain (CLSC) network which starts with the suppliers and recycles with the decomposition centers. As a traditional network design, we consider minimizing the all transportation costs and the raw material purchasing costs. To pay attention for the green impacts, different transportation choices are presented between echelons according to their CO2 emissions. The plants can purchase different raw materials in respect of their recyclable ratios. The focuses of this paper are conducting the minimizing total CO2 emissions. Also we try to encourage the customers to use recyclable materials as an environmental performance viewpoint besides minimizing total costs. A multi objective linear programming model is developed via presenting a numerical example. We close the paper with recommendations for future researches.

Solar electricity supply isolines of generation capacity and storage.

PubMed

Grossmann, Wolf; Grossmann, Iris; Steininger, Karl W

2015-03-24

The recent sharp drop in the cost of photovoltaic (PV) electricity generation accompanied by globally rapidly increasing investment in PV plants calls for new planning and management tools for large-scale distributed solar networks. Of major importance are methods to overcome intermittency of solar electricity, i.e., to provide dispatchable electricity at minimal costs. We find that pairs of electricity generation capacity G and storage S that give dispatchable electricity and are minimal with respect to S for a given G exhibit a smooth relationship of mutual substitutability between G and S. These isolines between G and S support the solving of several tasks, including the optimal sizing of generation capacity and storage, optimal siting of solar parks, optimal connections of solar parks across time zones for minimizing intermittency, and management of storage in situations of far below average insolation to provide dispatchable electricity. G-S isolines allow determining the cost-optimal pair (G,S) as a function of the cost ratio of G and S. G-S isolines provide a method for evaluating the effect of geographic spread and time zone coverage on costs of solar electricity.

Solar electricity supply isolines of generation capacity and storage

PubMed Central

Grossmann, Wolf; Grossmann, Iris; Steininger, Karl W.

2015-01-01

The recent sharp drop in the cost of photovoltaic (PV) electricity generation accompanied by globally rapidly increasing investment in PV plants calls for new planning and management tools for large-scale distributed solar networks. Of major importance are methods to overcome intermittency of solar electricity, i.e., to provide dispatchable electricity at minimal costs. We find that pairs of electricity generation capacity G and storage S that give dispatchable electricity and are minimal with respect to S for a given G exhibit a smooth relationship of mutual substitutability between G and S. These isolines between G and S support the solving of several tasks, including the optimal sizing of generation capacity and storage, optimal siting of solar parks, optimal connections of solar parks across time zones for minimizing intermittency, and management of storage in situations of far below average insolation to provide dispatchable electricity. G−S isolines allow determining the cost-optimal pair (G,S) as a function of the cost ratio of G and S. G−S isolines provide a method for evaluating the effect of geographic spread and time zone coverage on costs of solar electricity. PMID:25755261

Cost analysis of public health influenza vaccine clinics in Ontario.

PubMed

Mercer, Nicola J

2009-01-01

Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings

PubMed Central

Keus, Frederik; de Jonge, Trudy; Gooszen, Hein G; Buskens, Erik; van Laarhoven, Cornelis JHM

2009-01-01

Background After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisability Methods A blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective. Results Operative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave. Conclusion Based on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society. Trial registration ISRCTN Register, number ISRCTN67485658. PMID:19732431

The affordability of minimally invasive procedures in major lung resection: a prospective study.

PubMed

Gondé, Henri; Laurent, Marc; Gillibert, André; Sarsam, Omar-Matthieu; Varin, Rémi; Grimandi, Gaël; Peillon, Christophe; Baste, Jean-Marc

2017-09-01

Minimally invasive procedures are used for the surgical treatment of lung cancer. Two techniques are proposed: video-assisted thoracic surgery or robotic-assisted thoracic surgery. Our goal was to study the economic impact of our long-standing program for minimally invasive procedures for major lung resection. We conducted a single-centre, 1-year prospective cost study. Patients who underwent lobectomy or segmentectomy were included. Patient characteristics and perioperative outcomes were collected. Medical supply expenses based on the microcosting method and capital depreciation were estimated. Total cost was evaluated using a national French database. One hundred twelve patients were included, 57 with and 55 without robotic assistance. More segmentectomies were performed with robotic assistance. The median length of stay was 5 days for robotic-assisted and 6 days for video-assisted procedures (P = 0.13). The duration of median chest drains (4 days, P = 0.36) and of operating room time (255 min, P = 0.55) was not significantly different between the groups. The overall conversion rate to thoracotomy was 9%, significantly higher in the video-assisted group than in the robotic group (16% vs 2%, P = 0.008). No difference was observed in postoperative complications. The cost of most robotic-assisted procedures ranged from €10 000 to €12 000 (median €10 972) and that of most video-assisted procedures ranged from €8 000 to €10 000 (median €9 637) (P = 0.007); median medical supply expenses were €3 236 and €2 818, respectively (P = 0.004). The overall mean cost of minimally invasive techniques (€11 759) was significantly lower than the mean French cost of lung resection surgical procedures (€13 424) (P = 0.001). The cost at our centre of performing minimally invasive surgical procedures appeared lower than the cost nationwide. Robotic-assisted thoracic surgery demonstrated acceptable additional costs for a long-standing program. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Solar Electric Propulsion

NASA Technical Reports Server (NTRS)

LaPointe, Michael

2006-01-01

The Solar Electric Propulsion (SEP) technology area is tasked to develop near and mid-term SEP technology to improve or enable science mission capture while minimizing risk and cost to the end user. The solar electric propulsion investments are primarily driven by SMD cost-capped mission needs. The technology needs are determined partially through systems analysis tasks including the recent "Re-focus Studies" and "Standard Architecture Study." These systems analysis tasks transitioned the technology development to address the near term propulsion needs suitable for cost-capped open solicited missions such as Discovery and New Frontiers Class missions. Major SEP activities include NASA's Evolutionary Xenon Thruster (NEXT), implementing a Standard Architecture for NSTAR and NEXT EP systems, and developing a long life High Voltage Hall Accelerator (HiVHAC). Lower level investments include advanced feed system development and xenon recovery testing. Future plans include completion of ongoing ISP development activities and evaluating potential use of commercial electric propulsion systems for SMD applications. Examples of enhanced mission capability and technology readiness dates shall be discussed.

Resilience-based optimal design of water distribution network

NASA Astrophysics Data System (ADS)

Suribabu, C. R.

2017-11-01

Optimal design of water distribution network is generally aimed to minimize the capital cost of the investments on tanks, pipes, pumps, and other appurtenances. Minimizing the cost of pipes is usually considered as a prime objective as its proportion in capital cost of the water distribution system project is very high. However, minimizing the capital cost of the pipeline alone may result in economical network configuration, but it may not be a promising solution in terms of resilience point of view. Resilience of the water distribution network has been considered as one of the popular surrogate measures to address ability of network to withstand failure scenarios. To improve the resiliency of the network, the pipe network optimization can be performed with two objectives, namely minimizing the capital cost as first objective and maximizing resilience measure of the configuration as secondary objective. In the present work, these two objectives are combined as single objective and optimization problem is solved by differential evolution technique. The paper illustrates the procedure for normalizing the objective functions having distinct metrics. Two of the existing resilience indices and power efficiency are considered for optimal design of water distribution network. The proposed normalized objective function is found to be efficient under weighted method of handling multi-objective water distribution design problem. The numerical results of the design indicate the importance of sizing pipe telescopically along shortest path of flow to have enhanced resiliency indices.

Adopting a plant-based diet minimally increased food costs in WHEL Study.

PubMed

Hyder, Joseph A; Thomson, Cynthia A; Natarajan, Loki; Madlensky, Lisa; Pu, Minya; Emond, Jennifer; Kealey, Sheila; Rock, Cheryl L; Flatt, Shirley W; Pierce, John P

2009-01-01

To assess the cost of adopting a plant-based diet. Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs. At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027). A major change to a plant-based diet was associated with a minimal increase in grocery costs.

Comparison between qualitative and real-time polymerase chain reaction to evaluate minimal residual disease in children with acute lymphoblastic leukemia.

PubMed

Paula, Francisco Danilo Ferreira; Elói-Santos, Silvana Maria; Xavier, Sandra Guerra; Ganazza, Mônica Aparecida; Jotta, Patricia Yoshioka; Yunes, José Andrés; Viana, Marcos Borato; Assumpção, Juliana Godoy

2015-01-01

Minimal residual disease is an important independent prognostic factor that can identify poor responders among patients with acute lymphoblastic leukemia. The aim of this study was to analyze minimal residual disease using immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements by conventional polymerase chain reaction followed by homo-heteroduplex analysis and to compare this with real-time polymerase chain reaction at the end of the induction period in children with acute lymphoblastic leukemia. Seventy-four patients diagnosed with acute lymphoblastic leukemia were enrolled. Minimal residual disease was evaluated by qualitative polymerase chain reaction in 57 and by both tests in 44. The Kaplan-Meier and multivariate Cox methods and the log-rank test were used for statistical analysis. Nine patients (15.8%) were positive for minimal residual disease by qualitative polymerase chain reaction and 11 (25%) by real-time polymerase chain reaction considering a cut-off point of 1×10(-3) for precursor B-cell acute lymphoblastic leukemia and 1×10(-2) for T-cell acute lymphoblastic leukemia. Using the qualitative method, the 3.5-year leukemia-free survival was significantly higher in children negative for minimal residual disease compared to those with positive results (84.1%±5.6% versus 41.7%±17.3%, respectively; p-value=0.004). There was no significant association between leukemia-free survival and minimal residual disease by real-time polymerase chain reaction. Minimal residual disease by qualitative polymerase chain reaction was the only variable significantly correlated to leukemia-free survival. Given the difficulties in the implementation of minimal residual disease monitoring by real-time polymerase chain reaction in most treatment centers in Brazil, the qualitative polymerase chain reaction strategy may be a cost-effective alternative. Copyright © 2015 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.

Optimization, Monotonicity and the Determination of Nash Equilibria — An Algorithmic Analysis

NASA Astrophysics Data System (ADS)

Lozovanu, D.; Pickl, S. W.; Weber, G.-W.

2004-08-01

This paper is concerned with the optimization of a nonlinear time-discrete model exploiting the special structure of the underlying cost game and the property of inverse matrices. The costs are interlinked by a system of linear inequalities. It is shown that, if the players cooperate, i.e., minimize the sum of all the costs, they achieve a Nash equilibrium. In order to determine Nash equilibria, the simplex method can be applied with respect to the dual problem. An introduction into the TEM model and its relationship to an economic Joint Implementation program is given. The equivalence problem is presented. The construction of the emission cost game and the allocation problem is explained. The assumption of inverse monotony for the matrices leads to a new result in the area of such allocation problems. A generalization of such problems is presented.

Reducing Formation-Keeping Maneuver Costs for Formation Flying Satellites in Low-Earth Orbit

NASA Technical Reports Server (NTRS)

Hamilton, Nicholas

2001-01-01

Several techniques are used to synthesize the formation-keeping control law for a three-satellite formation in low-earth orbit. The objective is to minimize maneuver cost and position tracking error. Initial reductions are found for a one-satellite case by tuning the state-weighting matrix within the linear-quadratic-Gaussian framework. Further savings come from adjusting the maneuver interval. Scenarios examined include cases with and without process noise. These results are then applied to a three-satellite formation. For both the one-satellite and three-satellite cases, increasing the maneuver interval yields a decrease in maneuver cost and an increase in position tracking error. A maneuver interval of 8-10 minutes provides a good trade-off between maneuver cost and position tracking error. An analysis of the closed-loop poles with respect to varying maneuver intervals explains the effectiveness of the chosen maneuver interval.

Optimizing water purchases for an Environmental Water Account

NASA Astrophysics Data System (ADS)

Lund, J. R.; Hollinshead, S. P.

2005-12-01

State and federal agencies in California have established an Environmental Water Account (EWA) to buy water to protect endangered fish in the San Francisco Bay/ Sacramento-San Joaquin Delta Estuary. This paper presents a three-stage probabilistic optimization model that identifies least-cost strategies for purchasing water for the EWA given hydrologic, operational, and biological uncertainties. This approach minimizes the expected cost of long-term, spot, and option water purchases to meet uncertain flow dedications for fish. The model prescribes the location, timing, and type of optimal water purchases and can illustrate how least-cost strategies change with hydrologic, operational, biological, and cost inputs. Details of the optimization model's application to California's EWA are provided with a discussion of its utility for strategic planning and policy purposes. Limitations in and sensitivity analysis of the model's representation of EWA operations are discussed, as are operational and research recommendations.

Cost analysis of plasma-exchange therapy for the treatment of Guillain-Barré syndrome. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome.

PubMed

Espérou, H; Jars-Guincestre, M C; Bolgert, F; Raphaël, J C; Durand-Zaleski, I

2000-08-01

To undertake a cost analysis of therapeutic strategies with plasma exchange (PE) for the treatment of patients with Guillain-Barré syndrome. A randomized clinical trial including 556 patients with Guillain-Barré syndrome. We demonstrated that in the group with mild disease (walking possible) two PEs were more effective than none in shortening the time to beginning motor recovery. In the groups with moderate disease (walking impossible) and or severe disease (mechanically ventilated patients) four sessions were more effective than two and no more effective than six in shortening the time to recovery of walking with assistance and for the recovery rate of full muscle strength within 1 year. Data on outcomes and costs was collected. Complete cost data were available on 546 from the 556 patients of the trial. Costs were estimated from the viewpoint of the healthcare system and computed over a 1-year period. Because the analysis of medical outcomes did not show any difference regarding mortality but only on intermediate short-term and long-term outcomes, we carried out a cost minimization analysis. In two groups a dominant strategy appeared, with greater efficacy and lower costs in the two-PE arm for the mild group: 21,353 euros vs. 38,753 euros and in the four-PE arm in the moderate group: 59,480 euros vs. 80,737 euros. In the severe group four PEs were as efficient and somewhat less expensive than six: 57,621 vs. 61,056 euros. The treatment of Guillain-Barré syndrome by PE at the onset of disease appears to have medical justification. The least expensive strategies are either more or equally efficient as more expensive strategies.

Analysis of System Training Impact for Major Defense Acquisition Programs

DTIC Science & Technology

2011-08-01

simulation fidelity but rather were due to poor training development planning, the absence of instructional support and training features on the simulation...reduce detectability of the soldier, prevent attack if detected, prevent damage if attacked, minimize medical injury if wounded or otherwise injured, and...instance, a National Guard tank battalion that stores and maintains its tanks at a central maintenance/training facility may find it more cost

The role of pre-field operations at four forest inventory units: We can see the trees, not just the forest

Treesearch

Sara A. Goeking; Greg C. Liknes

2009-01-01

The Forest Inventory and Analysis (FIA) program attempts to inventory all forested lands throughout the United States. Each of the four FIA units has developed a process to minimize inventory costs by refraining from visiting those plots in the national inventory grid that are undoubtedly nonforest. We refer to this process as pre-field operations. Until recently, the...

Potential applications of prefield land use and canopy cover data: Examples from nonforest and nonsampled forest inventory plots

Treesearch

Sara A. Goeking

2012-01-01

The Forest Inventory and Analysis (FIA) prefield workflow involves interpreting aerial imagery to determine whether each plot in a given inventory year may meet FIA’s definition of forest land. The primary purpose of this determination is to minimize inventory costs by avoiding unnecessary ground surveys of plots that are obviously in nonforest areas. Since the...

Analysis of alternatives for immobilized low activity waste disposal

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

Burbank, D.A.

This report presents a study of alternative disposal system architectures and implementation strategies to provide onsite near-surface disposal capacity to receive the immobilized low-activity waste produced by the private vendors. The analysis shows that a flexible unit strategy that provides a suite of design solutions tailored to the characteristics of the immobilized low-activity waste will provide a disposal system that best meets the program goals of reducing the environmental, health, and safety impacts; meeting the schedule milestones; and minimizing the life-cycle cost of the program.

Economic evaluations and randomized trials in spinal disorders: principles and methods.

PubMed

Korthals-de Bos, Ingeborg; van Tulder, Maurits; van Dieten, Hiske; Bouter, Lex

2004-02-15

Descriptive methodologic recommendations. To help researchers designing, conducting, and reporting economic evaluations in the field of back and neck pain. Economic evaluations of both existing and new therapeutic interventions are becoming increasingly important. There is a need to improve the methods of economic evaluations in the field of spinal disorders. To improve the methods of economic evaluations in the field of spinal disorders, this article describes the various steps in an economic evaluation, using as example a study on the cost-effectiveness of manual therapy, physiotherapy, and usual care provided by the general practitioner for patients with neck pain. An economic evaluation is a study in which two or more interventions are systematically compared with regard to both costs and effects. There are four types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, and (4) cost-benefit. The cost-utility analysis is a special case of cost-effectiveness analysis. The first step in all these economic evaluations is to identify the perspective of the study. The choice of the perspective will have consequences for the identification of costs and effects. Secondly, the alternatives that will be compared should be identified. Thirdly, the relevant costs and effects should be identified. Economic evaluations are usually performed from a societal perspective and include consequently direct health care costs, direct nonhealth care costs, and indirect costs. Fourthly, effect data are collected by means of questionnaires or interviews, and relevant cost data with regard to effect measures and health care utilization, work absenteeism, travel expenses, use of over-the-counter medication, and help from family and friends, are collected by means of cost diaries, questionnaires, or (telephone) interviews. Fifthly, real costs are calculated, or the costs are estimated on the basis of real costs, guideline prices, or tariffs. Finally, in the statistical analysis the mean direct, indirect, and total costs of the alternatives are compared, using bootstrapping techniques. Incremental cost-effectiveness ratios are graphically presented on a cost-effectiveness plane and acceptability curves are calculated. Economic evaluations require specific methods. These recommendations may be helpful in improving the quality of economic evaluations of new and existing therapeutic interventions in the field of spinal disorders.

