An Assessment of Smallsat Technology to Future Exploration Missions

NASA Technical Reports Server (NTRS)

Chan, Steve

1997-01-01

This reports the results of a general study for NASA Lewis in relation to the use of small satellites for a Mars Relay Satellite (MRS) that supports communications between Mars and Earth: commands to, and telemetry from, Mars Landers and Rover. The scope of the study encompasses a survey of small satellites, those that are lower than 800 kg in mass, by NASA, DoD, and commercial companies. Additionally, surveys in advanced technologies in the area of composite materials, propulsion subsystems, battery subsystems, communications components and subsystems, and ground operations are also provided, A summary of NASA Mars Programs and their status as relevant to MRS is also included. Attempts to draw detailed cost conclusion is generally not possible due to its proprietary nature. In any event, cost is driven by market demands rather than new technologies. A preliminary comparison with the cost estimate of the S-Tel/OSC report did suggest the possibility of cost savings for the MRS by the use of production busses. On the other hand, cost savings in normalized terms from the use of automated ground systems were obtained with some degree of details.

Analysis of the proposed utilization of TDRS system by the HEAO-C satellite

NASA Technical Reports Server (NTRS)

Weathers, G.

1974-01-01

The primary function of the study was to assess the impact upon the HEAO telecommunications system of the proposed relay satellite-to-ground-link configuration. The system is designed to perform the function of most of the NASA ground tracking and communications network at a net cost savings for NASA.

Managing Credit Card Expenses: Nova Southeastern University Shares Cost-Saving Techniques.

ERIC Educational Resources Information Center

Peskin, Carol Ann

1994-01-01

Nova Southeastern University, Florida, has implemented a variety of techniques of cost containment for campus credit card transactions. These include restricted card acceptance parameters, careful merchant rate negotiation, increased automation of transaction processing, and sophisticated processing techniques. The university has demonstrated…

Budesonide + formoterol delivered via Spiromax® for the management of asthma and COPD: The potential impact on unscheduled healthcare costs of improving inhalation technique compared with Turbuhaler®.

PubMed

Lewis, A; Torvinen, S; Dekhuijzen, P N R; Chrystyn, H; Melani, A; Zöllner, Y; Kolbe, K; Watson, A T; Blackney, M; Plich, A

2017-08-01

Fixed-dose combinations of inhaled corticosteroids and long-acting β 2 agonists are commonly used for the treatment of asthma and COPD. However, the most frequently prescribed dry powder inhaler delivering this medicine - Symbicort ® (budesonide and formoterol, BF) Turbuhaler ® - is associated with poor inhalation technique, which can lead to poor disease control and high disease management costs. A recent study showed that patients make fewer inhaler errors when using the novel DuoResp ® (BF) Spiromax ® inhaler, compared with BF Turbuhaler ® . Therefore switching patients from BF Turbuhaler ® to BF Spiromax ® could improve inhalation technique, and potentially lead to better disease control and healthcare cost savings. A model was developed to estimate the budget impact of reducing poor inhalation technique by switching asthma and COPD patients from BF Turbuhaler ® to BF Spiromax ® over three years in Germany, Italy, Sweden and the UK. The model estimated changes to the number, and associated cost, of unscheduled healthcare events. The model considered two scenarios: in Scenario 1, all patients were immediately switched from BF Turbuhaler ® to BF Spiromax ® ; in Scenario 2, 4%, 8% and 12% of patients were switched in years 1, 2 and 3 of the model, respectively. In Scenario 1, per patient cost savings amounted to €60.10, €49.67, €94.14 and €38.20 in Germany, Italy, Sweden and the UK, respectively. Total cost savings in each country were €100.86 million, €19.42 million, €36.65 million and €15.44 million over three years, respectively, with an estimated 597,754, 151,480, 228,986 and 122,368 healthcare events avoided. In Scenario 2, cost savings totalled €8.07 million, €1.55 million, €2.93 million and €1.23 million over three years, respectively, with 47,850, 12,118, 18,319, and 9789 healthcare events avoided. Savings per patient were €4.81, €3.97, €7.53 and €3.06. We demonstrated that reductions in poor inhalation technique by switching patients from BF Turbuhaler ® to BF Spiromax ® are likely to improve patients' disease control and generate considerable cost savings through healthcare events avoided. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review.

PubMed

Farbman, L; Avni, T; Rubinovitch, B; Leibovici, L; Paul, M

2013-12-01

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with <500-beds and with interventions of >6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Autonomous hip exoskeleton saves metabolic cost of walking uphill.

PubMed

Seo, Keehong; Lee, Jusuk; Park, Young Jin

2017-07-01

We have developed a hip joint exoskeleton to boost gait function in the elderly and rehabilitation of post-stroke patients. To quantitatively evaluate the impact of the power and mass of the exoskeleton, we measured the metabolic cost of walking on slopes of 0, 5, and 10% grade, once not wearing the exoskeleton and then wearing it. The exoskeleton reduced the metabolic cost by 13.5,15.5 and 9.8% (31.9, 51.6 and 45.6 W) at 0, 5, and 10% grade, respectively. The exoskeleton performance index was computed as 0.97, 1.24, and 1.24 at each grade, implicating that the hip exoskeleton was more effective on slopes than level ground in saving the metabolic cost.

Compressed Air System Optimization: Case Study Food Industry in Indonesia

NASA Astrophysics Data System (ADS)

Widayati, Endang; Nuzahar, Hasril

2016-01-01

Compressors and compressed air systems was one of the most important utilities in industries or factories. Approximately 10% of the cost of electricity in the industry was used to produce compressed air. Therefore the potential for energy savings in the compressors and compressed air systems had a big challenge. This field was conducted especially in Indonesia food industry or factory. Compressed air system optimization was a technique approach to determine the optimal conditions for the operation of compressors and compressed air systems that included evaluation of the energy needs, supply adjustment, eliminating or reconfiguring the use and operation of inefficient, changing and complementing some equipment and improving operating efficiencies. This technique gave the significant impact for energy saving and costs. The potential savings based on this study through measurement and optimization e.g. system that lowers the pressure of 7.5 barg to 6.8 barg would reduce energy consumption and running costs approximately 4.2%, switch off the compressor GA110 and GA75 was obtained annual savings of USD 52,947 ≈ 455 714 kWh, running GA75 light load or unloaded then obtained annual savings of USD 31,841≈ 270,685 kWh, install new compressor 2x132 kW and 1x 132 kW VSD obtained annual savings of USD 108,325≈ 928,500 kWh. Furthermore it was needed to conduct study of technical aspect of energy saving potential (Investment Grade Audit) and performed Cost Benefit Analysis. This study was one of best practice solutions how to save energy and improve energy performance in compressors and compressed air system.

Literature Searching Services--Choosing the Contract with the Best Discount Plan.

ERIC Educational Resources Information Center

Buckel, William L. (Bill)

1982-01-01

Focuses on the cost-saving technique--selecting the contract that offers the best discount--available when using the Lockheed DIALOG system. Examples of savings, password/contract options, and discount plans are given and a microcomputer program written in BASIC II to aid in calculating savings is described. (EJS)

Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people.

PubMed

Sisk, J E; Moskowitz, A J; Whang, W; Lin, J D; Fedson, D S; McBean, A M; Plouffe, J F; Cetron, M S; Butler, J C

Clinical, epidemiologic, and policy considerations support updating the cost-effectiveness of pneumococcal vaccination for elderly people and targeting the evaluation only to prevention of pneumococcal bacteremia. To assess the implications for medical costs and health effects of vaccination against pneumococcal bacteremia in elderly people. Cost-effectiveness analysis of pneumococcal vaccination compared with no vaccination, from a societal perspective. The elderly population aged 65 years and older in the United States in 3 geographic areas: metropolitan Atlanta, Ga; Franklin County, Ohio; and Monroe County, New York. Incremental medical costs and health effects, expressed in quality-adjusted life-years per person vaccinated. Vaccination was cost saving, ie, it both reduced medical expenses and improved health, for all age groups and geographic areas analyzed in the base case. For people aged 65 years and older, vaccination saved $8.27 and gained 1.21 quality-adjusted days of life per person vaccinated. Vaccination of the 23 million elderly people unvaccinated in 1993 would have gained about 78000 years of healthy life and saved $194 million. In univariate sensitivity analysis, the results remained cost saving except for doubling vaccination costs, including future medical costs of survivors, and lowering vaccination effectiveness. With assumptions most unfavorable to vaccination, cost per quality-adjusted life-year ranged from $35 822 for ages 65 to 74 years to $598 487 for ages 85 years and older. In probabilistic sensitivity analysis, probability intervals were more narrow, with less than 5% probability that the ratio for ages 85 years and older would exceed $100000. Pneumococcal vaccination saves costs in the prevention of bacteremia alone and is greatly underused among the elderly population, on both health and economic grounds. These results support recent recommendations of the Advisory Committee on Immunization Practices and public and private efforts under way to improve vaccination rates.

Relationship between implant use, operative time, and costs associated with distal biceps tendon reattachment.

PubMed

Grant, John A; Bissell, Benjamin; Hake, Mark E; Miller, Bruce S; Hughes, Richard E; Carpenter, James E

2012-11-01

The suture anchor and transosseous drill hole techniques for reattachment of the distal biceps tendon to the radius have been found to have similar clinical and biomechanical outcomes. However, a comparison of the cost effectiveness of these techniques is lacking. The purpose of this study was to determine whether the use of suture anchors decreases operative time enough to offset the additional cost of the implants. The records of all patients undergoing a distal biceps tendon reattachment were reviewed to determine the method of fixation, operative time, and associated surgical costs. Two surgeons used a technique of fixing the tendon directly to the bone (transosseous group), whereas 3 surgeons used suture anchors. Given the standard nature of the surgical procedure (other than the fixation technique), only the costs that differed between the 2 groups were included. Surgical center costs were obtained from the local outpatient surgical center in 2011 US dollars. Five surgeons treated 70 men (mean age, 45.9±9.2 years). Mean time from injury to surgery was 14 days. Mean operative times for the transosseous and suture anchor groups were 97.6±14.9 and 95.8±25.8 minutes, respectively (P=.74). Two anchors were used in 79% of the anchor cases. The use of anchors cost $474.33 more per patient. However, this value is sensitive to the cost of the individual anchors, intersurgeon variation in operative time, and per-minute value of saved operative time. No operative time was saved with the use of suture anchors. This cost comparison framework can be used to evaluate the balance in surgical resource use due to implant cost vs savings in operative time. Copyright 2012, SLACK Incorporated.

Mission aware energy saving strategies for Army ground vehicles

NASA Astrophysics Data System (ADS)

Dattathreya, Macam S.