46 CFR 252.34 - Protection and indemnity insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... The adjustment of the wage percentage differential shall not be used for Japan, where operators incur minimal costs for deductible absorptions, rather than no costs. For Japan, the insurance related costs...

Efficacy and cost-efficacy of biologic therapies for moderate to severe psoriasis: a meta-analysis and cost-efficacy analysis using the intention-to-treat principle.

PubMed

Chi, Ching-Chi; Wang, Shu-Hui

2014-01-01

Compared to conventional therapies, biologics are more effective but expensive in treating psoriasis. To evaluate the efficacy and cost-efficacy of biologic therapies for psoriasis. We conducted a meta-analysis to calculate the efficacy of etanercept, adalimumab, infliximab, and ustekinumab for at least 75% reduction in the Psoriasis Area and Severity Index score (PASI 75) and Physician's Global Assessment clear/minimal (PGA 0/1). The cost-efficacy was assessed by calculating the incremental cost-effectiveness ratio (ICER) per subject achieving PASI 75 and PGA 0/1. The incremental efficacy regarding PASI 75 was 55% (95% confidence interval (95% CI) 38%-72%), 63% (95% CI 59%-67%), 71% (95% CI 67%-76%), 67% (95% CI 62%-73%), and 72% (95% CI 68%-75%) for etanercept, adalimumab, infliximab, and ustekinumab 45 mg and 90 mg, respectively. The corresponding 6-month ICER regarding PASI 75 was $32,643 (best case $24,936; worst case $47,246), $21,315 (best case $20,043; worst case $22,760), $27,782 (best case $25,954; worst case $29,440), $25,055 (best case $22,996; worst case $27,075), and $46,630 (best case $44,765; worst case $49,373), respectively. The results regarding PGA 0/1 were similar. Infliximab and ustekinumab 90 mg had the highest efficacy. Meanwhile, adalimumab had the best cost-efficacy, followed by ustekinumab 45 mg and infliximab.

Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform.

PubMed

Zallman, Leah; Nardin, Rachel; Sayah, Assaad; McCormick, Danny

2015-10-29

Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.

Routing and Scheduling Optimization Model of Sea Transportation

NASA Astrophysics Data System (ADS)

barus, Mika debora br; asyrafy, Habib; nababan, Esther; mawengkang, Herman

2018-01-01

This paper examines the routing and scheduling optimization model of sea transportation. One of the issues discussed is about the transportation of ships carrying crude oil (tankers) which is distributed to many islands. The consideration is the cost of transportation which consists of travel costs and the cost of layover at the port. Crude oil to be distributed consists of several types. This paper develops routing and scheduling model taking into consideration some objective functions and constraints. The formulation of the mathematical model analyzed is to minimize costs based on the total distance visited by the tanker and minimize the cost of the ports. In order for the model of the problem to be more realistic and the cost calculated to be more appropriate then added a parameter that states the multiplier factor of cost increases as the charge of crude oil is filled.

Integrated least-cost lumber grade-mix solver

Treesearch

U. Buehlmann; R. Buck; R.E. Thomas

2011-01-01

Hardwood lumber costs account for up to 70 percent of the total product costs of U.S. secondary wood products producers. Reducing these costs is difficult and often requires substantial capital investments. However, lumber-purchasing costs can be minimized by buying the least-cost lumber grade-mix that satisfies a company's component needs. Price differentials...

Economics of image guidance and navigation in spine surgery.

PubMed

Al-Khouja, Lutfi; Shweikeh, Faris; Pashman, Robert; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2015-01-01

Image-guidance and navigation in spinal surgery is becoming more widely utilized. Several studies have shown the use of this technology to increase accuracy of pedicle screw placement, decrease the rates of revision surgery, and minimize radiation exposure. In this paper, the authors analyze the economics of image-guided surgery (IGS) and navigation in spine surgery. A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database. Each article was screened for inclusion and exclusion criteria, including costs, reoperation, readmission rates, operating room time, and length of stay. Thirteen studies were included in the analysis. Six studies were identified to meet the inclusion criteria for reporting costs and seven met the criteria for analysis of efficacy. Average costs ranged from $17,650 to $39,643. Pedicle screw misplacement rates using IGS ranged from 1.20% to 15.07% while reoperation rates ranged from 0% to 7.42%. There is currently an insufficient amount of studies reporting on the economics of spinal navigation to accurately conclude on its cost-effectiveness in clinical practice. Although a few of these studies showed less costs associated with intraoperative imaging, none were able to establish a statistically significant difference. Preliminary findings drawn from this study indicate a possible cost-effectiveness advantage with IGS, but more comprehensive data on costs need to be reported in order to validate its utilization.

Financial costs for families of children with Type 1 diabetes in lower-income countries.

PubMed

Ogle, G D; Kim, H; Middlehurst, A C; Silink, M; Jenkins, A J

2016-06-01

To assess the direct costs of necessary consumables for minimal care of a child with Type 1 diabetes in countries where the public health system does not regularly provide such care. Supply costs were collected between January 2013 and February 2015 from questionnaires submitted by centres requesting International Diabetes Federation Life for a Child Program support. All 20 centres in 15 countries agreed to the use of their responses. Annual costs for minimal care were estimated for: 18 × 10 ml 100 IU/ml insulin, 1/3 cost of a blood glucose meter, two blood glucose test strips/day, two syringes/week, and four HbA1c tests/year. Costs were expressed in US dollars, and as % of gross national income (purchasing power parity) per capita. The ranges (median) for the minimum supply costs through the private system were: insulin 10 ml 100 IU/ml equivalent vial: $5.10-$25 ($8.00); blood glucose meter: $15-$121 ($33.33); test strip: $0.15-$1.20 ($0.50); syringe: $0.10-$0.56 ($0.20); and HbA1c : $4.90-$20 ($9.75). Annual costs ranged from $255 (Pakistan) to $1,185 (Burkina Faso), with a median of $553. Annual % gross national income costs were 12-370% (median 56%). For the lowest 20% income earners the annual cost ranged 20-1535% (median 153%). St Lucia and Mongolia were the only countries whose governments consistently provided insulin. No government provided meters and strips, which were the most expensive supplies (62% of total cost). In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed. © 2015 Diabetes UK.

Minimally invasive treatment of ureteropelvic junction obstruction: a critical analysis of results.

PubMed

Eden, Christopher G

2007-10-01

To analyse the indications and long-term results of endoscopic and minimal access approaches for the treatment of ureteropelvic junction (UPJ) obstruction and to compare them to open surgery. A review of the literature from 1950 to January 2007 was conducted using the Ovid Medline database. A lack of standardisation of techniques used to diagnose UPJ obstruction and to follow up treated patients introduces a degree of inaccuracy in interpreting the success rates of the various modalities of treatment. However, there is no indication that any one of these techniques is affected by this to a greater or lesser extent than another. Open pyeloplasty achieves very good (90-100% success) results, endopyelotomy and balloon disruption of the UPJ fail to match these results by 15-20%, and minimal access pyeloplasty produces results that are at least as good as those of open surgery but with the advantages of a minimal access approach. Minimal access pyeloplasty is likely to gradually replace endopyelotomy and balloon disruption of the UPJ for the treatment of UPJ obstruction. The much higher cost of robotic pyeloplasty and greater availability of laparoscopic expertise in teaching centres are likely to limit the dissemination of robotic pyeloplasty.

Retrospective return on investment analysis of an electronic treatment adherence device piloted in the Northern Cape Province.

PubMed

Broomhead, Sean; Mars, Maurice

2012-01-01

The return on investment (ROI) for utilizing the SIMpill electronic treatment adherence solution as an adjunct to directly observed treatment short-course (DOTS) is assessed using data from a 2005 pilot of the SIMpill solution among new smear-positive tuberculosis (TB) patients in the Northern Cape Province. The value of this cost minimization analysis (CMA), for use by public health planners in low-resource settings as a precursor to more rigorous assessment, is discussed. The retrospective analysis compares the costs and health outcomes of the DOTS-SIMpill cohort with DOTS-only controls. Hypothetical 5-year cash flows are generated and discounted to estimate net present values (NPVs). Comparison between the DOTS-SIMpill pilot cohort and DOTS-only supported controls, for a hypothetical implementation of 1,000 devices, over 5 years, demonstrates positive ROI for the DOTS-SIMpill cohort based on improved health outcomes and reduced average cost per patient. The net stream is shown to be positive from the first year. Discounted NPV is ZAR 3,255,256 (US$ 493,221) for a cohort that would have started mid 2005 and ZAR 3,747,636 (US$ 487,339) starting mid 2010. This is an ROI of 23% over the 5-year period. The addition of electronic treatment adherence support technology can help to improve TB outcomes and lower average cost per patient by reducing treatment failure and the associated higher cost and burden on limited resources. CMA is an appropriate initial analysis for health planners to highlight options that may justify more sophisticated methods such as cost effectiveness analysis or full cost benefit analysis where a preferred option is immediately revealed. CMA is proposed as a tool for use by public health planners in low-resource settings to evaluate the ROI of treatment adherence technology postpilot and prior to implementation.

Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense?

PubMed

Schwaitzberg, S D

2016-05-01

More than 500,000 robotically assisted procedures were performed worldwide in 2013. Despite broad adoption, there remains a lack of clarity concerning the added cost of the robotic system to the procedure especially in light of an increasing number of ambulatory procedures which are now marketed by hospitals, surgeons and the manufacturer. These procedures are associated with much less reimbursement than inpatient procedures. It is unclear whether these added expenses can be absorbed in these scenarios. Reports vary in opinion concerning the added net costs during robotically assisted laparoscopic hernia or cholecystectomy. The worldwide revenues, procedures, and the installed base of robotic system data were reviewed and reanalyzed from the 2013 Intuitive Surgical Investors report. This provided an opportunity to look cost per case projections from the vantage point of actual revenue. This analysis was based on revenue of 2.27 billion US dollars in the three categories of capital acquisition, instrumentation and accessories, and service revenue. These revenues were then spread across 523,000 cases with varying assumptions. Without regard to expense offsets, the additional cost ranges from $2908 to $8675 depending on what system was purchased and the ability to distribute costs against case volume. Estimates of commercial and government revenue were then compared against these expenses. The use of the extraordinary technology in the face of low-morbidity low-cost established minimally invasive procedures needs to withstand scrutiny of outcome assessment, revenue and expense considerations and appropriateness review in order to create financially viable approaches to high-volume minimally invasive procedures. Revenue estimates associated with outpatient reimbursement make it difficult to support these expenses, recognizing inpatient procedures represent a different net financial picture.

Costs of medical care after open or minimally invasive prostate cancer surgery: a population-based analysis.

PubMed

Lowrance, William T; Eastham, James A; Yee, David S; Laudone, Vincent P; Denton, Brian; Scardino, Peter T; Elkin, Elena B

2012-06-15

Evidence suggests that minimally invasive radical prostatectomy (MRP) and open radical prostatectomy (ORP) have similar short-term clinical and functional outcomes. MRP with robotic assistance is generally more expensive than ORP, but it is not clear whether subsequent costs of care vary by approach. In the Surveillance, Epidemiology, and End Results (SEER) cancer registry linked with Medicare claims, men aged 66 years or older who received MRP or ORP in 2003 through 2006 for prostate cancer were identified. Total cost of care was estimated as the sum of Medicare payments from all claims for hospital care, outpatient care, physician services, home health and hospice care, and durable medical equipment in the first year from the date of surgical admission. The impact of surgical approach on costs was estimated, controlling for patient and disease characteristics. Of 5445 surgically treated prostate cancer patients, 4454 (82%) had ORP and 991 (18%) had MRP. Mean total first-year costs were more than $1200 greater for MRP compared with ORP ($16,919 vs $15,692; P = .08). Controlling for patient and disease characteristics, MRP was associated with 2% greater mean total payments, but this difference was not statistically significant. First-year costs were greater for men who were older, black, lived in the Northeast, had lymph node involvement, more advanced tumor stage, or greater comorbidity. In this population-based cohort of older men, MRP and ORP had similar economic outcomes. From a payer's perspective, any benefits associated with MRP may not translate to net savings compared with ORP in the first year after surgery. Copyright © 2011 American Cancer Society.

Rate of transmission: a major determinant of the cost of clinical mastitis.

PubMed

Down, P M; Green, M J; Hudson, C D

2013-10-01

The aim of this research was to use probabilistic sensitivity analysis to evaluate the relative importance of different components of a model designed to estimate the cost of clinical mastitis (CM). A particular focus was placed on the importance of pathogen transmission relative to other factors, such as milk price or treatment costs. A stochastic Monte Carlo model was developed to simulate a case of CM at the cow level and to calculate the associated costs for 5 defined treatment protocols. The 5 treatment protocols modeled were 3 d of antibiotic intramammary treatment, 5 d of antibiotic intramammary treatment, 3 d of intramammary and systemic antibiotic treatment, 3d of intramammary and systemic antibiotic treatment plus 1 d of nonsteroidal antiinflammatory drug treatment, and 5 d of intramammary and systemic antibiotic treatment. Uniform distributions were used throughout the model to enable investigation of the cost of CM over a spectrum of clinically realistic scenarios without specifying which scenario was more or less likely. A risk of transmission parameter distribution, based on literature values, was included to model the effect of pathogen transmission to uninfected cows, from cows that remained subclinically infected after treatment for CM. Spearman rank correlation coefficients were used to evaluate the relationships between model input values and the estimated cost of CM. Linear regression models were used to explore the effect that changes to specific independent variables had on the cost of CM. Risk of transmission was found to have the strongest association with the cost of CM, followed by bacteriological cure rate, cost of culling, and yield loss. Other factors such as milk price, cost of labor, and cost of medicines were of minimal influence in comparison. The cost of CM was similar for all 5 treatment protocols. The results from this study suggest that, when seeking to minimize the economic impact of CM in dairy herds, great emphasis should be placed on the reduction of pathogen transmission from cows with CM to uninfected cows. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia: results from a cluster randomized cross-over trial.

PubMed

van Werkhoven, Cornelis H; Postma, Douwe F; Mangen, Marie-Josee J; Oosterheert, Jan Jelrik; Bonten, Marc J M

2017-01-10

To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy. Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i.e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death. A total of 2,283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were €4,294, €4,392, and €4,002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were €106 (95% CI €-697 to €754) for the beta-lactam/macrolide combination strategy and €-278 (95%CI €-991 to €396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results. There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy. The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.

Upstream solutions to coral reef conservation: The payoffs of smart and cooperative decision-making.

PubMed

Oleson, Kirsten L L; Falinski, Kim A; Lecky, Joey; Rowe, Clara; Kappel, Carrie V; Selkoe, Kimberly A; White, Crow

2017-04-15

Land-based source pollutants (LBSP) actively threaten coral reef ecosystems globally. To achieve the greatest conservation outcome at the lowest cost, managers could benefit from appropriate tools that evaluate the benefits (in terms of LBSP reduction) and costs of implementing alternative land management strategies. Here we use a spatially explicit predictive model (InVEST-SDR) that quantifies change in sediment reaching the coast for evaluating the costs and benefits of alternative threat-abatement scenarios. We specifically use the model to examine trade-offs among possible agricultural road repair management actions (water bars to divert runoff and gravel to protect the road surface) across the landscape in West Maui, Hawaii, USA. We investigated changes in sediment delivery to coasts and costs incurred from management decision-making that is (1) cooperative or independent among landowners, and focused on (2) minimizing costs, reducing sediment, or both. The results illuminate which management scenarios most effectively minimize sediment while also minimizing the cost of mitigation efforts. We find targeting specific "hotspots" within all individual parcels is more cost-effective than targeting all road segments. The best outcomes are achieved when landowners cooperate and target cost-effective road repairs, however, a cooperative strategy can be counter-productive in some instances when cost-effectiveness is ignored. Simple models, such as the one developed here, have the potential to help managers make better choices about how to use limited resources. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Comparative analysis for various redox flow batteries chemistries using a cost performance model

NASA Astrophysics Data System (ADS)

Crawford, Alasdair; Viswanathan, Vilayanur; Stephenson, David; Wang, Wei; Thomsen, Edwin; Reed, David; Li, Bin; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

2015-10-01

The total energy storage system cost is determined by means of a robust performance-based cost model for multiple flow battery chemistries. Systems aspects such as shunt current losses, pumping losses and various flow patterns through electrodes are accounted for. The system cost minimizing objective function determines stack design by optimizing the state of charge operating range, along with current density and current-normalized flow. The model cost estimates are validated using 2-kW stack performance data for the same size electrodes and operating conditions. Using our validated tool, it has been demonstrated that an optimized all-vanadium system has an estimated system cost of < 350 kWh-1 for 4-h application. With an anticipated decrease in component costs facilitated by economies of scale from larger production volumes, coupled with performance improvements enabled by technology development, the system cost is expected to decrease to 160 kWh-1 for a 4-h application, and to 100 kWh-1 for a 10-h application. This tool has been shared with the redox flow battery community to enable cost estimation using their stack data and guide future direction.

Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer

PubMed Central

Goldstein, Daniel A.; Ahmad, Bilal B.; Chen, Qiushi; Ayer, Turgay; Howard, David H.; Lipscomb, Joseph; El-Rayes, Bassel F.; Flowers, Christopher R.

2015-01-01

Purpose Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. Methods We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Results Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Conclusion Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing. PMID:26304904

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

PubMed

Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

2017-01-01

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.

Unbalanced and Minimal Point Equivalent Estimation Second-Order Split-Plot Designs

NASA Technical Reports Server (NTRS)

Parker, Peter A.; Kowalski, Scott M.; Vining, G. Geoffrey

2007-01-01

Restricting the randomization of hard-to-change factors in industrial experiments is often performed by employing a split-plot design structure. From an economic perspective, these designs minimize the experimental cost by reducing the number of resets of the hard-to- change factors. In this paper, unbalanced designs are considered for cases where the subplots are relatively expensive and the experimental apparatus accommodates an unequal number of runs per whole-plot. We provide construction methods for unbalanced second-order split- plot designs that possess the equivalence estimation optimality property, providing best linear unbiased estimates of the parameters; independent of the variance components. Unbalanced versions of the central composite and Box-Behnken designs are developed. For cases where the subplot cost approaches the whole-plot cost, minimal point designs are proposed and illustrated with a split-plot Notz design.

Cost reduction in space operations - Structuring a planetary program to minimize the annual funding requirement as opposed to minimizing the program runout cost

NASA Technical Reports Server (NTRS)

Herman, D. H.; Niehoff, J. C.; Spadoni, D. J.

1980-01-01

An approach is proposed for the structuring of a planetary mission set wherein the peak annual funding is minimized to meet the annual budget restraint. One aspect of the approach is to have a transportation capability that can launch a mission in any planetary opportunity; such capability can be provided by solar electric propulsion. Another cost reduction technique is to structure a mission test in a time sequenced fashion that could utilize essentially the same spacecraft for the implementation of several missions. A third technique would be to fulfill a scientific objective in several sequential missions rather than attempt to accomplish all of the objectives with one mission. The application of the approach is illustrated by an example involving the Solar Orbiter Dual Probe mission.

Aether: leveraging linear programming for optimal cloud computing in genomics

PubMed Central

Luber, Jacob M; Tierney, Braden T; Cofer, Evan M; Patel, Chirag J

2018-01-01

Abstract Motivation Across biology, we are seeing rapid developments in scale of data production without a corresponding increase in data analysis capabilities. Results Here, we present Aether (http://aether.kosticlab.org), an intuitive, easy-to-use, cost-effective and scalable framework that uses linear programming to optimally bid on and deploy combinations of underutilized cloud computing resources. Our approach simultaneously minimizes the cost of data analysis and provides an easy transition from users’ existing HPC pipelines. Availability and implementation Data utilized are available at https://pubs.broadinstitute.org/diabimmune and with EBI SRA accession ERP005989. Source code is available at (https://github.com/kosticlab/aether). Examples, documentation and a tutorial are available at http://aether.kosticlab.org. Contact chirag_patel@hms.harvard.edu or aleksandar.kostic@joslin.harvard.edu Supplementary information Supplementary data are available at Bioinformatics online. PMID:29228186

Organ Donor Recovery Performed at an Organ Procurement Organization-Based Facility Is an Effective Way to Minimize Organ Recovery Costs and Increase Organ Yield.

PubMed

Doyle, Majella; Subramanian, Vijay; Vachharajani, Neeta; Collins, Kelly; Wellen, Jason R; Stahlschmidt, Emily; Brockmeier, Diane; Coleman, Jason; Kappel, Dean; Chapman, William C

2016-04-01

A new era in organ donation with national redistricting is being proposed. With these proposals, costs of organ acquisition are estimated to more than double. Traditionally, organ recoveries occur in the donor hospital setting, incurring premium hospital expenses. The aim of the study was to determine organ recovery costs and organ yield for donor recoveries performed at an organ procurement organization (OPO) facility. In 2001, we established an OPO facility and in 2008 began transferring the donor expeditiously when brain death was declared. The OPO donor and hospital costs on a per donor basis were calculated. Donation after cardiac death donors cannot be transferred and were included in the hospital cost analysis. From January 2009 to December 2014, nine hundred and sixty-three donors originating in our OPO had organs recovered and transplanted. Seven hundred and sixty-six (79.5%) donors were transferred to the OPO facility 8.6 hours (range 0.6 to 23.6 hours) after declaration of brain death. Donor recovery cost was 51% less when donors were transferred to the OPO facility ($16,153 OPO recovery vs $33,161 hospital recovery; p < 0.0001). Organ yield was 27.5% better (3.43 organs) from OPO-recovered donors vs an organ yield of 2.69 from hospital-recovered donors (p < 0.0001). Standard criteria donor organ yield from our OPO was 6% higher than the national average (3.92 vs 3.7 nationally; p = 0.012) and expanded criteria donor organ yield was 18% higher (2.2 vs 1.87 nationally; p = 0.03). An OPO facility for donor organ recovery increases efficiency and organ yield, reduces costs, and minimizes organ acquisition charge. As we face new considerations with broader sharing, increased efficiencies, cost. and organ use should be considered. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis.

PubMed

Legrand, Guillaume; Ruscio, Laura; Benhamou, Dan; Pelletier-Fleury, Nathalie

2015-07-01

Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets.

PubMed

Parlesak, Alexandr; Tetens, Inge; Dejgård Jensen, Jørgen; Smed, Sinne; Gabrijelčič Blenkuš, Mojca; Rayner, Mike; Darmon, Nicole; Robertson, Aileen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.

The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part II. A cost analysis.

PubMed

Jansen, Leigh A; Macadam, Sheina A

2011-06-01

Increasingly, AlloDerm is being used in alloplastic breast reconstruction, and has been the subject of a recent systematic review. The authors' objective was to perform a cost analysis comparing direct-to-implant with AlloDerm reconstruction to two-stage non-AlloDerm reconstruction. Seven clinically important health outcomes and their probabilities for both types of reconstruction were derived from the recent review. A decision analytic model from the Canadian provincial payer's perspective was constructed based on these health states. Direct medical costs were estimated from a university-based hospital, yielding expected costs for direct-to-implant reconstruction with AlloDerm and two-stage non-AlloDerm reconstruction. Sensitivity analyses were conducted. Baseline and expected costs were calculated for direct-to-implant AlloDerm and two-stage non-AlloDerm reconstruction. Direct-to-implant reconstruction with AlloDerm was found to be less expensive in the baseline ($10,240 versus $10,584) and expected cost ($10,734 versus $11,251) using a 6 × 16-cm AlloDerm sheet. With a 6 × 12-cm sheet, expected cost falls to $9673. By increasing direct-to-implant operative time from 2 hours to 2.5 hours, expected cost rises to $11,784. If capsular contracture rate requiring revision is set at 15 percent for both procedures, expected costs are $10,926 and $11,251 for direct-to-implant and two-stage procedures, respectively. If the capsular contracture rate is lowered for either procedure, this has minimal impact on expected cost. Although AlloDerm is expensive, it appears to be cost-effective if used for direct-to-implant breast reconstruction. The methods used here may be extrapolated to different centers incorporating local costs and complication rates. A formal randomized controlled trial, including costs, is recommended.

An evaluation of the budget impact of a new 20% subcutaneous immunoglobulin (Ig20Gly) for the management of primary immunodeficiency diseases in Switzerland.

PubMed

Pollock, Richard F; Meckley, Lisa M

2018-01-01

While most individual primary immunodeficiency diseases (PID) are rare, the collective prevalence of PID results in a substantial economic and clinical burden. The aim of this study was to evaluate the budgetary implications of Ig20Gly (Immune Globulin Subcutaneous [human] 20% solution; CUVITRU ® , Baxalta US Inc, now part of Shire Plc, Westlake Village, CA, USA) as a treatment for PID relative to intravenous immunoglobulin (IVIG) and other subcutaneous immunoglobulin (SCIG) formulations in the Swiss health care setting. A budget impact model was developed in Microsoft Excel to capture the estimated prevalence of PID in Switzerland, the proportion of patients treated in different health care settings, and the costs of administering SCIG and IVIG in each setting. Unit costs were based on a recent cost-minimization analysis of SCIG in Lausanne, and drug costs were taken from the Spezialitätenliste. All costs were reported in 2016 Swiss Francs (CHF), and future costs were not discounted. The total cost of treating PID in Switzerland was estimated to be CHF 11.16 m over 3 years, comprising CHF 9.28 m of drug costs and CHF 1.87 m of ancillary costs, including health care professional time and other administration costs, such as pumps and needle sets. The analysis showed that using Ig20Gly in place of other SCIG formulations would be cost neutral, while using Ig20Gly in place of IVIG would result in savings of 4.0%. Ig20Gly would be cost neutral relative to existing SCIG products and would result in cost savings relative to IVIG in patients with PID in Switzerland, even with modest uptake.

Percutaneous Kirschner Wire Versus Commercial Implant for Hammertoe Repair: A Cost-Effectiveness Analysis.

PubMed

Albright, Rachel H; Waverly, Brett J; Klein, Erin; Weil, Lowell; Weil, Lowell S; Fleischer, Adam E

Hammertoe deformities are one of the most common foot deformities, affecting up to one third of the general population. Fusion of the joint can be achieved with various devices, with the current focus on percutaneous Kirschner (K)-wire fixation or commercial intramedullary implant devices. The purpose of the present study was to determine whether surgical intervention with percutaneous K-wire fixation versus commercial intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic tree model was conducted to investigate the healthcare costs and outcomes associated with either K-wire or commercial intramedullary implant fixation. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. Our results found that commercial implants were minimally more effective than K-wires but carried significantly higher costs. The total cost for treatment with percutaneous K-wire fixation was $5041 with an effectiveness of 0.82 QALY compared with a commercial implant cost of $6059 with an effectiveness of 0.83 QALY. The incremental cost-effectiveness ratio of commercial implants was $146,667. With an incremental cost-effectiveness ratio of >$50,000, commercial implants failed to justify their proposed benefits to outweigh their cost compared to percutaneous K-wire fixation. In conclusion, percutaneous K-wire fixation would be preferred for arthrodesis of the proximal interphalangeal joint for hammertoes from a healthcare system perspective. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Optimal strategies for the surveillance and control of forest pathogens: A case study with oak wilt

Treesearch

Tetsuya Horie; Robert G. Haight; Frances R. Homans; Robert C. Venette

2013-01-01

Cost-effective strategies are needed to find and remove diseased trees in forests damaged by pathogens. We develop a model of cost-minimizing surveillance and control of forest pathogens across multiple sites where there is uncertainty about the extent of the infestation in each site and when the goal is to minimize the expected number of new infections. We allow for a...

L{sup {infinity}} Variational Problems with Running Costs and Constraints

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

Aronsson, G., E-mail: gunnar.aronsson@liu.se; Barron, E. N., E-mail: enbarron@math.luc.edu

2012-02-15

Various approaches are used to derive the Aronsson-Euler equations for L{sup {infinity}} calculus of variations problems with constraints. The problems considered involve holonomic, nonholonomic, isoperimetric, and isosupremic constraints on the minimizer. In addition, we derive the Aronsson-Euler equation for the basic L{sup {infinity}} problem with a running cost and then consider properties of an absolute minimizer. Many open problems are introduced for further study.

Navy Program Manager’s Guide, 1985 Edition

DTIC Science & Technology

1985-01-01

1-7 Relationship of Development Cost in System Life -Cycle Cost (LCC) ......................... 1-7 Realistic Costing and Budgeting...Review (PROR)..... 4-53 x MI *) First-Article Configuration Inspection (FACI) ...... 4-54 Cost Management- Life -Cycle Costing (LCC) ..................... 4...innovation and minimize costs. 4. Consideration of life -cycle cost (LCC) such that affordability is put on an equal basis with system performance, schedule

A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia

PubMed Central

Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

2017-01-01

Background Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. Methods We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Results Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group (p<0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN (p=0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. Conclusion AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy. PMID:29138585

Cost-effectiveness of Store-and-Forward Teledermatology: A Systematic Review.

PubMed

Snoswell, Centaine; Finnane, Anna; Janda, Monika; Soyer, H Peter; Whitty, Jennifer A

2016-06-01

Teledermatology is a topical clinical approach being tested in Australia and elsewhere. With most dermatologists residing in metropolitan areas, teledermatology provides an apparent low-cost and convenient means of access for individuals living outside these areas. It is important that any proposed new addition to a health care system is assessed on the grounds of economic cost and effectiveness. To summarize and evaluate the current economic evidence comparing store-and-forward teledermatology (S&FTD) with conventional face-to-face care. Search terms with appropriate amendments were used to identify S&FTD articles that included economic analysis. Six databases were searched, and title, abstract and full-text reviews were conducted by 2 researchers. References of all unique returned articles were searched by hand. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate quality of the included articles. Eleven articles were selected for inclusion, including 1 cost analysis, 4 cost-minimization analyses, 4 cost-effectiveness analyses, and 2 cost-utility analyses. CHEERS scores ranged from 7 to 21 out of a possible 24 points, with a median score of 17. Current evidence is sparse but suggests that S&FTD can be cost-effective. It appears to be cost-effective when used as a triage mechanism to reduce face-to-face appointment requirements. The cost-effectiveness of S&FTD increases when patients are required to travel farther distances to access dermatology services. Further economic research is required for the emerging S&FTD, which uses dermoscopes in combination with smartphone applications, as well as regarding the possibility and consequences of patients self-capturing and transmitting images.

Integrated Building Energy Systems Design Considering Storage Technologies

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

Stadler, Michael; Marnay, Chris; Siddiqui, Afzal

The addition of storage technologies such as flow batteries, conventional batteries, and heat storage can improve the economic, as well as environmental attraction of micro-generation systems (e.g., PV or fuel cells with or without CHP) and contribute to enhanced demand response. The interactions among PV, solar thermal, and storage systems can be complex, depending on the tariff structure, load profile, etc. In order to examine the impact of storage technologies on demand response and CO2 emissions, a microgrid's distributed energy resources (DER) adoption problem is formulated as a mixed-integer linear program that can pursue two strategies as its objective function.more » These two strategies are minimization of its annual energy costs or of its CO2 emissions. The problem is solved for a given test year at representative customer sites, e.g., nursing homes, to obtain not only the optimal investment portfolio, but also the optimal hourly operating schedules for the selected technologies. This paper focuses on analysis of storage technologies in micro-generation optimization on a building level, with example applications in New York State and California. It shows results from a two-year research projectperformed for the U.S. Department of Energy and ongoing work. Contrary to established expectations, our results indicate that PV and electric storage adoption compete rather than supplement each other considering the tariff structure and costs of electricity supply. The work shows that high electricity tariffs during on-peak hours are a significant driver for the adoption of electric storage technologies. To satisfy the site's objective of minimizing energy costs, the batteries have to be charged by grid power during off-peak hours instead of PV during on-peak hours. In contrast, we also show a CO2 minimization strategy where the common assumption that batteries can be charged by PV can be fulfilled at extraordinarily high energy costs for the site.« less

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

Canavan, G.H.

This note studies the impact of maximizing the stability index rather than minimizing the first strike cost in choosing offensive missile allocations. It does so in the context of a model in which exchanges between vulnerable missile forces are modeled probabilistically, converted into first and second strike costs through approximations to the value target sets at risk, and the stability index is taken to be their ratio. The value of the allocation that minimizes the first strike cost for both attack preferences are derived analytically. The former recovers results derived earlier. The latter leads to an optimum at unity allocationmore » for which the stability index is determined analytically. For values of the attack preference greater than about unity, maximizing the stability index increases the cost of striking first 10--15%. For smaller values of the attack preference, maximizing the index increases the second strike cost a similar amount. Both are stabilizing, so if both sides could be trusted to target on missiles in order to minimize damage to value and maximize stability, the stability index for vulnerable missiles could be increased by about 15%. However, that would increase the cost to the first striker by about 15%. It is unclear why--having decided to strike--he would do so in a way that would increase damage to himself.« less

Optimum sample size allocation to minimize cost or maximize power for the two-sample trimmed mean test.