Fuel energy is a basic necessity for this planet and the modern technology to perform many activities on earth. On the other hand, quadrupled automotive vehicle usage by the commercial industry and military has increased fuel consumption. Military readiness of Army ground vehicles is very important for a country to protect its people and resources. Fuel energy is a major requirement for Army ground vehicles. According to a report, a department of defense has spent nearly $13.6 billion on fuel and electricity to conduct ground missions. On the contrary, energy availability on this plant is slowly decreasing. Therefore, saving energy in Army ground vehicles is very important. Army ground vehicles are embedded with numerous electronic systems to conduct missions such as silent and normal stationary surveillance missions. Increasing electrical energy consumption of these systems is influencing higher fuel consumption of the vehicle. To save energy, the vehicles can use any of the existing techniques, but they require complex, expensive, and time consuming implementations. Therefore, cheaper and simpler approaches are required. In addition, the solutions have to save energy according to mission needs and also overcome size and weight constraints of the vehicle. Existing research in the current literature do not have any mission aware approaches to save energy. This dissertation research proposes mission aware online energy saving strategies for stationary Army ground vehicles to save energy as well as to meet the electrical needs of the vehicle during surveillance missions. The research also proposes theoretical models of surveillance missions, fuzzy logic models of engine and alternator efficiency data, and fuzzy logic algorithms. Based on these models, two energy saving strategies are proposed for silent and normal surveillance type of missions. During silent mission, the engine is on and batteries power the systems. During normal surveillance mission, the engine is on, gear is on neutral position, the vehicle is stationary, and the alternator powers the systems. The proposed energy saving strategy for silent surveillance mission minimizes unnecessary battery discharges by controlling the power states of systems according to the mission needs and available battery capacity. Initial experiments show that the proposed approach saves 3% energy when compared with the baseline strategy for one scenario and 1.8% for the second scenario. The proposed energy saving strategy for normal surveillance mission operates the engine at fuel-efficient speeds to meet vehicle demand and to save fuel. The experiment and simulation uses a computerized vehicle model and a test bench to validate the approach. In comparison to vehicles with fixed high-idle engine speed increments, experiments show that the proposed strategy saves fuel energy in the range of 0-4.9% for the tested power demand range of 44-69 kW. It is hoped to implement the proposed strategies on a real Army ground vehicle to start realizing the energy savings.

Cost-effectiveness analysis in relation to budgetary constraints and reallocative restrictions.

PubMed

Adang, Eddy; Voordijk, Leo; Jan van der Wilt, Gert; Ament, André

2005-10-01

Present cost-effectiveness analyses (CEAs) provide not all information necessary for decision-making. One of the factors that hamper decision-making is the difficulty in reallocating resources to new technologies. In a CEA, the incremental costs and incremental benefits of a new technology are calculated. In this article we focus on the incremental cost side. The underlying assumption in socio-economic evaluation is that resources from the substituted alternatives can be used to finance the new technology. In practice, however, not all resources are becoming available to introduce the alternative. The budgets in health care are rather fixed and shifting from one alternative to another or from one sector to another is often impossible. Even within a budget, the personnel and material resources are usually not entirely usable for the new technology, and sometimes not at all. Therefore, the present CEA outcomes might overestimate the cost-effectiveness in practice, which might influence implementation of a new technology. To optimise the usefulness of economic evaluation for health care decision-making by correcting the incremental costs of a new technology for the possible limitations in reallocating resources and adjusting budgets in health care. Case Research. Literature, data from two completed CEAs and interviews with decision makers in the hospital setting. Case 1: The combined outpatient and home-treatment of psoriasis--In a CEA it was calculated that the new technology lead to much lower cost, given the same effects. The direct costs of this technology comprise personnel, material and capacity costs. Personnel and capacity are inflexible with regard to reallocation, at least in the short term. Considering these reallocative restrictions results show that the cost-savings of the combined treatment are in the short run significantly smaller than in the long run: 694 versus 6.058, respectively. Therefore, the anticipated savings, estimated are not realistic for decision makers with a short time horizon. The short-term savings amount to only 11% of the anticipated savings in the long run. Nevertheless, the combined treatment remains a cost-effective treatment. Analysing the budgetary constraints resulted in the finding that the substitution of the in-hospital treatment by the combined treatment has taken place without negative financial consequences for the hospital. Case 2: The ground bound mobile medical team--Economic arguments to implement the ground bound mobile medical team (MMT) are undecided. With respect to the budgetary constraints we find that the budget for the trauma centre is conditional upon the deployment of the ground bound MMT. Moreover, the cost of the ground bound MMT is a relatively small part of the budget for the trauma centre and therefore no hurdle to implement. On the basis of these findings we conclude that limitations in reallocating resources and adjusting budgets in health care may hamper the usefulness of economic evaluation for decision-making. Researching the extent of these limitations provides, together with the CEA, better information on which the decision whether a new technology should be implemented and what the expected welfare gains from such an implementation might be can be made. For this a set of checklists is developed.

A Decolorization Technique with Spent “Greek Coffee” Grounds as Zero-Cost Adsorbents for Industrial Textile Wastewaters

PubMed Central

Kyzas, George Z.

2012-01-01

In this study, the decolorization of industrial textile wastewaters was studied in batch mode using spent “Greek coffee” grounds (COF) as low-cost adsorbents. In this attempt, there is a cost-saving potential given that there was no further modification of COF (just washed with distilled water to remove dirt and color, then dried in an oven). Furthermore, tests were realized both in synthetic and real textile wastewaters for comparative reasons. The optimum pH of adsorption was acidic (pH = 2) for synthetic effluents, while experiments in free pH (non-adjusted) were carried out for real effluents. Equilibrium data were fitted to the Langmuir, Freundlich and Langmuir-Freundlich (L-F) models. The calculated maximum adsorption capacities (Qmax) for total dye (reactive) removal at 25 °C was 241 mg/g (pH = 2) and 179 mg/g (pH = 10). Thermodynamic parameters were also calculated (ΔH0, ΔG0, ΔS0). Kinetic data were fitted to the pseudo-first, -second and -third order model. The optimum pH for desorption was determined, in line with desorption and reuse analysis. Experiments dealing the increase of mass of adsorbent showed a strong increase in total dye removal.

Rooftop level rainwater harvesting system

NASA Astrophysics Data System (ADS)

Traboulsi, Hayssam; Traboulsi, Marwa

2017-05-01

Unfortunately, in Lebanon and other countries in the Middle East region, water becomes scarcer than ever before, and over the last decades the demand on domestic water has increased due to population and economic growth. Although rainwater harvesting is considered to be a safe and reliable alternative source for domestic water, the inconvenience or impracticalities related to the cost and space needed for the construction of ground or underground storage tanks makes this practice not widely common in rural areas and rarely implemented in urban cities. This paper introduces a new technique to rainwater harvesting which can be easily used in both rural and urban areas: it collects and stores rainwater directly in tanks already installed on building roofs and not necessarily in special ground or underground ones. If widely adopted in Lebanon, this technique could help in: (1) collecting around 23 MCM (70 % of the current deficit in the domestic water supply) of rainwater and thus increasing the available water per m2 of building by 0.4 m3 per year, (2) saving around 7 % of the amount of electric energy usually needed to pump water from an aquifer well and ground or underground tank, and (3) considerably reducing the rate of surface runoff of rainwater at the coastal zones where rainwater is not captured at all and goes directly to the sea.

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

Im, Piljae; Liu, Xiaobing

High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects have been competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This paper highlights the findings of a case study of one of the ARRA-funded GSHP demonstration projects, a ground-source variable refrigerant flow (GS-VRF) system installed at the Human Health Building at Oakland University in Rochester, Michigan.more » This case study is based on the analysis of measured performance data, maintenance records, construction costs, and simulations of the energy consumption of conventional central heating, ventilation, and air-conditioning (HVAC) systems providing the same level of space conditioning as the demonstrated GS-VRF system. The evaluated performance metrics include the energy efficiency of the heat pump equipment and the overall GS-VRF system, pumping performance, energy savings, carbon emission reductions, and cost-effectiveness of the GS-VRF system compared with conventional HVAC systems. This case study also identified opportunities for reducing uncertainties in the performance evaluation, improving the operational efficiency, and reducing the installed cost of similar GSHP systems in the future.« less

Expert system decision support for low-cost launch vehicle operations

NASA Technical Reports Server (NTRS)

Szatkowski, G. P.; Levin, Barry E.

1991-01-01

Progress in assessing the feasibility, benefits, and risks associated with AI expert systems applied to low cost expendable launch vehicle systems is described. Part one identified potential application areas in vehicle operations and on-board functions, assessed measures of cost benefit, and identified key technologies to aid in the implementation of decision support systems in this environment. Part two of the program began the development of prototypes to demonstrate real-time vehicle checkout with controller and diagnostic/analysis intelligent systems and to gather true measures of cost savings vs. conventional software, verification and validation requirements, and maintainability improvement. The main objective of the expert advanced development projects was to provide a robust intelligent system for control/analysis that must be performed within a specified real-time window in order to meet the demands of the given application. The efforts to develop the two prototypes are described. Prime emphasis was on a controller expert system to show real-time performance in a cryogenic propellant loading application and safety validation implementation of this system experimentally, using commercial-off-the-shelf software tools and object oriented programming techniques. This smart ground support equipment prototype is based in C with imbedded expert system rules written in the CLIPS protocol. The relational database, ORACLE, provides non-real-time data support. The second demonstration develops the vehicle/ground intelligent automation concept, from phase one, to show cooperation between multiple expert systems. This automated test conductor (ATC) prototype utilizes a knowledge-bus approach for intelligent information processing by use of virtual sensors and blackboards to solve complex problems. It incorporates distributed processing of real-time data and object-oriented techniques for command, configuration control, and auto-code generation.

Autonomous Sensors for Large Scale Data Collection

NASA Astrophysics Data System (ADS)

Noto, J.; Kerr, R.; Riccobono, J.; Kapali, S.; Migliozzi, M. A.; Goenka, C.

2017-12-01

Presented here is a novel implementation of a "Doppler imager" which remotely measures winds and temperatures of the neutral background atmosphere at ionospheric altitudes of 87-300Km and possibly above. Incorporating both recent optical manufacturing developments, modern network awareness and the application of machine learning techniques for intelligent self-monitoring and data classification. This system achieves cost savings in manufacturing, deployment and lifetime operating costs. Deployed in both ground and space-based modalities, this cost-disruptive technology will allow computer models of, ionospheric variability and other space weather models to operate with higher precision. Other sensors can be folded into the data collection and analysis architecture easily creating autonomous virtual observatories. A prototype version of this sensor has recently been deployed in Trivandrum India for the Indian Government. This Doppler imager is capable of operation, even within the restricted CubeSat environment. The CubeSat bus offers a very challenging environment, even for small instruments. The lack of SWaP and the challenging thermal environment demand development of a new generation of instruments; the Doppler imager presented is well suited to this environment. Concurrent with this CubeSat development is the development and construction of ground based arrays of inexpensive sensors using the proposed technology. This instrument could be flown inexpensively on one or more CubeSats to provide valuable data to space weather forecasters and ionospheric scientists. Arrays of magnetometers have been deployed for the last 20 years [Alabi, 2005]. Other examples of ground based arrays include an array of white-light all sky imagers (THEMIS) deployed across Canada [Donovan et al., 2006], oceans sensors on buoys [McPhaden et al., 2010], and arrays of seismic sensors [Schweitzer et al., 2002]. A comparable array of Doppler imagers can be constructed and deployed on the ground, to compliment the CubeSat data.

Meeting the needs of an ever-demanding market.

PubMed

Rigby, Richard

2002-04-01

Balancing cost and performance in packaging is critical. This article outlines techniques to assist in this whilst delivering added value and product differentiation. The techniques include a rigorous statistical process capable of delivering cost reduction and improved quality and a computer modelling process that can save time when validating new packaging options.

Data on electrical energy conservation using high efficiency motors for the confidence bounds using statistical techniques.