PubMed

Guo, Jiin-Huarng; Luh, Wei-Ming

2009-05-01

When planning a study, sample size determination is one of the most important tasks facing the researcher. The size will depend on the purpose of the study, the cost limitations, and the nature of the data. By specifying the standard deviation ratio and/or the sample size ratio, the present study considers the problem of heterogeneous variances and non-normality for Yuen's two-group test and develops sample size formulas to minimize the total cost or maximize the power of the test. For a given power, the sample size allocation ratio can be manipulated so that the proposed formulas can minimize the total cost, the total sample size, or the sum of total sample size and total cost. On the other hand, for a given total cost, the optimum sample size allocation ratio can maximize the statistical power of the test. After the sample size is determined, the present simulation applies Yuen's test to the sample generated, and then the procedure is validated in terms of Type I errors and power. Simulation results show that the proposed formulas can control Type I errors and achieve the desired power under the various conditions specified. Finally, the implications for determining sample sizes in experimental studies and future research are discussed.

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.

Application of Harmony Search algorithm to the solution of groundwater management models

NASA Astrophysics Data System (ADS)

Tamer Ayvaz, M.

2009-06-01

This study proposes a groundwater resources management model in which the solution is performed through a combined simulation-optimization model. A modular three-dimensional finite difference groundwater flow model, MODFLOW is used as the simulation model. This model is then combined with a Harmony Search (HS) optimization algorithm which is based on the musical process of searching for a perfect state of harmony. The performance of the proposed HS based management model is tested on three separate groundwater management problems: (i) maximization of total pumping from an aquifer (steady-state); (ii) minimization of the total pumping cost to satisfy the given demand (steady-state); and (iii) minimization of the pumping cost to satisfy the given demand for multiple management periods (transient). The sensitivity of HS algorithm is evaluated by performing a sensitivity analysis which aims to determine the impact of related solution parameters on convergence behavior. The results show that HS yields nearly same or better solutions than the previous solution methods and may be used to solve management problems in groundwater modeling.

VDA, a Method of Choosing a Better Algorithm with Fewer Validations

PubMed Central

Kluger, Yuval

2011-01-01

The multitude of bioinformatics algorithms designed for performing a particular computational task presents end-users with the problem of selecting the most appropriate computational tool for analyzing their biological data. The choice of the best available method is often based on expensive experimental validation of the results. We propose an approach to design validation sets for method comparison and performance assessment that are effective in terms of cost and discrimination power. Validation Discriminant Analysis (VDA) is a method for designing a minimal validation dataset to allow reliable comparisons between the performances of different algorithms. Implementation of our VDA approach achieves this reduction by selecting predictions that maximize the minimum Hamming distance between algorithmic predictions in the validation set. We show that VDA can be used to correctly rank algorithms according to their performances. These results are further supported by simulations and by realistic algorithmic comparisons in silico. VDA is a novel, cost-efficient method for minimizing the number of validation experiments necessary for reliable performance estimation and fair comparison between algorithms. Our VDA software is available at http://sourceforge.net/projects/klugerlab/files/VDA/ PMID:22046256

Energy and economic analysis of total energy systems for residential and commercial buildings. [utilizing waste heat recovery techniques

NASA Technical Reports Server (NTRS)

Maag, W. L.; Bollenbacher, G.

1974-01-01

Energy and economic analyses were performed for an on-site power-plant with waste heat recovery. The results show that for any specific application there is a characteristic power conversion efficiency that minimizes fuel consumption, and that efficiencies greater than this do not significantly improve fuel consumption. This type of powerplant appears to be a reasonably attractive investment if higher fuel costs continue.

Medication Waste Reduction in Pediatric Pharmacy Batch Processes

PubMed Central

Veltri, Michael A.; Hamrock, Eric; Mollenkopf, Nicole L.; Holt, Kristen; Levin, Scott

2014-01-01

OBJECTIVES: To inform pediatric cart-fill batch scheduling for reductions in pharmaceutical waste using a case study and simulation analysis. METHODS: A pre and post intervention and simulation analysis was conducted during 3 months at a 205-bed children's center. An algorithm was developed to detect wasted medication based on time-stamped computerized provider order entry information. The algorithm was used to quantify pharmaceutical waste and associated costs for both preintervention (1 batch per day) and postintervention (3 batches per day) schedules. Further, simulation was used to systematically test 108 batch schedules outlining general characteristics that have an impact on the likelihood for waste. RESULTS: Switching from a 1-batch-per-day to a 3-batch-per-day schedule resulted in a 31.3% decrease in pharmaceutical waste (28.7% to 19.7%) and annual cost savings of $183,380. Simulation results demonstrate how increasing batch frequency facilitates a more just-in-time process that reduces waste. The most substantial gains are realized by shifting from a schedule of 1 batch per day to at least 2 batches per day. The simulation exhibits how waste reduction is also achievable by avoiding batch preparation during daily time periods where medication administration or medication discontinuations are frequent. Last, the simulation was used to show how reducing batch preparation time per batch provides some, albeit minimal, opportunity to decrease waste. CONCLUSIONS: The case study and simulation analysis demonstrate characteristics of batch scheduling that may support pediatric pharmacy managers in redesign toward minimizing pharmaceutical waste. PMID:25024671

Medication waste reduction in pediatric pharmacy batch processes.

PubMed

Toerper, Matthew F; Veltri, Michael A; Hamrock, Eric; Mollenkopf, Nicole L; Holt, Kristen; Levin, Scott

2014-04-01

To inform pediatric cart-fill batch scheduling for reductions in pharmaceutical waste using a case study and simulation analysis. A pre and post intervention and simulation analysis was conducted during 3 months at a 205-bed children's center. An algorithm was developed to detect wasted medication based on time-stamped computerized provider order entry information. The algorithm was used to quantify pharmaceutical waste and associated costs for both preintervention (1 batch per day) and postintervention (3 batches per day) schedules. Further, simulation was used to systematically test 108 batch schedules outlining general characteristics that have an impact on the likelihood for waste. Switching from a 1-batch-per-day to a 3-batch-per-day schedule resulted in a 31.3% decrease in pharmaceutical waste (28.7% to 19.7%) and annual cost savings of $183,380. Simulation results demonstrate how increasing batch frequency facilitates a more just-in-time process that reduces waste. The most substantial gains are realized by shifting from a schedule of 1 batch per day to at least 2 batches per day. The simulation exhibits how waste reduction is also achievable by avoiding batch preparation during daily time periods where medication administration or medication discontinuations are frequent. Last, the simulation was used to show how reducing batch preparation time per batch provides some, albeit minimal, opportunity to decrease waste. The case study and simulation analysis demonstrate characteristics of batch scheduling that may support pediatric pharmacy managers in redesign toward minimizing pharmaceutical waste.

Optimal dual-fuel propulsion for minimum inert weight or minimum fuel cost

NASA Technical Reports Server (NTRS)

Martin, J. A.

1973-01-01

An analytical investigation of single-stage vehicles with multiple propulsion phases has been conducted with the phasing optimized to minimize a general cost function. Some results are presented for linearized sizing relationships which indicate that single-stage-to-orbit, dual-fuel rocket vehicles can have lower inert weight than similar single-fuel rocket vehicles and that the advantage of dual-fuel vehicles can be increased if a dual-fuel engine is developed. The results also indicate that the optimum split can vary considerably with the choice of cost function to be minimized.

Estimation of the cost of large-scale school deworming programmes with benzimidazoles

PubMed Central

Montresor, A.; Gabrielli, A.F.; Engels, D.

2017-01-01

Summary This study estimates the cost of distributing benzimidazole tablets in the context of school deworming programmes: we analysed studies reporting the cost of school deworming from seven countries in four WHO regions. The estimated cost for drug procurement to cover one million children (including customs clearance and international transport) is approximately US$20 000. The estimated financial costs (including the cost of training of personnel, drug transport, social mobilization and monitoring) is, on average, equivalent to US$33 000 per million school-age children with minimal variation in different countries and continents. The estimated economic costs of distribution (including the time spent by teachers, and health personnel at central, provincial and district level) to cover one million children approximately corresponds to US$19 000. This study shows the minimal cost of school deworming activities, but also shows the significant contribution (corresponding to a quarter of the entire cost of the programme) provided by health and education systems in endemic countries even in the case of drug donations and donor support of distribution costs. PMID:19926104

Application of modern tools and techniques to maximize engineering productivity in the development of orbital operations plans for the space station progrm

NASA Technical Reports Server (NTRS)

Manford, J. S.; Bennett, G. R.

1985-01-01

The Space Station Program will incorporate analysis of operations constraints and considerations in the early design phases to avoid the need for later modifications to the Space Station for operations. The application of modern tools and administrative techniques to minimize the cost of performing effective orbital operations planning and design analysis in the preliminary design phase of the Space Station Program is discussed. Tools and techniques discussed include: approach for rigorous analysis of operations functions, use of the resources of a large computer network, and providing for efficient research and access to information.

Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

PubMed

Mmeje, Chinedu O; Martin, Aaron D; Nunez-Nateras, Rafael; Parker, Alexander S; Thiel, David D; Castle, Erik P

2013-02-01

Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

Essays on wholesale auctions in deregulated electricity markets

NASA Astrophysics Data System (ADS)

Baltaduonis, Rimvydas

2007-12-01

The early experience in the restructured electric power markets raised several issues, including price spikes, inefficiency, security, and the overall relationship of market clearing prices to generation costs. Unsatisfactory outcomes in these markets are thought to have resulted in part from strategic generator behaviors encouraged by inappropriate market design features. In this dissertation, I examine the performance of three auction mechanisms for wholesale power markets - Offer Cost Minimization auction, Payment Cost Minimization auction and Simple-Offer auction - when electricity suppliers act strategically. A Payment Cost Minimization auction has been proposed as an alternative to the traditional Offer Cost Minimization auction with the intention to solve the problem of inflated wholesale electricity prices. Efficiency concerns for this proposal were voiced due to insights predicated on the assumption of true production cost revelation. Using a game theoretic approach and an experimental method, I compare the two auctions, strictly controlling for the level of unilateral market power. A specific feature of these complex-offer auctions is that the sellers submit not only the quantities and the minimum prices that they are willing to sell at, but also the start-up fees, which are designed to reimburse the fixed start-up costs of the generation plants. I find that the complex structure of the offers leaves considerable room for strategic behavior, which consequently leads to anti-competitive and inefficient market outcomes. In the last chapter of my dissertation, I use laboratory experiments to contrast the performance of two complex-offer auctions against the performance of a simple-offer auction, in which the sellers have to recover all their generation costs - fixed and variable - through a uniform market-clearing price. I find that a simple-offer auction significantly reduces consumer prices and lowers price volatility. It mitigates anti-competitive effects that are present in the complex-offer auctions and achieves allocative efficiency more quickly.

Assessing efficiency of spatial sampling using combined coverage analysis in geographical and feature spaces

NASA Astrophysics Data System (ADS)

Hengl, Tomislav

2015-04-01

Efficiency of spatial sampling largely determines success of model building. This is especially important for geostatistical mapping where an initial sampling plan should provide a good representation or coverage of both geographical (defined by the study area mask map) and feature space (defined by the multi-dimensional covariates). Otherwise the model will need to extrapolate and, hence, the overall uncertainty of the predictions will be high. In many cases, geostatisticians use point data sets which are produced using unknown or inconsistent sampling algorithms. Many point data sets in environmental sciences suffer from spatial clustering and systematic omission of feature space. But how to quantify these 'representation' problems and how to incorporate this knowledge into model building? The author has developed a generic function called 'spsample.prob' (Global Soil Information Facilities package for R) and which simultaneously determines (effective) inclusion probabilities as an average between the kernel density estimation (geographical spreading of points; analysed using the spatstat package in R) and MaxEnt analysis (feature space spreading of points; analysed using the MaxEnt software used primarily for species distribution modelling). The output 'iprob' map indicates whether the sampling plan has systematically missed some important locations and/or features, and can also be used as an input for geostatistical modelling e.g. as a weight map for geostatistical model fitting. The spsample.prob function can also be used in combination with the accessibility analysis (cost of field survey are usually function of distance from the road network, slope and land cover) to allow for simultaneous maximization of average inclusion probabilities and minimization of total survey costs. The author postulates that, by estimating effective inclusion probabilities using combined geographical and feature space analysis, and by comparing survey costs to representation efficiency, an optimal initial sampling plan can be produced which satisfies both criteria: (a) good representation (i.e. within a tolerance threshold), and (b) minimized survey costs. This sampling analysis framework could become especially interesting for generating sampling plans in new areas e.g. for which no previous spatial prediction model exists. The presentation includes data processing demos with standard soil sampling data sets Ebergotzen (Germany) and Edgeroi (Australia), also available via the GSIF package.

Application of improved Vogel’s approximation method in minimization of rice distribution costs of Perum BULOG

NASA Astrophysics Data System (ADS)

Nahar, J.; Rusyaman, E.; Putri, S. D. V. E.

2018-03-01

This research was conducted at Perum BULOG Sub-Divre Medan which is the implementing institution of Raskin program for several regencies and cities in North Sumatera. Raskin is a program of distributing rice to the poor. In order to minimize rice distribution costs then rice should be allocated optimally. The method used in this study consists of the Improved Vogel Approximation Method (IVAM) to analyse the initial feasible solution, and Modified Distribution (MODI) to test the optimum solution. This study aims to determine whether the IVAM method can provide savings or cost efficiency of rice distribution. From the calculation with IVAM obtained the optimum cost is lower than the company's calculation of Rp945.241.715,5 while the cost of the company's calculation of Rp958.073.750,40. Thus, the use of IVAM can save rice distribution costs of Rp12.832.034,9.

National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty.

PubMed

Varda, Briony K; Johnson, Emilie K; Clark, Curtis; Chung, Benjamin I; Nelson, Caleb P; Chang, Steven L

2014-04-01

We performed a population based study comparing trends in perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. Specific billing items contributing to cost were also investigated. Using the Perspective database (Premier, Inc., Charlotte, North Carolina), we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 to 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications and costs for the competing surgical approaches. Propensity weighting was used to minimize selection bias. Sampling weights were used to yield a nationally representative sample. A decrease in open pyeloplasty and an increase in minimally invasive pyeloplasty were observed. All procedures had low complication rates. Compared to open pyeloplasty, laparoscopic and robotic pyeloplasty had longer median operative times (240 minutes, p <0.0001 and 270 minutes, p <0.0001, respectively). There was no difference in median length of stay. Median total cost was lower among patients undergoing open vs robotic pyeloplasty ($7,221 vs $10,780, p <0.001). This cost difference was largely attributable to robotic supply costs. During the study period open pyeloplasty made up a declining majority of cases. Use of laparoscopic pyeloplasty plateaued, while robotic pyeloplasty increased. Operative time was longer for minimally invasive pyeloplasty, while length of stay was equivalent across all procedures. A higher cost associated with robotic pyeloplasty was driven by operating room use and robotic equipment costs, which nullified low room and board cost. This study reflects an adoption period for robotic pyeloplasty. With time, perioperative outcomes and cost may improve. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Reexamining Sample Size Requirements for Multivariate, Abundance-Based Community Research: When Resources are Limited, the Research Does Not Have to Be.

PubMed

Forcino, Frank L; Leighton, Lindsey R; Twerdy, Pamela; Cahill, James F

2015-01-01

Community ecologists commonly perform multivariate techniques (e.g., ordination, cluster analysis) to assess patterns and gradients of taxonomic variation. A critical requirement for a meaningful statistical analysis is accurate information on the taxa found within an ecological sample. However, oversampling (too many individuals counted per sample) also comes at a cost, particularly for ecological systems in which identification and quantification is substantially more resource consuming than the field expedition itself. In such systems, an increasingly larger sample size will eventually result in diminishing returns in improving any pattern or gradient revealed by the data, but will also lead to continually increasing costs. Here, we examine 396 datasets: 44 previously published and 352 created datasets. Using meta-analytic and simulation-based approaches, the research within the present paper seeks (1) to determine minimal sample sizes required to produce robust multivariate statistical results when conducting abundance-based, community ecology research. Furthermore, we seek (2) to determine the dataset parameters (i.e., evenness, number of taxa, number of samples) that require larger sample sizes, regardless of resource availability. We found that in the 44 previously published and the 220 created datasets with randomly chosen abundances, a conservative estimate of a sample size of 58 produced the same multivariate results as all larger sample sizes. However, this minimal number varies as a function of evenness, where increased evenness resulted in increased minimal sample sizes. Sample sizes as small as 58 individuals are sufficient for a broad range of multivariate abundance-based research. In cases when resource availability is the limiting factor for conducting a project (e.g., small university, time to conduct the research project), statistically viable results can still be obtained with less of an investment.

A periodic review integrated inventory model with controllable safety stock and setup cost under service level constraint and distribution-free demand

NASA Astrophysics Data System (ADS)

Kurdhi, N. A.; Jamaluddin, A.; Jauhari, W. A.; Saputro, D. R. S.

2017-06-01

In this study, we consider a stochastic integrated manufacturer-retailer inventory model with service level constraint. The model analyzed in this article considers the situation in which the vendor and the buyer establish a long-term contract and strategic partnership to jointly determine the best strategy. The lead time and setup cost are assumed can be controlled by an additional crashing cost and an investment, respectively. It is assumed that shortages are allowed and partially backlogged on the buyer’s side, and that the protection interval (i.e., review period plus lead time) demand distribution is unknown but has given finite first and second moments. The objective is to apply the minmax distribution free approach to simultaneously optimize the review period, the lead time, the setup cost, the safety factor, and the number of deliveries in order to minimize the joint total expected annual cost. The service level constraint guarantees that the service level requirement can be satisfied at the worst case. By constructing Lagrange function, the analysis regarding the solution procedure is conducted, and a solution algorithm is then developed. Moreover, a numerical example and sensitivity analysis are given to illustrate the proposed model and to provide some observations and managerial implications.

Techno-economic analysis of using corn stover to supply heat and power to a corn ethanol plant - Part 1: Cost of feedstock supply logistics

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

Sokhansanj, Shahabaddine; Mani, Sudhagar; Togore, Sam

2010-01-01

Supply of corn stover to produce heat and power for a typical 170 dam3 dry mill ethanol plant is proposed. The corn ethanol plant requires 5.6 MW of electricity and 52.3 MW of process heat, which creates the annual stover demand of as much as 140 Gg. The corn stover supply system consists of collection, preprocessing, transportation and on-site fuel storage and preparation to produce heat and power for the ethanol plant. Economics of the entire supply system was conducted using the Integrated Biomass Supply Analysis and Logistics (IBSAL) simulation model. Corn stover was delivered in three formats (square bales,more » dry chops and pellets) to the combined heat and power plant. Delivered cost of biomass ready to be burned was calculated at 73 $ Mg-1 for bales, 86 $ Mg-1 for pellets and 84 $ Mg-1 for field chopped biomass. Among the three formats of stover supply systems, delivered cost of pelleted biomass was the highest due to high pelleting cost. Bulk transport of biomass in the form of chops and pellets can provide a promising future biomass supply logistic system in the US, if the costs of pelleting and transport are minimized.« less

Net present value analysis to select public R&D programs and valuate expected private sector participation

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

Hinman, N.D.; Yancey, M.A.

1997-12-31

One of the main functions of government is to invest taxpayers dollars in projects, programs, and properties that will result in social benefit. Public programs focused on the development of technology are examples of such opportunities. Selecting these programs requires the same investment analysis approaches that private companies and individuals use. Good use of investment analysis approaches to these programs will minimize our tax costs and maximize public benefit from tax dollars invested. This article describes the use of the net present value (NPV) analysis approach to select public R&D programs and valuate expected private sector participation in the programs.more » 5 refs.« less

Impact of minimally invasive surgery on healthcare utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH).

PubMed

Mikami, Dean J; Melvin, W Scott; Murayama, Michael J; Murayama, Kenric M

2017-11-01

Incisional hernia repair is one of the most common general surgery operations being performed today. With the advancement of laparoscopy since the 1990s, we have seen vast improvements in faster return to normal activity, shorter hospital stays and less post-operative narcotic use, to name a few. The key aims of this review were to measure the impact of minimally invasive surgery versus open surgery on health care utilization, cost, and work place absenteeism in the patients undergoing inpatient incisional/ventral hernia (IVH) repair. We analyzed data from the Truven Health Analytics MarketScan ® Commercial Claims and Encounters Database. Total of 2557 patients were included in the analysis. Of the patient that underwent IVH surgery, 24.5% (n = 626) were done utilizing minimally invasive surgical (MIS) techniques and 75.5% (n = 1931) were done open. Ninety-day post-surgery outcomes were significantly lower in the MIS group compared to the open group for total payment ($19,288.97 vs. $21,708.12), inpatient length of stay (3.12 vs. 4.24 days), number of outpatient visit (5.48 vs. 7.35), and estimated days off (11.3 vs. 14.64), respectively. At 365 days post-surgery, the total payment ($27,497.96 vs. $30,157.29), inpatient length of stay (3.70 vs. 5.04 days), outpatient visits (19.75 vs. 23.42), and estimated days off (35.71 vs. 41.58) were significantly lower for MIS group versus the open group, respectively. When surgical repair of IVH is performed, there is a clear advantage in the MIS approach versus the open approach in regard to cost, length of stay, number of outpatient visits, and estimated days off.

Cost-effectiveness of the stream-gaging program in New Jersey

USGS Publications Warehouse

Schopp, R.D.; Ulery, R.L.

1984-01-01

The results of a study of the cost-effectiveness of the stream-gaging program in New Jersey are documented. This study is part of a 5-year nationwide analysis undertaken by the U.S. Geological Survey to define and document the most cost-effective means of furnishing streamflow information. This report identifies the principal uses of the data and relates those uses to funding sources, applies, at selected stations, alternative less costly methods (that is flow routing, regression analysis) for furnishing the data, and defines a strategy for operating the program which minimizes uncertainty in the streamflow data for specific operating budgets. Uncertainty in streamflow data is primarily a function of the percentage of missing record and the frequency of discharge measurements. In this report, 101 continuous stream gages and 73 crest-stage or stage-only gages are analyzed. A minimum budget of $548,000 is required to operate the present stream-gaging program in New Jersey with an average standard error of 27.6 percent. The maximum budget analyzed was $650,000, which resulted in an average standard error of 17.8 percent. The 1983 budget of $569,000 resulted in a standard error of 24.9 percent under present operating policy. (USGS)

Analysis and optimization of hybrid electric vehicle thermal management systems

NASA Astrophysics Data System (ADS)

Hamut, H. S.; Dincer, I.; Naterer, G. F.

2014-02-01

In this study, the thermal management system of a hybrid electric vehicle is optimized using single and multi-objective evolutionary algorithms in order to maximize the exergy efficiency and minimize the cost and environmental impact of the system. The objective functions are defined and decision variables, along with their respective system constraints, are selected for the analysis. In the multi-objective optimization, a Pareto frontier is obtained and a single desirable optimal solution is selected based on LINMAP decision-making process. The corresponding solutions are compared against the exergetic, exergoeconomic and exergoenvironmental single objective optimization results. The results show that the exergy efficiency, total cost rate and environmental impact rate for the baseline system are determined to be 0.29, ¢28 h-1 and 77.3 mPts h-1 respectively. Moreover, based on the exergoeconomic optimization, 14% higher exergy efficiency and 5% lower cost can be achieved, compared to baseline parameters at an expense of a 14% increase in the environmental impact. Based on the exergoenvironmental optimization, a 13% higher exergy efficiency and 5% lower environmental impact can be achieved at the expense of a 27% increase in the total cost.

Sociology of the growth/no-growth debate

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

Humphrey, C.R.; Buttel, F.H.

The properties of conservative, liberal, and radical patterns in social science are analyzed and applied to the growth/no-growth debate in environmental policy literature. The fact that conservatives work with an evolutionary model of society suggests that environmental problems are imperfections to be remedied by science, technology, and the free market. Liberals recognize the benefits and costs of growth, and they articulate ways to minimize the costs through state regulation and planning. Radicals argue for state ownership of the means of production and new cultural values about growth as the only effective environmental policies. This analysis closes with a discussion ofmore » the future of the growth debate in terms of these paradigms. 40 references.« less

Enhanced solar energy options using earth-orbiting mirrors

NASA Technical Reports Server (NTRS)

Gilbreath, W. P.; Billman, K. W.; Bowen, S. W.

1978-01-01

A system of orbiting space reflectors is described, analyzed, and shown to economically provide nearly continuous insolation to preselected ground sites, producing benefits hitherto lacking in conventional solar farms and leading to large reductions in energy costs for such installations. Free-flying planar mirrors of about 1 sq km are shown to be optimum and can be made at under 10 g/sq m of surface, thus minimizing material needs and space transportation costs. Models are developed for both the design of such mirrors and for the analysis of expected ground insolation as a function of orbital parameters, time, and site location. Various applications (agricultural, solar-electric production, weather enhancement, etc.) are described.

Optimization of Highway Work Zone Decisions Considering Short-Term and Long-Term Impacts

DTIC Science & Technology

2010-01-01

strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature of this optimization problem, a heuristic...combination of lane closure and traffic control strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature ...zone) NV # the number of vehicle classes NPV $ Net Present Value p’(t) % Adjusted traffic diversion rate at time t p(t) % Natural diversion rate

A decision analysis approach for risk management of near-earth objects

NASA Astrophysics Data System (ADS)

Lee, Robert C.; Jones, Thomas D.; Chapman, Clark R.

2014-10-01

Risk management of near-Earth objects (NEOs; e.g., asteroids and comets) that can potentially impact Earth is an important issue that took on added urgency with the Chelyabinsk event of February 2013. Thousands of NEOs large enough to cause substantial damage are known to exist, although only a small fraction of these have the potential to impact Earth in the next few centuries. The probability and location of a NEO impact are subject to complex physics and great uncertainty, and consequences can range from minimal to devastating, depending upon the size of the NEO and location of impact. Deflecting a potential NEO impactor would be complex and expensive, and inter-agency and international cooperation would be necessary. Such deflection campaigns may be risky in themselves, and mission failure may result in unintended consequences. The benefits, risks, and costs of different potential NEO risk management strategies have not been compared in a systematic fashion. We present a decision analysis framework addressing this hazard. Decision analysis is the science of informing difficult decisions. It is inherently multi-disciplinary, especially with regard to managing catastrophic risks. Note that risk analysis clarifies the nature and magnitude of risks, whereas decision analysis guides rational risk management. Decision analysis can be used to inform strategic, policy, or resource allocation decisions. First, a problem is defined, including the decision situation and context. Second, objectives are defined, based upon what the different decision-makers and stakeholders (i.e., participants in the decision) value as important. Third, quantitative measures or scales for the objectives are determined. Fourth, alternative choices or strategies are defined. Fifth, the problem is then quantitatively modeled, including probabilistic risk analysis, and the alternatives are ranked in terms of how well they satisfy the objectives. Sixth, sensitivity analyses are performed in order to examine the impact of uncertainties. Finally, the need for further analysis, data collection, or refinement is determined. The first steps of defining the problem and the objectives are critical to constructing an informative decision analysis. Such steps must be undertaken with participation from experts, decision-makers, and stakeholders (defined here as "decision participants"). The basic problem here can be framed as: “What is the best strategy to manage risk associated with NEOs?” Some high-level objectives might be to minimize: mortality and injuries, damage to critical infrastructure (e.g., power, communications and food distribution), ecosystem damage, property damage, ungrounded media and public speculation, resources expended, and overall cost. Another valuable objective would be to maximize inter-agency/government coordination. Some of these objectives (e.g., “minimize mortality”) are readily quantified (e.g., deaths and injuries averted). Others are less so (e.g., “maximize inter-agency/government coordination”), but these can be scaled. Objectives may be inversely related: e.g., a strategy that minimizes mortality may cost more. They are also unlikely to be weighted equally. Defining objectives and assessing their relative weight and interactions requires early engagement with decision participants. High-level decisions include whether to deflect a NEO, when to deflect, what is the best alternative for deflection/destruction, and disaster management strategies if an impact occurs. Important influences include, for example: NEO characteristics (orbital characteristics, diameter, mass, spin and composition), impact probability and location, interval between discovery and projected impact date, interval between discovery and deflection target date, costs of information collection, costs and technological feasibility of deflection alternatives, risks of deflection campaigns, requirements for inter-agency and international cooperation, and timing of informing the public. The analytical aspects of decision analysis center on estimation of the expected value (i.e. utility) of different alternatives. The expected value of an alternative is a function of the probability-weighted consequences, estimated using Bayesian calculations in a decision tree or influence diagram model. The result is a set of expected-value estimates for all alternatives evaluated that enables a ranking; the higher the expected value, the more preferred the alternative. A common way to include resource limitations is by framing the decision analysis in the context of economics (e.g., cost-effectiveness analysis). An important aspect of decision analysis in the NEO risk management case is the ability, known as sensitivity analysis, to examine the effect of parameter uncertainty upon decisions. The simplest way to evaluate uncertainty associated with the information used in a decision analysis is to adjust the input values one at a time (or simultaneously) to examine how the results change. Monte Carlo simulations can be used to adjust the inputs over ranges or distributions of values; statistical means then are used to determine the most influential variables. These techniques yield a measure known as the expected value of imperfect information. This value is highly informative, because it allows the decision-maker with imperfect information to evaluate the impact of using experiments, tests, or data collection (e.g. Earth-based observations, space-based remote sensing, etc.) to refine judgments; and indeed to estimate how much should be spent to reduce uncertainty.

The Cost-Effectiveness of Three Screening Alternatives for People with Diabetes with No or Early Diabetic Retinopathy

PubMed Central

Rein, David B; Wittenborn, John S; Zhang, Xinzhi; Allaire, Benjamin A; Song, Michael S; Klein, Ronald; Saaddine, Jinan B

2011-01-01

Objective To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30–84 with diabetes but no or minimal diabetic retinopathy. Data Sources United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule. Study Design Cost-effectiveness Monte Carlo simulation. Data Collection/Extraction Methods Literature review, analysis of existing surveys. Principal Findings Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels. Conclusions Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation. PMID:21492158

A cost comparison of traditional drainage and SUDS in Scotland.

PubMed

Duffy, A; Jefferies, C; Waddell, G; Shanks, G; Blackwood, D; Watkins, A

2008-01-01

The Dunfermline Eastern Expansion (DEX) is a 350 ha mixed development which commenced in 1996. Downstream water quality and flooding issues necessitated a holistic approach to drainage planning and the site has become a European showcase for the application of Sustainable Urban Drainage Systems (SUDS). However, there is minimal data available regarding the real costs of operating and maintaining SUDS to ensure they continue to perform as per their design function. This remains one of the primary barriers to the uptake and adoption of SUDS. This paper reports on what is understood to be the only study in the UK where actual costs of constructing and maintaining SUDS have been compared to an equivalent traditional drainage solution. To compare SUDS costs with traditional drainage, capital and maintenance costs of underground storage chambers of analogous storage volumes were estimated. A whole life costing methodology was then applied to data gathered. The main objective was to produce a reliable and robust cost comparison between SUDS and traditional drainage. The cost analysis is supportive of SUDS and indicates that well designed and maintained SUDS are more cost effective to construct, and cost less to maintain than traditional drainage solutions which are unable to meet the environmental requirements of current legislation. (c) IWA Publishing 2008.

Is minimal access spine surgery more cost-effective than conventional spine surgery?

PubMed

Lubelski, Daniel; Mihalovich, Kathryn E; Skelly, Andrea C; Fehlings, Michael G; Harrop, James S; Mummaneni, Praveen V; Wang, Michael Y; Steinmetz, Michael P

2014-10-15

Systematic review. To summarize and critically review the economic literature evaluating the cost-effectiveness of minimal access surgery (MAS) compared with conventional open procedures for the cervical and lumbar spine. MAS techniques may improve perioperative parameters (length of hospital stay and extent of blood loss) compared with conventional open approaches. However, some have questioned the clinical efficacy of these differences and the associated cost-effectiveness implications. When considering the long-term outcomes, there seem to be no significant differences between MAS and open surgery. PubMed, EMBASE, the Cochrane Collaboration database, University of York, Centre for Reviews and Dissemination (NHS-EED and HTA), and the Tufts CEA Registry were reviewed to identify full economic studies comparing MAS with open techniques prior to December 24, 2013, based on the key questions established a priori. Only economic studies that evaluated and synthesized the costs and consequences of MAS compared with conventional open procedures (i.e., cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were considered for inclusion. Full text of the articles meeting inclusion criteria were reviewed by 2 independent investigators to obtain the final collection of included studies. The Quality of Health Economic Studies instrument was scored by 2 independent reviewers to provide an initial basis for critical appraisal of included economic studies. The search strategy yielded 198 potentially relevant citations, and 6 studies met the inclusion criteria, evaluating the costs and consequences of MAS versus conventional open procedures performed for the lumbar spine; no studies for the cervical spine met the inclusion criteria. Studies compared MAS tubular discectomy with conventional microdiscectomy, minimal access transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion, and multilevel hemilaminectomy via MAS versus open approach. Overall, the included cost-effectiveness studies generally supported no significant differences between open surgery and MAS lumbar approaches. However, these conclusions are preliminary because there was a paucity of high-quality evidence. Much of the evidence lacked details on methodology for modeling, related assumptions, justification of economic model chosen, and sources and types of included costs and consequences. The follow-up periods were highly variable, indirect costs were not frequently analyzed or reported, and many of the studies were conducted by a single group, thereby limiting generalizability. Prospective studies are needed to define differences and optimal treatment algorithms. 3.