PubMed

Shaikh, Muhammad Mujtaba; Memon, Abdul Jabbar; Hussain, Manzoor

2016-09-01

In this article, we describe details of the data used in the research paper "Confidence bounds for energy conservation in electric motors: An economical solution using statistical techniques" [1]. The data presented in this paper is intended to show benefits of high efficiency electric motors over the standard efficiency motors of similar rating in the industrial sector of Pakistan. We explain how the data was collected and then processed by means of formulas to show cost effectiveness of energy efficient motors in terms of three important parameters: annual energy saving, cost saving and payback periods. This data can be further used to construct confidence bounds for the parameters using statistical techniques as described in [1].

Case Study for the ARRA-funded Ground Source Heat Pump Demonstration at Denver Museum of Nature & Science

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

Im, Piljae; Liu, Xiaobing

High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects were competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This report highlights the findings of a case study of one such GSHP demonstration projects that uses a recycled water heat pump (RWHP) system installed at the Denver Museum of Nature & Science in Denver, Colorado. Themore » RWHP system uses recycled water from the city’s water system as the heat sink and source for a modular water-to-water heat pump (WWHP). This case study was conducted based on the available measured performance data from December 2014 through August 2015, utility bills of the building in 2014 and 2015, construction drawings, maintenance records, personal communications, and construction costs. The annual energy consumption of the RWHP system was calculated based on the available measured data and other related information. It was compared with the performance of a baseline scenario— a conventional VAV system using a water-cooled chiller and a natural gas fired boiler, both of which have the minimum energy efficiencies allowed by ASHRAE 90.1-2010. The comparison was made to determine energy savings, operating cost savings, and CO2 emission reductions achieved by the RWHP system. A cost analysis was performed to evaluate the simple payback of the RWHP system. Summarized below are the results of the performance analysis, the learned lessons, and recommended improvement in the operation of the RWHP system.« less

Cost savings from peritoneal dialysis therapy time extension using icodextrin.

PubMed

Johnson, David W; Vincent, Kaia; Blizzard, Sophie; Rumpsfeld, Markus; Just, Paul

2003-01-01

Previous retrospective studies have reported that icodextrin may prolong peritoneal dialysis (PD) treatment time in patients with refractory fluid overload (RFO). Because the annual cost of PD therapy is lower than that of hemodialysis (HD) therapy in Australia, we prospectively investigated the ability of icodextrin to prolong PD technique survival in patients with RFO. We used a computer model to estimate the savings associated with that therapeutic strategy, based on annual therapy costs determined in a regional PD and HD costing exercise. Patients who met standard criteria for RFO and who were otherwise to be converted immediately to HD, were asked to consent to an open-label assessment of the ability of icodextrin to delay the need to start HD. Time to conversion to HD was measured. The study enrolled 39 patients who were followed for a mean period of 1.1 years. Icodextrin significantly increased peritoneal ultrafiltration by a median value of 368 mL daily. It prolonged technique survival by a mean period of 1.21 years [95% confidence interval (CI): 0.80-1.62 years]. Extension of PD treatment time by icodextrin was particularly marked for patients who had ultrafiltration failure (UFF, n = 20), defined as net daily peritoneal ultrafiltration < 1 L daily (mean extension time: 1.70 years; 95% CI: 1.16-2.25 years). Overall, annualized savings were US$3,683 per patient per year. If just the patients with UFF were considered, the savings increased to US$4,893 per year. Icodextrin prolongs PD technique survival in patients with RFO, permitting them to continue on their preferred therapy. In Australia, that practice is highly cost-effective, particularly in individuals with UFF.

Influence of preheating on grindability of coal

USGS Publications Warehouse

Lytle, J.; Choi, N.; Prisbrey, K.

1992-01-01

Enormous quantities of coal must be ground as feed to power generation facilities. The energy cost of grinding is significant at 5 to 15 kWh/ton. If grindability could be increased by preheating the coal with waste heat, energy costs could be reduced. The objective of this work was to determine how grindability was affected by preheating. The method was to use population balance grinding models to interpret results of grinding coal before and after a heat treatment. Simulation of locked cycle tests gave a 40% increase in grindability. Approximately 40% grinding energy saving can be expected. By using waste heat for coal treatment, the targeted energy savings would be maintained. ?? 1992.

Laboratory Workflow Analysis of Culture of Periprosthetic Tissues in Blood Culture Bottles.

PubMed

Peel, Trisha N; Sedarski, John A; Dylla, Brenda L; Shannon, Samantha K; Amirahmadi, Fazlollaah; Hughes, John G; Cheng, Allen C; Patel, Robin

2017-09-01

Culture of periprosthetic tissue specimens in blood culture bottles is more sensitive than conventional techniques, but the impact on laboratory workflow has yet to be addressed. Herein, we examined the impact of culture of periprosthetic tissues in blood culture bottles on laboratory workflow and cost. The workflow was process mapped, decision tree models were constructed using probabilities of positive and negative cultures drawn from our published study (T. N. Peel, B. L. Dylla, J. G. Hughes, D. T. Lynch, K. E. Greenwood-Quaintance, A. C. Cheng, J. N. Mandrekar, and R. Patel, mBio 7:e01776-15, 2016, https://doi.org/10.1128/mBio.01776-15), and the processing times and resource costs from the laboratory staff time viewpoint were used to compare periprosthetic tissues culture processes using conventional techniques with culture in blood culture bottles. Sensitivity analysis was performed using various rates of positive cultures. Annualized labor savings were estimated based on salary costs from the U.S. Labor Bureau for Laboratory staff. The model demonstrated a 60.1% reduction in mean total staff time with the adoption of tissue inoculation into blood culture bottles compared to conventional techniques (mean ± standard deviation, 30.7 ± 27.6 versus 77.0 ± 35.3 h per month, respectively; P < 0.001). The estimated annualized labor cost savings of culture using blood culture bottles was $10,876.83 (±$337.16). Sensitivity analysis was performed using various rates of culture positivity (5 to 50%). Culture in blood culture bottles was cost-effective, based on the estimated labor cost savings of $2,132.71 for each percent increase in test accuracy. In conclusion, culture of periprosthetic tissue in blood culture bottles is not only more accurate than but is also cost-saving compared to conventional culture methods. Copyright © 2017 American Society for Microbiology.

Towards a Multi-Variable Parametric Cost Model for Ground and Space Telescopes

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Henrichs, Todd

2016-01-01

Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper hypothesizes a single model, based on published models and engineering intuition, for both ground and space telescopes: OTA Cost approximately (X) D(exp (1.75 +/- 0.05)) lambda(exp(-0.5 +/- 0.25) T(exp -0.25) e (exp (-0.04)Y). Specific findings include: space telescopes cost 50X to 100X more ground telescopes; diameter is the most important CER; cost is reduced by approximately 50% every 20 years (presumably because of technology advance and process improvements); and, for space telescopes, cost associated with wavelength performance is balanced by cost associated with operating temperature. Finally, duplication only reduces cost for the manufacture of identical systems (i.e. multiple aperture sparse arrays or interferometers). And, while duplication does reduce the cost of manufacturing the mirrors of segmented primary mirror, this cost savings does not appear to manifest itself in the final primary mirror assembly (presumably because the structure for a segmented mirror is more complicated than for a monolithic mirror).

Multivariable parametric cost model for space and ground telescopes

NASA Astrophysics Data System (ADS)

Stahl, H. Philip; Henrichs, Todd

2016-09-01

Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper hypothesizes a single model, based on published models and engineering intuition, for both ground and space telescopes: OTA Cost (X) D (1.75 +/- 0.05) λ (-0.5 +/- 0.25) T-0.25 e (-0.04) Y Specific findings include: space telescopes cost 50X to 100X more ground telescopes; diameter is the most important CER; cost is reduced by approximately 50% every 20 years (presumably because of technology advance and process improvements); and, for space telescopes, cost associated with wavelength performance is balanced by cost associated with operating temperature. Finally, duplication only reduces cost for the manufacture of identical systems (i.e. multiple aperture sparse arrays or interferometers). And, while duplication does reduce the cost of manufacturing the mirrors of segmented primary mirror, this cost savings does not appear to manifest itself in the final primary mirror assembly (presumably because the structure for a segmented mirror is more complicated than for a monolithic mirror).

Manufacturing development of DC-10 advanced rudder

NASA Technical Reports Server (NTRS)

Cominsky, A.

1979-01-01

The design, manufacture, and ground test activities during development of production methods for an advanced composite rudder for the DC-10 transport aircraft are described. The advanced composite aft rudder is satisfactory for airline service and a cost saving in a full production manufacturing mode is anticipated.

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.

Development of low cost fabrication techniques for large solid rocket nozzles

NASA Technical Reports Server (NTRS)

Warga, J. J.

1971-01-01

Property measurements and fabrication characteristics were determined and the performance in subscale (Minuteman Wing 2 second stage) motors was evaluated. It was demonstrated that the incorporation of low cost fabrication techniques in a full scale 260 in. nozzle could result in savings of $149,000 when compared with an identical design using tape-wrapped components throughout.

Demand reduction analysis for Aberdeen Proving Grounds, Aberdeen, Maryland. Final report

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

NONE

1996-06-01

The objectives of the project are to research, identify, evaluate, and define energy saving projects that meet the Army`s criteria and lead to energy savings at the Aberdeen Proving Grounds, Aberdeen campus, with respect to electrical demand reduction. Details of the authorization and objectives of this report, which delineates our contractual arrangement with the government, may be found in Section 8.11. Synopsis of Findings Entech Engineering, Inc. metered the Post at the substation level to provide some definition to the $7,000,000 annual electric cost consumed by the 19,500 people who occupy over 1,700 buildings and 13 million square feet onmore » Post Overall, Entech considered means of reducing the demand portion of the electrical cost estimated at over $2,900,000 per year. A total of fourteen (14) Energy Conservation Opportunities (ECOs) were developed and evaluated. ECOs describe the means to reduce energy consumption and operating cost. Of the fourteen (14) ECOs, six (6) have been developed as economically feasible. The remaining eight (8) investigated did not prove to be economically attractive. Table 1.2.1 on the following page displays a summary of all ECOs investigated, prioritized by SIR.« less

Improving inhaler adherence in patients with chronic obstructive pulmonary disease: a cost-effectiveness analysis.

PubMed

van Boven, Job Fm; Tommelein, Eline; Boussery, Koen; Mehuys, Els; Vegter, Stefan; Brusselle, Guy Go; Rutten-van Mölken, Maureen Pmh; Postma, Maarten J

2014-06-14

The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness. An economic analysis was performed from the Belgian healthcare payer's perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty. In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses. Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies.

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

PubMed Central

2014-01-01

Background The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness. Methods An economic analysis was performed from the Belgian healthcare payer’s perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty. Results In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses. Conclusions Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies. PMID:24929799

Celebrating Success: EPA Region 3 Greener Cleanup and Sustainable Reuse Award Winner: Aberdeen Proving Ground Federal Facility Superfund Site

EPA Pesticide Factsheets

Greener Cleanup practices were implemented as part of a successful Time-Critical Removal Action (TCRA) completed at the APG Former NIKE Missile Site which has resulted in a reduced environmental footprint, accelerated site closure, and a cost savings.

The Foot's Arch and the Energetics of Human Locomotion.