48 CFR 5215.605 - Evaluation factors.

Code of Federal Regulations, 2012 CFR

2012-10-01

... REGULATIONS CONTRACTING BY NEGOTIATION Source Selection 5215.605 Evaluation factors. (S-90)(1) When a cost... the proposed costs may be adjusted, for purposes of evaluation, based upon the results of the cost... minimally acceptable approach or a cost/benefit approach. When the quality desired is that necessary to meet...

48 CFR 5215.402 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... pricing in the Navy is through the use of competition, without the need for cost or pricing data and cost... procurement leadtime as a result of minimizing the requirement for cost or pricing data and associated audit reports. As competition is increasingly relied upon and the need for cost or pricing data is reduced...

Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

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

Mailhot Vega, Raymond B.; Ishaq, Omar; Raldow, Ann

Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model wasmore » constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.« less

Mathematical Optimization Algorithm for Minimizing the Cost Function of GHG Emission in AS/RS Using Positive Selection Based Clonal Selection Principle

NASA Astrophysics Data System (ADS)

Mahalakshmi; Murugesan, R.

2018-04-01

This paper regards with the minimization of total cost of Greenhouse Gas (GHG) efficiency in Automated Storage and Retrieval System (AS/RS). A mathematical model is constructed based on tax cost, penalty cost and discount cost of GHG emission of AS/RS. A two stage algorithm namely positive selection based clonal selection principle (PSBCSP) is used to find the optimal solution of the constructed model. In the first stage positive selection principle is used to reduce the search space of the optimal solution by fixing a threshold value. In the later stage clonal selection principle is used to generate best solutions. The obtained results are compared with other existing algorithms in the literature, which shows that the proposed algorithm yields a better result compared to others.

A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion.

PubMed

Singh, Kern; Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Oglesby, Mathew; Pelton, Miguel A; Andersson, Gunnar B; Isayeva, Darya; Jegier, Briana J; Phillips, Frank M

2014-08-01

Emerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes. The purpose of the study was to determine the differences in hospitalization costs and payments for patients treated with primary single-level MIS versus open TLIF. The impact of clinical outcomes and their contribution to financial differences was explored as well. This study was a nonrandomized, nonblinded prospective review. Sixty-six consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open, 33 MIS). Patients in either cohort (MIS/open) were matched based on race, sex, age, smoking status, medical comorbidities (Charlson Comorbidity index), payer, and diagnosis. Every patient in the study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (minutes), length of stay (LOS, days), estimated blood loss (EBL, mL), anesthesia time (minutes), Visual Analog Scale (VAS) scores, and hospital cost/payment amount were assessed. The MIS and open TLIF groups were compared based on clinical outcomes measures and hospital cost/payment data using SPSS version 20.0 for statistical analysis. The two groups were compared using bivariate chi-squared analysis. Mann-Whitney tests were used for non-normal distributed data. Effect size estimate was calculated with the Cohen d statistic and the r statistic with a 95% confidence interval. Average surgical time was shorter for the MIS than the open TLIF group (115.8 minutes vs. 186.0 minutes respectively; p=.001). Length of stay was also reduced for the MIS versus the open group (2.3 days vs. 2.9 days, respectively; p=.018). Average anesthesia time and EBL were also lower in the MIS group (p<.001). VAS scores decreased for both groups, although these scores were significantly lower for the MIS group (p<.001). Financial analysis demonstrated lower total hospital direct costs (blood, imaging, implant, laboratory, pharmacy, physical therapy/occupational therapy/speech, room and board) in the MIS versus the open group ($19,512 vs. $23,550, p<.001). Implant costs were similar (p=.686) in both groups, although these accounted for about two-thirds of the hospital direct costs in the MIS cohort ($13,764) and half of these costs ($13,778) in the open group. Hospital payments were $6,248 higher for open TLIF patients compared with the MIS group (p=.267). MIS TLIF technique demonstrated significant reductions of operative time, LOS, anesthesia time, VAS scores, and EBL compared with the open technique. This reduction in perioperative parameters translated into lower total hospital costs over a 60-day perioperative period. Although hospital reimbursements appear higher in the open group over the MIS group, shorter surgical times and LOS days in the MIS technique provide opportunities for hospitals to reduce utilization of resources and to increase surgical case volume. Copyright © 2014 Elsevier Inc. All rights reserved.

A New Distributed Optimization for Community Microgrids Scheduling

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

Starke, Michael R; Tomsovic, Kevin

This paper proposes a distributed optimization model for community microgrids considering the building thermal dynamics and customer comfort preference. The microgrid central controller (MCC) minimizes the total cost of operating the community microgrid, including fuel cost, purchasing cost, battery degradation cost and voluntary load shedding cost based on the customers' consumption, while the building energy management systems (BEMS) minimize their electricity bills as well as the cost associated with customer discomfort due to room temperature deviation from the set point. The BEMSs and the MCC exchange information on energy consumption and prices. When the optimization converges, the distributed generation scheduling,more » energy storage charging/discharging and customers' consumption as well as the energy prices are determined. In particular, we integrate the detailed thermal dynamic characteristics of buildings into the proposed model. The heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently to reduce the electricity cost while maintaining the indoor temperature in the comfort range set by customers. Numerical simulation results show the effectiveness of proposed model.« less

Cost-efficient scheduling of FAST observations

NASA Astrophysics Data System (ADS)

Luo, Qi; Zhao, Laiping; Yu, Ce; Xiao, Jian; Sun, Jizhou; Zhu, Ming; Zhong, Yi

2018-03-01

A cost-efficient schedule for the Five-hundred-meter Aperture Spherical radio Telescope (FAST) requires to maximize the number of observable proposals and the overall scientific priority, and minimize the overall slew-cost generated by telescope shifting, while taking into account the constraints including the astronomical objects visibility, user-defined observable times, avoiding Radio Frequency Interference (RFI). In this contribution, first we solve the problem of maximizing the number of observable proposals and scientific priority by modeling it as a Minimum Cost Maximum Flow (MCMF) problem. The optimal schedule can be found by any MCMF solution algorithm. Then, for minimizing the slew-cost of the generated schedule, we devise a maximally-matchable edges detection-based method to reduce the problem size, and propose a backtracking algorithm to find the perfect matching with minimum slew-cost. Experiments on a real dataset from NASA/IPAC Extragalactic Database (NED) show that, the proposed scheduler can increase the usage of available times with high scientific priority and reduce the slew-cost significantly in a very short time.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed

Desmond, Katherine A; Rice, Thomas H; Leibowitz, Arleen A

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs.

PubMed

Pyne, Jeffrey M; Fortney, John C; Mouden, Sip; Lu, Liya; Hudson, Teresa J; Mittal, Dinesh

2015-05-01

Collaborative care for depression in primary care settings is effective and cost-effective. However, there is minimal evidence to support the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in federally qualified health centers (FQHCs). In a multisite, randomized, pragmatic comparative cost-effectiveness trial, 19,285 patients were screened for depression, 2,863 (14.8%) screened positive, and 364 were enrolled. Telephone interview data were collected at baseline and at six, 12, and 18 months. Base case analysis used Arkansas FQHC health care costs, and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, the 12-Item Short-Form Survey, and the Quality of Well-Being (QWB) Scale. Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. The TBCC intervention resulted in more depression-free days and QALYs but at a greater cost than the PBCC intervention. The disease-specific (depression-free day) and generic (QALY) incremental cost-effectiveness ratios (ICERs) were below their respective ICER thresholds for implementation, suggesting that the TBCC intervention was more cost effective than the PBCC intervention. These results support the cost-effectiveness of TBCC in medically underserved primary care settings. Information about whether to insource (make) or outsource (buy) depression care management is important, given the current interest in patient-centered medical homes, value-based purchasing, and bundled payments for depression care.

Use of technical and economic analysis for optimizing technology selection and remedial design for contaminated sites

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

Hardisty, P.E.; Brown, A.

1996-12-01

The decision to remediate a contaminated site can be seen from the macroeconomic and microeconomic viewpoints. Macroeconomics can be used to plan and account for the overall cost of pollution as part of a firm`s production, and thus make overall decisions on the real cost of pollution and the level of clean-up which may be called for. Valuation of damaged resources, option values and intrinsic worth is an important part of this process. Once the decision to remediate has been taken, the question becomes how best to remediate. Microeconomic analysis deals with providing efficient allocative decisions for reaching specified goals.more » it is safe to say that cost is one of the single most important factors in site clean-up decision making. A basic rule of remediation is often taken to be the maximization of contaminant mass removed per dollar spent. However, remediation may also be governed by other objectives and constraints. In some situations, minimization of time, rather than cost, could be the constraint. Or perhaps the objective could be to achieve a set level of clean-up for the lowest possible cost, even if a large program would result in unit-cost reductions. Evaluation of the economics of a clean-up project is directly linked to the objectives of the site owner, and the constraints within which the remediation is to be performed. Economic analysis of remedial options for containment of a 350,000 L hydrocarbon spill migrating through fractured rock into a river in Alberta, Canada, clear direction to the site owner.« less

The role of radiation hard solar cells in minimizing the costs of global satellite communications systems

NASA Technical Reports Server (NTRS)

Summers, Geoffrey P.; Walters, Robert J.; Messenger, Scott R.; Burke, Edward A.

1995-01-01

An analysis embodied in a PC computer program is presented which quantitatively demonstrates how the availability of radiation hard solar cells can minimize the cost of a global satellite communication system. The chief distinction between the currently proposed systems, such as Iridium Odyssey and Ellipsat, is the number of satellites employed and their operating altitudes. Analysis of the major costs associated with implementing these systems shows that operation within the earth's radiation belts can reduce the total system cost by as much as a factor of two, so long as radiation hard components including solar cells, can be used. A detailed evaluation of several types of planar solar cells is given, including commercially available Si and GaAs/Ge cells, and InP/Si cells which are under development. The computer program calculates the end of life (EOL) power density of solar arrays taking into account the cell geometry, coverglass thickness, support frame, electrical interconnects, etc. The EOL power density can be determined for any altitude from low earth orbit (LEO) to geosynchronous (GEO) and for equatorial to polar planes of inclination. The mission duration can be varied over the entire range planned for the proposed satellite systems. An algorithm is included in the program for determining the degradation of cell efficiency for different cell technologies due to proton and electron irradiation. The program can be used to determine the optimum configuration for any cell technology for a particular orbit and for a specified mission life. Several examples of applying the program are presented, in which it is shown that the EOL power density of different technologies can vary by an order of magnitude for certain missions. Therefore, although a relatively radiation soft technology can be made to provide the required EOL power by simply increasing the size of the array, the impact on the total system budget could be unacceptable, due to increased launch and hardware costs. In aggregate these factors can account for more than a 10% increase in the total system cost. Since the estimated total costs of proposed global coverage systems range from $1 Billion to $9 Billion, the availability of radiation hard solar cells could make a decisive difference in the selection of a particular constellation architecture.

Optimal design of the satellite constellation arrangement reconfiguration process

NASA Astrophysics Data System (ADS)

Fakoor, Mahdi; Bakhtiari, Majid; Soleymani, Mahshid

2016-08-01

In this article, a novel approach is introduced for the satellite constellation reconfiguration based on Lambert's theorem. Some critical problems are raised in reconfiguration phase, such as overall fuel cost minimization, collision avoidance between the satellites on the final orbital pattern, and necessary maneuvers for the satellites in order to be deployed in the desired position on the target constellation. To implement the reconfiguration phase of the satellite constellation arrangement at minimal cost, the hybrid Invasive Weed Optimization/Particle Swarm Optimization (IWO/PSO) algorithm is used to design sub-optimal transfer orbits for the satellites existing in the constellation. Also, the dynamic model of the problem will be modeled in such a way that, optimal assignment of the satellites to the initial and target orbits and optimal orbital transfer are combined in one step. Finally, we claim that our presented idea i.e. coupled non-simultaneous flight of satellites from the initial orbital pattern will lead to minimal cost. The obtained results show that by employing the presented method, the cost of reconfiguration process is reduced obviously.

The Protein Cost of Metabolic Fluxes: Prediction from Enzymatic Rate Laws and Cost Minimization.

PubMed

Noor, Elad; Flamholz, Avi; Bar-Even, Arren; Davidi, Dan; Milo, Ron; Liebermeister, Wolfram

2016-11-01

Bacterial growth depends crucially on metabolic fluxes, which are limited by the cell's capacity to maintain metabolic enzymes. The necessary enzyme amount per unit flux is a major determinant of metabolic strategies both in evolution and bioengineering. It depends on enzyme parameters (such as kcat and KM constants), but also on metabolite concentrations. Moreover, similar amounts of different enzymes might incur different costs for the cell, depending on enzyme-specific properties such as protein size and half-life. Here, we developed enzyme cost minimization (ECM), a scalable method for computing enzyme amounts that support a given metabolic flux at a minimal protein cost. The complex interplay of enzyme and metabolite concentrations, e.g. through thermodynamic driving forces and enzyme saturation, would make it hard to solve this optimization problem directly. By treating enzyme cost as a function of metabolite levels, we formulated ECM as a numerically tractable, convex optimization problem. Its tiered approach allows for building models at different levels of detail, depending on the amount of available data. Validating our method with measured metabolite and protein levels in E. coli central metabolism, we found typical prediction fold errors of 4.1 and 2.6, respectively, for the two kinds of data. This result from the cost-optimized metabolic state is significantly better than randomly sampled metabolite profiles, supporting the hypothesis that enzyme cost is important for the fitness of E. coli. ECM can be used to predict enzyme levels and protein cost in natural and engineered pathways, and could be a valuable computational tool to assist metabolic engineering projects. Furthermore, it establishes a direct connection between protein cost and thermodynamics, and provides a physically plausible and computationally tractable way to include enzyme kinetics into constraint-based metabolic models, where kinetics have usually been ignored or oversimplified.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

PubMed Central

Tetens, Inge; Dejgård Jensen, Jørgen; Smed, Sinne; Gabrijelčič Blenkuš, Mojca; Rayner, Mike; Darmon, Nicole; Robertson, Aileen

2016-01-01

Background Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Methods Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. Results The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Conclusion Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable. PMID:27760131

Cost-Effectiveness of Dabigatran Compared to Vitamin-K Antagonists for the Treatment of Deep Venous Thrombosis in the Netherlands Using Real-World Data.

PubMed

van Leent, Merlijn W J; Stevanović, Jelena; Jansman, Frank G; Beinema, Maarten J; Brouwers, Jacobus R B J; Postma, Maarten J

2015-01-01

Vitamin-K antagonists (VKAs) present an effective anticoagulant treatment in deep venous thrombosis (DVT). However, the use of VKAs is limited because of the risk of bleeding and the necessity of frequent and long-term laboratory monitoring. Therefore, new oral anticoagulant drugs (NOACs) such as dabigatran, with lower rates of (major) intracranial bleeding compared to VKAs and not requiring monitoring, may be considered. To estimate resource utilization and costs of patients treated with the VKAs acenocoumarol and phenprocoumon, for the indication DVT. Furthermore, a formal cost-effectiveness analysis of dabigatran compared to VKAs for DVT treatment was performed, using these estimates. A retrospective observational study design in the thrombotic service of a teaching hospital (Deventer, The Netherlands) was applied to estimate real-world resource utilization and costs of VKA monitoring. A pooled analysis of data from RE-COVER and RE-COVER II on DVT was used to reflect the probabilities for events in the cost-effectiveness model. Dutch costs, utilities and specific data on coagulation monitoring levels were incorporated in the model. Next to the base case analysis, univariate probabilistic sensitivity and scenario analyses were performed. Real-world resource utilization in the thrombotic service of patients treated with VKA for the indication of DVT consisted of 12.3 measurements of the international normalized ratio (INR), with corresponding INR monitoring costs of €138 for a standardized treatment period of 180 days. In the base case, dabigatran treatment compared to VKAs in a cohort of 1,000 DVT patients resulted in savings of €18,900 (95% uncertainty interval (UI) -95,832, 151,162) and 41 (95% UI -18, 97) quality-adjusted life-years (QALYs) gained calculated from societal perspective. The probability that dabigatran is cost-effective at a conservative willingness-to pay threshold of €20,000 per QALY was 99%. Sensitivity and scenario analyses also indicated cost savings or cost-effectiveness below this same threshold. Total INR monitoring costs per patient were estimated at minimally €138. Inserting these real-world data into a cost-effectiveness analysis for patients diagnosed with DVT, dabigatran appeared to be a cost-saving alternative to VKAs in the Netherlands in the base case. Cost savings or favorable cost-effectiveness were robust in sensitivity and scenario analyses. Our results warrant confirmation in other settings and locations.

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

PubMed

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

Feasibility analysis of reciprocating magnetic heat pumps

NASA Technical Reports Server (NTRS)

Larson, A. V.; Hartley, J. G.; Shelton, Sam V.; Smith, M. M.