PubMed

Stearne, Sarah M; McDonald, Kirsty A; Alderson, Jacqueline A; North, Ian; Oxnard, Charles E; Rubenson, Jonas

2016-01-19

The energy-sparing spring theory of the foot's arch has become central to interpretations of the foot's mechanical function and evolution. Using a novel insole technique that restricted compression of the foot's longitudinal arch, this study provides the first direct evidence that arch compression/recoil during locomotion contributes to lowering energy cost. Restricting arch compression near maximally (~80%) during moderate-speed (2.7 ms(-1)) level running increased metabolic cost by + 6.0% (p < 0.001, d = 0.67; unaffected by foot strike technique). A simple model shows that the metabolic energy saved by the arch is largely explained by the passive-elastic work it supplies that would otherwise be done by active muscle. Both experimental and model data confirm that it is the end-range of arch compression that dictates the energy-saving role of the arch. Restricting arch compression had no effect on the cost of walking or incline running (3°), commensurate with the smaller role of passive-elastic mechanics in these gaits. These findings substantiate the elastic energy-saving role of the longitudinal arch during running, and suggest that arch supports used in some footwear and orthotics may increase the cost of running.

A Demonstration System for Capturing Geothermal Energy from Mine Waters beneath Butte, Montana

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

Blackketter, Donald

2015-06-01

Executive Summary An innovative 50-ton ground-source heat pump (GSHP) system was installed to provide space heating and cooling for a 56,000 square foot (5,200 square meter) building in Butte Montana, in conjunction with its heating and chiller systems. Butte is a location with winter conditions much colder than the national average. The GSHP uses flooded mine waters at 78F (25C) as the heat source and heat sink. The heat transfer performance and efficiency of the system were analyzed using data from January through July 2014. This analysis indicated that for typical winter conditions in Butte, Montana, the GSHP could delivermore » about 88% of the building’s annual heating needs. Compared with a baseline natural-gas/electric system, the system demonstrated at least 69% site energy savings, 38% source energy savings, 39% carbon dioxide emissions reduction, and a savings of $17,000 per year (40%) in utility costs. Assuming a $10,000 per ton cost for installing a production system, the payback period at natural gas costs of $9.63/MMBtu and electricity costs of $0.08/kWh would be in the range of 40 to 50 years. At higher utility prices, or lower installation costs, the payback period would obviously be reduced.« less

Cost Savings Potential of Modification to the Standard Light Rail Vehicle Specification

DOT National Transportation Integrated Search

1979-02-01

This report describes an assessment of the Standard Light Rail Vehicle (SLRV) specification to determine whether the relaxation or modification of some requirements could result in a significant reduction in vehicle costs. A Technique of Assessment b...

Novel method for water vapour monitoring using wireless communication networks measurements

NASA Astrophysics Data System (ADS)

David, N.; Alpert, P.; Messer, H.

2009-04-01

We propose a new technique for monitoring near-surface water vapour, by estimating humidity from data collected through existing wireless communication networks. Water vapour plays a crucial part in a variety of atmospheric processes. As the most influential of greenhouse gases, it absorbs long-wave terrestrial radiation. The water vapour cycle of evaporation and recondensation is a major energy redistributing mechanism transferring heat energy from the Earth's surface to the atmosphere. Additionally, humidity has an important role in weather forecasting as a key variable required for initialization of atmospheric models and hazard warning techniques. However, current methods of monitoring humidity suffer from low spatial resolution, high cost or a lack of precision when measuring near ground levels. Weather conditions and atmospheric phenomena affect the electromagnetic channel, causing attenuations to the radio signals. Thus, wireless communication networks are in effect built-in environmental monitoring facilities. The wireless microwave links, used in these networks, are widely deployed by cellular providers for backhaul communication between base stations, a few tens of meters above ground level. As a result, the proposed method can provide moisture observations at high temporal and spatial resolution. Further, the implementation cost is minimal, since the data used is already collected and saved by the cellular operators. In addition - many of these links are installed in areas where access is difficult such as orographic terrain and complex topography. As such, our method enables measurements in places that have been hard to measure in the past, or have never been measured before. The technique is restricted to weather conditions which include absence of rain, fog or clouds along the propagation path. We present results from real-data measurements taken from microwave links used in a backhaul cellular network that show very good agreement with surface station humidity measurements.

Robot Drills Holes To Relieve Excess Tire Pressures

NASA Technical Reports Server (NTRS)

Carrott, David T.

1996-01-01

Small, relatively inexpensive, remotely controlled robot called "tire assault vehicle" (TAV) developed to relieve excess tire pressures to protect ground crew, aircraft equipment, and nearby vehicles engaged in landing tests of CV-990 Landing System Research Aircraft. Reduces costs and saves time in training, maintenance, and setup related to "yellow" and "red" tire conditions. Adapted to any heavy-aircraft environment in which ground-crew safety at risk because of potential for tire explosions. Also ideal as scout vehicle for performing inspections in hazardous locations.

Methodology for energy strategy to prescreen the feasibility of Ground Source Heat Pump systems in residential and commercial buildings in the United States

DOE PAGES

Cho, Soolyeon; Ray, Saurabh; Im, Piljae; ...

2017-09-21

Geothermal resources have potential to reduce dependence on fossil fuels. The viability of geothermal heat pumps or ground source heat pumps (GSHPs) is significant as a potential alternative energy source with substantial savings potential. While the prospect of these systems is promising for energy efficiency, careful feasibility analysis is required before implementation. Here, this paper presents the results of evaluation of the application feasibility for GSHPs in buildings across seven climate zones in three United States regions. A comprehensive methodology is developed to measure the integrated feasibility of GSHPs using compiled data for energy use intensity, energy cost and designmore » parameters. Four different feasibility metrics are utilized: ground temperature, outdoor weather condition, energy savings potential, and cost benefits. For each metric, a corresponding feasibility score system is developed. The defined integrated feasibility score classifies the locations into five different feasibility levels ranging from Fair (0–20), Moderate (21–40), Good (41–60), High (61–80), and Very High (81–100). Conclusions show the GSHP feasibility level is High for 3 sites, Good for 8 sites and Moderate for 4 sites. Through the methodology, it is possible to develop a practical energy strategy for more economic and sustainable GSHP systems at an early design stage in the various viewpoints of geometries, climate conditions, operational factors, and energy costs.« less