1989-01-01

A reciprocating gadolinium core in a regeneration fluid column in the warm bore of a superconducting solenoidal magnet is considered for magnetic refrigeration in 3.517 MW (1000 ton) applications. A procedure is presented to minimize the amount of superconducting cable needed in the magnet design. Estimated system capital costs for an ideal magnetic refrigerator of this type become comparable to conventional chillers as the frequency of reciprocation approaches 10 Hertz. A 1-D finite difference analysis of a regenerator cycling at 0.027 Hertz is presented which exhibits some of the features seen in the experiments of G. V. Brown.

Spectral analysis of natural solar ultraviolet B to promote synthesis of vitamin D

NASA Astrophysics Data System (ADS)

Hung, Min-Wei; Lin, Yu-Hsuan; Chang, Han-Chao; Huang, Kuo-Cheng

2016-10-01

This paper presents a spectral analysis system for the measurement of solar ultraviolet B over long durations. The proposed system provides high resolution at low cost in a highly robust and flexible format. We obtained information pertaining to the absolute irradiance of sunlight in a fixed location with the aim of identifying the best period in which to seek exposure to the sun with regard to maximizing the synthesis of vitamin D while minimizing damage to the skin. This study also provides a means of establishing a database for the development of healthy lamp technology.

An autonomous payload controller for the Space Shuttle

NASA Technical Reports Server (NTRS)

Hudgins, J. I.

1979-01-01

The Autonomous Payload Control (APC) system discussed in the present paper was designed on the basis of such criteria as minimal cost of implementation, minimal space required in the flight-deck area, simple operation with verification of the results, minimal additional weight, minimal impact on Orbiter design, and minimal impact on Orbiter payload integration. In its present configuration, the APC provides a means for the Orbiter crew to control as many as 31 autononous payloads. The avionics and human engineering aspects of the system are discussed.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Technical Reports Server (NTRS)

Brown, K. W.

1992-01-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Astrophysics Data System (ADS)

Brown, K. W.

1992-10-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Rough sets and Laplacian score based cost-sensitive feature selection

PubMed Central

Yu, Shenglong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of “good” features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms. PMID:29912884

Rough sets and Laplacian score based cost-sensitive feature selection.

PubMed

Yu, Shenglong; Zhao, Hong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of "good" features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms.

Bedside ROP screening and telemedicine interpretation integrated to a neonatal transport system: Economic aspects and return on investment analysis.

PubMed

Kovács, Gábor; Somogyvári, Zsolt; Maka, Erika; Nagyjánosi, László

Peter Cerny Ambulance Service - Premature Eye Rescue Program (PCA-PERP) uses digital retinal imaging (DRI) with remote interpretation in bedside ROP screening, which has advantages over binocular indirect ophthalmoscopy (BIO) in screening of premature newborns. We aimed to demonstrate that PCA-PERP provides good value for the money and to model the cost ramifications of a similar newly launched system. As DRI was demonstrated to have high diagnostic performance, only the costs of bedside DRI-based screening were compared to those of traditional transport and BIO-based screening (cost-minimization analysis). The total costs of investment and maintenance were analyzed with micro-costing method. A ten-year analysis time-horizon and service provider's perspective were applied. From the launch of PCA-PERP up to the end of 2014, 3722 bedside examinations were performed in the PCA covered central region of Hungary. From 2009 to 2014, PCA-PERP saved 92,248km and 3633 staff working hours, with an annual nominal cost-savings ranging from 17,435 to 35,140 Euro. The net present value was 127,847 Euro at the end of 2014, with a payback period of 4.1years and an internal rate of return of 20.8%. Our model presented the NPVs of different scenarios with different initial investments, annual number of transports and average transport distances. PCA-PERP as bedside screening with remote interpretation, when compared to a transport-based screening with BIO, produced better cost-savings from the perspective of the service provider and provided a return on initial investment within five years after the project initiation. Copyright © 2017 Elsevier B.V. All rights reserved.

Engineering risk reduction in satellite programs

NASA Technical Reports Server (NTRS)

Dean, E. S., Jr.

1979-01-01

Methods developed in planning and executing system safety engineering programs for Lockheed satellite integration contracts are presented. These procedures establish the applicable safety design criteria, document design compliance and assess the residual risks where non-compliant design is proposed, and provide for hazard analysis of system level test, handling and launch preparations. Operations hazard analysis identifies product protection and product liability hazards prior to the preparation of operational procedures and provides safety requirements for inclusion in them. The method developed for documenting all residual hazards for the attention of program management assures an acceptable minimum level of risk prior to program deployment. The results are significant for persons responsible for managing or engineering the deployment and production of complex high cost equipment under current product liability law and cost/time constraints, have a responsibility to minimize the possibility of an accident, and should have documentation to provide a defense in a product liability suit.

Induction motor broken rotor bar fault location detection through envelope analysis of start-up current using Hilbert transform

NASA Astrophysics Data System (ADS)

Abd-el-Malek, Mina; Abdelsalam, Ahmed K.; Hassan, Ola E.

2017-09-01

Robustness, low running cost and reduced maintenance lead Induction Motors (IMs) to pioneerly penetrate the industrial drive system fields. Broken rotor bars (BRBs) can be considered as an important fault that needs to be early assessed to minimize the maintenance cost and labor time. The majority of recent BRBs' fault diagnostic techniques focus on differentiating between healthy and faulty rotor cage. In this paper, a new technique is proposed for detecting the location of the broken bar in the rotor. The proposed technique relies on monitoring certain statistical parameters estimated from the analysis of the start-up stator current envelope. The envelope of the signal is obtained using Hilbert Transformation (HT). The proposed technique offers non-invasive, fast computational and accurate location diagnostic process. Various simulation scenarios are presented that validate the effectiveness of the proposed technique.

Process Design and Techno-economic Analysis for Materials to Treat Produced Waters.

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

Heimer, Brandon Walter; Paap, Scott M; Sasan, Koroush

Significant quantities of water are produced during enhanced oil recovery making these “produced water” streams attractive candidates for treatment and reuse. However, high concentrations of dissolved silica raise the propensity for fouling. In this paper, we report the design and economic analysis for a new ion exchange process using calcined hydrotalcite (HTC) to remove silica from water. This process improves upon known technologies by minimizing sludge product, reducing process fouling, and lowering energy use. Process modeling outputs included raw material requirements, energy use, and the minimum water treatment price (MWTP). Monte Carlo simulations quantified the impact of uncertainty and variabilitymore » in process inputs on MWTP. These analyses showed that cost can be significantly reduced if the HTC materials are optimized. Specifically, R&D improving HTC reusability, silica binding capacity, and raw material price can reduce MWTP by 40%, 13%, and 20%, respectively. Optimizing geographic deployment further improves cost competitiveness.« less

Structural optimization procedure of a composite wind turbine blade for reducing both material cost and blade weight

NASA Astrophysics Data System (ADS)

Hu, Weifei; Park, Dohyun; Choi, DongHoon

2013-12-01

A composite blade structure for a 2 MW horizontal axis wind turbine is optimally designed. Design requirements are simultaneously minimizing material cost and blade weight while satisfying the constraints on stress ratio, tip deflection, fatigue life and laminate layup requirements. The stress ratio and tip deflection under extreme gust loads and the fatigue life under a stochastic normal wind load are evaluated. A blade element wind load model is proposed to explain the wind pressure difference due to blade height change during rotor rotation. For fatigue life evaluation, the stress result of an implicit nonlinear dynamic analysis under a time-varying fluctuating wind is converted to the histograms of mean and amplitude of maximum stress ratio using the rainflow counting algorithm Miner's rule is employed to predict the fatigue life. After integrating and automating the whole analysis procedure an evolutionary algorithm is used to solve the discrete optimization problem.

Evaluating the effect placement capacitor and distributed photovoltaic generation for power system losses minimization in radial distribution system

NASA Astrophysics Data System (ADS)

Rahman, Yuli Asmi; Manjang, Salama; Yusran, Ilham, Amil Ahmad

2018-03-01

Power loss minimization have many advantagess to the distribution system radial among others reduction of power flow in feeder lines, freeing stress on feeder loading, deterrence of power procurement from the grid and also the cost of loss compensating instruments. This paper, presents capacitor and photovoltaic (PV) placement as alternative means to decrease power system losses. The paper aims to evaluate the best alternative for decreasing power system losses and improving voltage profile in the radial distribution system. To achieve the objectives of paper, they are used three cases tested by Electric Transient and Analysis Program (ETAP) simulation. Firstly, it performs simulation of placement capacitor. Secondly, simulated placement of PV. Lastly, it runs simulation of placement capacitor and PV simultaneously. The simulations were validated using the IEEE 34-bus test system. As a result, they proved that the installation of capacitor and PV integration simultaneously leading to voltage profile correction and power losses minimization significantly.

Preliminary study on enhancing waste management best practice model in Malaysia construction industry

NASA Astrophysics Data System (ADS)

Jamaludin, Amril Hadri; Karim, Nurulzatushima Abdul; Noor, Raja Nor Husna Raja Mohd; Othman, Nurulhidayah; Malik, Sulaiman Abdul

2017-08-01

Construction waste management (CWM) is the practice of minimizing and diverting construction waste, demolition debris, and land-clearing debris from disposal and redirecting recyclable resources back into the construction process. Best practice model means best choice from the collection of other practices that was built for purpose of construction waste management. The practice model can help the contractors in minimizing waste before the construction activities will be started. The importance of minimizing wastage will have direct impact on time, cost and quality of a construction project. This paper is focusing on the preliminary study to determine the factors of waste generation in the construction sites and identify the effectiveness of existing construction waste management practice conducted in Malaysia. The paper will also include the preliminary works of planned research location, data collection method, and analysis to be done by using the Analytical Hierarchy Process (AHP) to help in developing suitable waste management best practice model that can be used in the country.

Does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding?

PubMed

Breijer, M C; van Hanegem, N; Visser, N C M; Verheijen, R H M; Mol, B W J; Pijnenborg, J M A; Opmeer, B C; Timmermans, A

2015-01-01

To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Model based cost-minimization analysis. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Costs for the different strategies. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.

Archival storage solutions for PACS

NASA Astrophysics Data System (ADS)

Chunn, Timothy

1997-05-01

While they are many, one of the inhibitors to the wide spread diffusion of PACS systems has been robust, cost effective digital archive storage solutions. Moreover, an automated Nearline solution is key to a central, sharable data repository, enabling many applications such as PACS, telemedicine and teleradiology, and information warehousing and data mining for research such as patient outcome analysis. Selecting the right solution depends on a number of factors: capacity requirements, write and retrieval performance requirements, scaleability in capacity and performance, configuration architecture and flexibility, subsystem availability and reliability, security requirements, system cost, achievable benefits and cost savings, investment protection, strategic fit and more.This paper addresses many of these issues. It compares and positions optical disk and magnetic tape technologies, which are the predominant archive mediums today. Price and performance comparisons will be made at different archive capacities, plus the effect of file size on storage system throughput will be analyzed. The concept of automated migration of images from high performance, high cost storage devices to high capacity, low cost storage devices will be introduced as a viable way to minimize overall storage costs for an archive. The concept of access density will also be introduced and applied to the selection of the most cost effective archive solution.

Benefit-Cost Analysis of a Randomized Evaluation of Communities That Care: Monetizing Intervention Effects on the Initiation of Delinquency and Substance Use Through Grade 12.

PubMed

Kuklinski, Margaret R; Fagan, Abigail A; Hawkins, J David; Briney, John S; Catalano, Richard F

2015-06-01

To determine whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention. Data were from a longitudinal panel of 4,407 youth participating in a randomized controlled trial including 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. Significant differences favoring intervention youth in sustained abstinence from delinquency, alcohol use, and tobacco use through Grade 12 were monetized and compared to economic investment in CTC. CTC was estimated to produce $4,477 in benefits per youth (discounted 2011 dollars). It cost $556 per youth to implement CTC for 5 years. The net present benefit was $3,920. The benefit-cost ratio was $8.22 per dollar invested. The internal rate of return was 21%. Risk that investment would exceed benefits was minimal. Investment was expected to be recouped within 9 years. Sensitivity analyses in which effects were halved yielded positive cost-beneficial results. CTC is a cost-beneficial, community-based approach to preventing initiation of delinquency, alcohol use, and tobacco use. CTC is estimated to generate economic benefits that exceed implementation costs when disseminated with fidelity in communities.

Launch Vehicle Propulsion Parameter Design Multiple Selection Criteria

NASA Technical Reports Server (NTRS)

Shelton, Joey Dewayne

2004-01-01

The optimization tool described herein addresses and emphasizes the use of computer tools to model a system and focuses on a concept development approach for a liquid hydrogen/liquid oxygen single-stage-to-orbit system, but more particularly the development of the optimized system using new techniques. This methodology uses new and innovative tools to run Monte Carlo simulations, genetic algorithm solvers, and statistical models in order to optimize a design concept. The concept launch vehicle and propulsion system were modeled and optimized to determine the best design for weight and cost by varying design and technology parameters. Uncertainty levels were applied using Monte Carlo Simulations and the model output was compared to the National Aeronautics and Space Administration Space Shuttle Main Engine. Several key conclusions are summarized here for the model results. First, the Gross Liftoff Weight and Dry Weight were 67% higher for the design case for minimization of Design, Development, Test and Evaluation cost when compared to the weights determined by the minimization of Gross Liftoff Weight case. In turn, the Design, Development, Test and Evaluation cost was 53% higher for optimized Gross Liftoff Weight case when compared to the cost determined by case for minimization of Design, Development, Test and Evaluation cost. Therefore, a 53% increase in Design, Development, Test and Evaluation cost results in a 67% reduction in Gross Liftoff Weight. Secondly, the tool outputs define the sensitivity of propulsion parameters, technology and cost factors and how these parameters differ when cost and weight are optimized separately. A key finding was that for a Space Shuttle Main Engine thrust level the oxidizer/fuel ratio of 6.6 resulted in the lowest Gross Liftoff Weight rather than at 5.2 for the maximum specific impulse, demonstrating the relationships between specific impulse, engine weight, tank volume and tank weight. Lastly, the optimum chamber pressure for Gross Liftoff Weight minimization was 2713 pounds per square inch as compared to 3162 for the Design, Development, Test and Evaluation cost optimization case. This chamber pressure range is close to 3000 pounds per square inch for the Space Shuttle Main Engine.

Compendium of Operations Research and Economic Analysis Studies

DTIC Science & Technology

1992-10-01

were to: (1) review and document current po~icios and procedures, k2) identity relevant economic and non -economic decision vAriibles, (3) design a...minimize the total sample size while ensuring that the proportion of samples closely resembled the actual population proportions. Both linear and non ...would cost about $290.00. DLA-92-PlO10. Impact of Increasing the Non -Competitive Threshold from Index No. 92-26 $2,500 to $5,000 (October 1991) In

Regionalization of the C-17A Home Station Check to Minimize Costs

DTIC Science & Technology

2014-06-13

flexibility, and impact to combat operations. The goal of this research is to provide an analysis to determine if there are benefits to C-17 HSC...of the flight and 310 knots or 0.74 Mach for the cruise portion, and used standard Instrument Flight Rules ( IFR ) routes of flight to each base...maintenance flexibility, and possible impact to combat operations. Thus, despite the savings potential, there are a few limitations worth mentioning in

A Systems Analysis to Define the Types of Rations Needed to Support Amphibious Operations

DTIC Science & Technology

1985-09-01

Navy and the individual Marine) and in cost. • RATION QUALITY - High Acceptance - Maximize Quality - Minimize Menu Cycle As one of four...maintaining high customer acceptance. Carbohydrate-enhanced A- or B-Ration menus would be provided to embarked (shipboard) Marines for approximately 72...assistance; 2) the typical dietery myth that high protein meals are what will "help me perform at my peak" would be circumvented; the Marine would

Manned Orbital Transfer Vehicle (MOTV). Volume 5: Turnaround analysis

NASA Technical Reports Server (NTRS)

Boyland, R. E.; Sherman, S. W.; Morfin, H. W.

1979-01-01

The development of a low-cost reliable turnaround process to employ the MOTV in enhancing the utilization of the geosynchronous space region is analyzed. It is indicated that a routine effective turnaround/maintenance plan must make maximum use of flight data for maintenance planning, a high degree of test automation, and MOTV maintainability features in order to minimize tests, facilitate repair, and reduce manpower requirements. An effective turnaround plan provides a payback of reduced risks.

The Kra Canal: An Analysis of a Foreign Policy Alternative for the United States Navy in the Indian Ocean

DTIC Science & Technology

1975-03-01

construction and operation of the canal. The minimal advantages offered by the canal over the existing passages through the Malay Peninsula-Indonesian...was analyzed with respect to the advantages and costs that would result from U.S. participa- tion in the construction and operation of the canal. The...Present Status of the Canal -------------- 28 3. Motivating Factors for the Canal ..........- 31 4. Construction ----------------------------- 34 5

Secure Distributed Time for Secure Distributed Protocols

DTIC Science & Technology

1994-09-01

minimal generating set of X = UV (A) AEY Implications Suppose (M, M’) is an acyclic Typ, -tent and independent) parallel pair. A timeslice containing...compromise the system if the attacker is willing to pay tremendous amounts of money . (For a detailed analysis of the cost, see [Wein9l 1.) What do we do...example, suppose auditor Alice is asking for a snapshot to verify that the electronic currency in circulation sums correctly. If counterfeiter Bad

Quantitative Lateral Flow Assays for Salivary Biomarker Assessment: A Review

PubMed Central

Miočević, Olga; Cole, Craig R.; Laughlin, Mary J.; Buck, Robert L.; Slowey, Paul D.; Shirtcliff, Elizabeth A.

2017-01-01

Saliva is an emerging biofluid with a significant number of applications in use across research and clinical settings. The present paper explores the reasons why saliva has grown in popularity in recent years, balancing both the potential strengths and weaknesses of this biofluid. Focusing on reasons why saliva is different from other common biological fluids such as blood, urine, or tears, we review how saliva is easily obtained, with minimal risk to the donor, and reduced costs for collection, transportation, and analysis. We then move on to a brief review of the history and progress in rapid salivary testing, again reviewing the strengths and weaknesses of rapid immunoassays (e.g., lateral flow immunoassay) compared to more traditional immunoassays. We consider the potential for saliva as an alternative biofluid in a setting where rapid results are important. We focus the review on salivary tests for small molecule biomarkers using cortisol as an example. Such salivary tests can be applied readily in a variety of settings and for specific measurement purposes, providing researchers and clinicians with opportunities to assess biomarkers in real time with lower transportation, collection, and analysis costs, faster turnaround time, and minimal training requirements. We conclude with a note of cautious optimism that the field will soon gain the ability to collect and analyze salivary specimens at any location and return viable results within minutes. PMID:28660183

Uncertainties in Air Exchange using Continuous-Injection, Long-Term Sampling Tracer-Gas Methods

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

Sherman, Max H.; Walker, Iain S.; Lunden, Melissa M.

2013-12-01

The PerFluorocarbon Tracer (PFT) method is a low-cost approach commonly used for measuring air exchange in buildings using tracer gases. It is a specific application of the more general Continuous-Injection, Long-Term Sampling (CILTS) method. The technique is widely used but there has been little work on understanding the uncertainties (both precision and bias) associated with its use, particularly given that it is typically deployed by untrained or lightly trained people to minimize experimental costs. In this article we will conduct a first-principles error analysis to estimate the uncertainties and then compare that analysis to CILTS measurements that were over-sampled, throughmore » the use of multiple tracers and emitter and sampler distribution patterns, in three houses. We find that the CILTS method can have an overall uncertainty of 10-15percent in ideal circumstances, but that even in highly controlled field experiments done by trained experimenters expected uncertainties are about 20percent. In addition, there are many field conditions (such as open windows) where CILTS is not likely to provide any quantitative data. Even avoiding the worst situations of assumption violations CILTS should be considered as having a something like a ?factor of two? uncertainty for the broad field trials that it is typically used in. We provide guidance on how to deploy CILTS and design the experiment to minimize uncertainties.« less

Evaluation of broiler litter transportation in northern Alabama, USA.

PubMed

Paudel, Krishna P; Adhikari, Murali; Martin, Neil R

2004-10-01

The profitability of using broiler litter as a source of crop nutrients was calculated using a phosphorus-consistent litter application rule. A ton of litter can cost effectively be transported up to 164 miles from the production facility. A cost-minimizing phosphorus-consistent transportation model developed to meet the nutrient needs of 29 counties in northern Alabama revealed that not all of the litter can be utilized in the region. The total cost increased when transportation of the litter out of the heavily surplus counties was prioritized. Total litter use was minimally affected by changes in chemical fertilizer prices. Shadow prices indicated the robustness of the model.

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

PubMed

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

2012-09-01

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

The cost to successfully apply for level 3 medical home recognition

PubMed Central

Mottus, Kathleen; Reiter, Kristin; Mitchell, C. Madeline; Donahue, Katrina E.; Gabbard, Wilson M.; Gush, Kimberly

2016-01-01

BACKGROUND The NCQA Patient Centered Medical Home (PCMH) recognition program provides practices an opportunity to implement Medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. METHODS Practice coaches identified 5 exemplar practices that received level 3 recognition (3 pediatric and 2 family medicine practices). This analysis focuses on 4 that received 2011 recognition. Clinical, informatics and administrative staff participated in 2–3 hour interviews. We collected the time required to develop, implement and maintain required activities. We categorized costs as: 1) non-personnel, 2) developmental 3) those to implement activities 4) those to maintain activities, 5) those to document the work and 6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent provider (pFTE) RESULTS Practice size ranged from 2.5 – 10.5 pFTE’s, payer mixes from 7–43 % Medicaid. There was variation in the distribution of costs by activity by practice; but the costs to apply were remarkably similar ($11,453–$15,977 pFTE). CONCLUSION The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low value activities could benefit practices. PMID:26769879

Evaluation of the Turkish translation of the Minimal Standard Terminology for Digestive Endoscopy by development of an endoscopic information system.

PubMed

Atalağ, Koray; Bilgen, Semih; Gür, Gürden; Boyacioğlu, Sedat

2007-09-01

There are very few evaluation studies for the Minimal Standard Terminology for Digestive Endoscopy. This study aims to evaluate the usage of the Turkish translation of Minimal Standard Terminology by developing an endoscopic information system. After elicitation of requirements, database modeling and software development were performed. Minimal Standard Terminology driven forms were designed for rapid data entry. The endoscopic report was rapidly created by applying basic Turkish syntax and grammar rules. Entering free text and also editing of final report were possible. After three years of live usage, data analysis was performed and results were evaluated. The system has been used for reporting of all endoscopic examinations. 15,638 valid records were analyzed, including 11,381 esophagogastroduodenoscopies, 2,616 colonoscopies, 1,079 rectoscopies and 562 endoscopic retrograde cholangiopancreatographies. In accordance with other previous validation studies, the overall usage of Minimal Standard Terminology terms was very high: 85% for examination characteristics, 94% for endoscopic findings and 94% for endoscopic diagnoses. Some new terms, attributes and allowed values were also added for better clinical coverage. Minimal Standard Terminology has been shown to cover a high proportion of routine endoscopy reports. Good user acceptance proves that both the terms and structure of Minimal Standard Terminology were consistent with usual clinical thinking. However, future work on Minimal Standard Terminology is mandatory for better coverage of endoscopic retrograde cholangiopancreatographies examinations. Technically new software development methodologies have to be sought for lowering cost of development and the maintenance phase. They should also address integration and interoperability of disparate information systems.

Defining Continuous Improvement and Cost Minimization Possibilities through School Choice Experiments

ERIC Educational Resources Information Center

Merrifield, John

2009-01-01

Studies of existing best practices cannot determine whether the current "best" schooling practices could be even better, less costly, or more effective and/or improve at a faster rate, but we can discover a cost effective menu of schooling options and each item's minimum cost through market accountability experiments. This paper describes…

Spacecraft expected cost analysis with k-out-of-n:G subsystems

NASA Technical Reports Server (NTRS)

Patterson, Richard; Suich, Ron

1991-01-01

In designing a subsystem for a spacecraft, the design engineer is often faced with a number of options ranging from planning an inexpensive subsystem with low reliability to selecting a highly reliable system that would cost much more. We minimize the total of the cost of the subsytem and the costs that would occur if the subsystem fails. We choose the subsystem with the lowest total. A k-out-of-n:G subsystem has n modules, of which k are required to be good for the subsystem to be good. We examine two models to illustrate the principles of the k-out-of-n:G subsystem designs. For the first model, the following assumptions are necessary: the probability of failure of any module in the system is not affected by the failure of any other module; and each of the modules has the same probabillity of success. For the second model we are also free to choose k in our subsystem.

Active control of panel vibrations induced by boundary-layer flow

NASA Technical Reports Server (NTRS)

Chow, Pao-Liu

1991-01-01

Some problems in active control of panel vibration excited by a boundary layer flow over a flat plate are studied. In the first phase of the study, the optimal control problem of vibrating elastic panel induced by a fluid dynamical loading was studied. For a simply supported rectangular plate, the vibration control problem can be analyzed by a modal analysis. The control objective is to minimize the total cost functional, which is the sum of a vibrational energy and the control cost. By means of the modal expansion, the dynamical equation for the plate and the cost functional are reduced to a system of ordinary differential equations and the cost functions for the modes. For the linear elastic plate, the modes become uncoupled. The control of each modal amplitude reduces to the so-called linear regulator problem in control theory. Such problems can then be solved by the method of adjoint state. The optimality system of equations was solved numerically by a shooting method. The results are summarized.

A study on macroeconomic cost of CCS in Korea

NASA Astrophysics Data System (ADS)

Kim, Ji-Whan; Kim, Yoon Kyung

2015-04-01

CCS is an important measure for mitigating the problem of World Climate Change and already several projects are entered the step of commercialization. The benefits of CCS implementation ultimately depends on the alleviation level of CO2 on earth because it is caused by the mitigation of the World Climate Change problem. Thus it is possible not to coincide at same time between starting the CCS and getting the benefits. Considering the high costs of CCS, the time mismatch between imposing the costs and getting the benefits is apt to impose some heavy burden on the individual national economy. For this reason, at the political decision-making, the policy makers should consider the macroeconomic effects. Meanwhile, Korean electricity market's supply side is comprised of competitive production and a sole distributor(public enterprise) and then electricity is supplied by a single price structure(administered pricing). Under this condition, if CCS is introduced to power setor, electric charges must be increased and production costs will go high. High production costs will have unfavourable effects on disposable income, price level, purchasing power and so on. In order to minimize these effects, policy makers have to consider the economic effects of introducing CCS. This study estimates the microscopic cost of CCS using ICCSEM 2.0 methodology made by CO2CRC and after that, the macroeconomic effects of introducing CCS is estimated on the basis of microscopic cost estimating results. The macroeconomic effects of CCS applied to Power Generation sector are estimated using macroeconometrics model and Input-Output analysis. A macroeconometrics model is an analytical tool designed to describe the operation of the national economy. This model is usually applied to examine the dynamics of aggregate quantities such as the total amount of goods and services produced, total income earned, the level of employment of productive resources, the level of prices and so forth. Introducing the input-output relationship of Korean industries, the macroeconometrics model can show what response is caused by the CCS cost as supply and demand shock. This study is intended to provide a basic information for making reasonable policies which is to minimize the economic costs of introducing CCS.

Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion

PubMed Central

Beyer, Sebastian E.; Hunink, Myriam G.; Schöberl, Florian; von Baumgarten, Louisa; Petersen, Steffen E.; Dichgans, Martin; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F.

2015-01-01

Background and Purpose— This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods— A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80 000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values. Results— In the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80 000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80 000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ≤0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy. Conclusions— Our results suggest that CTA in patients with possible basilar artery occlusion is cost-effective. PMID:26022634

Preliminary analysis of the benefits derived to US Air Force spacecraft from on-orbit refueling

NASA Astrophysics Data System (ADS)

Smith, Scott

1993-02-01

This analysis was undertaken during FY-91 as a preliminary step to identify potential benefits from refueling Air Force satellites on orbit. Both economic and operational benefits were included. Operational benefits were related in economic terms to allow evaluation. All economic comparisons were made using FY-91 costs. An additional purpose of the effort was to identify the preferred mission parameters, for an on-orbit refueling system. A companion study was being concurrently conducted by SSD/XRP and NASA/JPL to develop a hardware concept for an on-orbit refueling system. The mass estimates for refueling missions obtained from the companion study were used in conducting the economic analyses of this benefits study. For this study, on-orbit refueling was based on the concept developed in the companion JPL study. The concept involves launching an S/C carrying fuel that would be transferred to another 'target' S/C which is already in orbit. The two S/C would then rendezvous, dock, and transfer fuel. Another fluid, such as a cryogenic, might be included if needed by the target S/C. The hardware concept for refueling was intended to minimize costs. The re-fueler S/C was designated to be expendable and would contain only the minimal capabilities. It would be launched into the orbit plane and altitude of the target S/C(s). The re-fueler S/C would rendezvous and dock with the target S/C and the fluid transfer would occur. When the refueling mission was completed, the re-fueler S/C would be ejected from the orbit. In order to optimize launch costs, some missions involved launching two re-fueler S/C on the LV. In this case the second re-fueler S/C would be placed in a storage orbit until needed.

Preliminary analysis of the benefits derived to US Air Force spacecraft from on-orbit refueling

NASA Technical Reports Server (NTRS)

Smith, Scott

1993-01-01

This analysis was undertaken during FY-91 as a preliminary step to identify potential benefits from refueling Air Force satellites on orbit. Both economic and operational benefits were included. Operational benefits were related in economic terms to allow evaluation. All economic comparisons were made using FY-91 costs. An additional purpose of the effort was to identify the preferred mission parameters, for an on-orbit refueling system. A companion study was being concurrently conducted by SSD/XRP and NASA/JPL to develop a hardware concept for an on-orbit refueling system. The mass estimates for refueling missions obtained from the companion study were used in conducting the economic analyses of this benefits study. For this study, on-orbit refueling was based on the concept developed in the companion JPL study. The concept involves launching an S/C carrying fuel that would be transferred to another 'target' S/C which is already in orbit. The two S/C would then rendezvous, dock, and transfer fuel. Another fluid, such as a cryogenic, might be included if needed by the target S/C. The hardware concept for refueling was intended to minimize costs. The re-fueler S/C was designated to be expendable and would contain only the minimal capabilities. It would be launched into the orbit plane and altitude of the target S/C(s). The re-fueler S/C would rendezvous and dock with the target S/C and the fluid transfer would occur. When the refueling mission was completed, the re-fueler S/C would be ejected from the orbit. In order to optimize launch costs, some missions involved launching two re-fueler S/C on the LV. In this case the second re-fueler S/C would be placed in a storage orbit until needed.

Application of multi-objective optimization to pooled experiments of next generation sequencing for detection of rare mutations.

PubMed

Zilinskas, Julius; Lančinskas, Algirdas; Guarracino, Mario Rosario

2014-01-01

In this paper we propose some mathematical models to plan a Next Generation Sequencing experiment to detect rare mutations in pools of patients. A mathematical optimization problem is formulated for optimal pooling, with respect to minimization of the experiment cost. Then, two different strategies to replicate patients in pools are proposed, which have the advantage to decrease the overall costs. Finally, a multi-objective optimization formulation is proposed, where the trade-off between the probability to detect a mutation and overall costs is taken into account. The proposed solutions are devised in pursuance of the following advantages: (i) the solution guarantees mutations are detectable in the experimental setting, and (ii) the cost of the NGS experiment and its biological validation using Sanger sequencing is minimized. Simulations show replicating pools can decrease overall experimental cost, thus making pooling an interesting option.

Multigrid one shot methods for optimal control problems: Infinite dimensional control

NASA Technical Reports Server (NTRS)

Arian, Eyal; Taasan, Shlomo

1994-01-01

The multigrid one shot method for optimal control problems, governed by elliptic systems, is introduced for the infinite dimensional control space. ln this case, the control variable is a function whose discrete representation involves_an increasing number of variables with grid refinement. The minimization algorithm uses Lagrange multipliers to calculate sensitivity gradients. A preconditioned gradient descent algorithm is accelerated by a set of coarse grids. It optimizes for different scales in the representation of the control variable on different discretization levels. An analysis which reduces the problem to the boundary is introduced. It is used to approximate the two level asymptotic convergence rate, to determine the amplitude of the minimization steps, and the choice of a high pass filter to be used when necessary. The effectiveness of the method is demonstrated on a series of test problems. The new method enables the solutions of optimal control problems at the same cost of solving the corresponding analysis problems just a few times.

Effects of well spacing on geological storage site distribution costs and surface footprint.

PubMed

Eccles, Jordan; Pratson, Lincoln F; Chandel, Munish Kumar

2012-04-17

Geological storage studies thus far have not evaluated the scale and cost of the network of distribution pipelines that will be needed to move CO(2) from a central receiving point at a storage site to injection wells distributed about the site. Using possible injection rates for deep-saline sandstone aquifers, we estimate that the footprint of a sequestration site could range from <100 km(2) to >100,000 km(2), and that distribution costs could be <$0.10/tonne to >$10/tonne. Our findings are based on two models for determining well spacing: one which minimizes spacing in order to maximize use of the volumetric capacity of the reservoir, and a second that determines spacing to minimize subsurface pressure interference between injection wells. The interference model, which we believe more accurately reflects reservoir dynamics, produces wider well spacings and a counterintuitive relationship whereby total injection site footprint and thus distribution cost declines with decreasing permeability for a given reservoir thickness. This implies that volumetric capacity estimates should be reexamined to include well spacing constraints, since wells will need to be spaced further apart than void space calculations might suggest. We conclude that site-selection criteria should include thick, low-permeability reservoirs to minimize distribution costs and site footprint.