Methodology for energy strategy to prescreen the feasibility of Ground Source Heat Pump systems in residential and commercial buildings in the United States

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

Cho, Soolyeon; Ray, Saurabh; Im, Piljae

Geothermal resources have potential to reduce dependence on fossil fuels. The viability of geothermal heat pumps or ground source heat pumps (GSHPs) is significant as a potential alternative energy source with substantial savings potential. While the prospect of these systems is promising for energy efficiency, careful feasibility analysis is required before implementation. Here, this paper presents the results of evaluation of the application feasibility for GSHPs in buildings across seven climate zones in three United States regions. A comprehensive methodology is developed to measure the integrated feasibility of GSHPs using compiled data for energy use intensity, energy cost and designmore » parameters. Four different feasibility metrics are utilized: ground temperature, outdoor weather condition, energy savings potential, and cost benefits. For each metric, a corresponding feasibility score system is developed. The defined integrated feasibility score classifies the locations into five different feasibility levels ranging from Fair (0–20), Moderate (21–40), Good (41–60), High (61–80), and Very High (81–100). Conclusions show the GSHP feasibility level is High for 3 sites, Good for 8 sites and Moderate for 4 sites. Through the methodology, it is possible to develop a practical energy strategy for more economic and sustainable GSHP systems at an early design stage in the various viewpoints of geometries, climate conditions, operational factors, and energy costs.« less

Commercial Internet Adoption in China: Comparing the Experience of Small, Medium and Large Businesses.

ERIC Educational Resources Information Center

Riquelme, Hernan

2002-01-01

Describes a study of small, medium, and large enterprises in Shanghai, China that investigated which size companies benefit the most from the Internet. Highlights include leveling the ground for small and medium enterprises (SMEs); increased sales and cost savings for large companies; and competitive advantages. (LRW)

The energetics of low browsing in sauropods.

PubMed

Ruxton, Graeme D; Wilkinson, David M

2011-10-23

It has recently been argued that the probable high cost of travel for sauropod dinosaurs would have made exploiting high forage energetically attractive, if this reduced the need to travel between food patches. This argument was supported by simple calculations. Here, we take a similar approach to evaluate the energetics of foraging close to the ground. We predict that small extensions of the neck beyond the minimum required for the mouth to reach the ground bring substantial energetic savings. Each increment of length brings a further saving, but the sizes of such benefits decrease with increasing neck length. However, the observed neck length of around 9 m for Brachiosaurus (for example) is predicted to reduce the overall cost of foraging by 80 per cent, compared with a minimally necked individual. We argue that the long neck of the sauropods may have been under positive selection for low foraging (instead of, or as well as, exploitation of high foraging), if this long neck allowed a greater area of food to be exploited from a given position and thus reduced the energetically expensive movement of the whole animal.

The cost-effectiveness of physician staffed Helicopter Emergency Medical Service (HEMS) transport to a major trauma centre in NSW, Australia.

PubMed

Taylor, Colman; Jan, Stephen; Curtis, Kate; Tzannes, Alex; Li, Qiang; Palmer, Cameron; Dickson, Cara; Myburgh, John

2012-11-01

Helicopter Emergency Medical Services (HEMS) are highly resource-intensive facilities that are well established as part of trauma systems in many high-income countries. We evaluated the cost-effectiveness of a physician-staffed HEMS intervention in combination with treatment at a major trauma centre versus ground ambulance or indirect transport (via a referral hospital) in New South Wales (NSW), Australia. Cost and effectiveness estimates were derived from a cohort of trauma patients arriving at St George Hospital in NSW, Australia during an 11-year period. Adjusted estimates of in-hospital mortality were derived using logistic regression and adjusted hospital costs were estimated through a general linear model incorporating a gamma distribution and log link. These estimates along with other assumptions were incorporated into a Markov model with an annual cycle length to estimate a cost per life saved and a cost per life-year saved at one year and over a patient's lifetime respectively in three patient groups (all patients; patients with serious injury [Injury Severity Score>12]; patients with traumatic brain injury [TBI]). Results showed HEMS to be more costly but more effective at reducing in-hospital mortality leading to a cost per life saved of $1,566,379, $533,781 and $519,787 in all patients, patients with serious injury and patients with TBI respectively. When modelled over a patient's lifetime, the improved mortality associated with HEMS led to a cost per life year saved of $96,524, $50,035 and $49,159 in the three patient groups respectively. Sensitivity analyses revealed a higher probability of HEMS being cost-effective in patients with serious injury and TBI. Our investigation confirms a HEMS intervention is associated with improved mortality in trauma patients, especially in patients with serious injury and TBI. The improved benefit of HEMS in patients with serious injury and TBI leads to improved estimated cost-effectiveness. Copyright © 2012 Elsevier Ltd. All rights reserved.

Summit Station Skiway Cost Analysis

DTIC Science & Technology

2016-07-01

Laboratory (CRREL) U.S. Army Engineer Research and Development Center (ERDC) 72 Lyme Road Hanover, NH 03755-1290 Final Report Approved for...cargo loads. To explore further skiway improvement and cost saving techniques, this report reviews alternative maintenance and construction options...3 2.2 Maintenance

Retail clinic utilization associated with lower total cost of care.

PubMed

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

2013-04-01

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

[Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].

PubMed

Fuchs, K H; Heimbucher, J; Geiger, D; Thiede, A

1997-01-01

The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.

Logging while fishing technique results in substantial savings

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

Tollefsen, E.; Everett, M.

1996-12-01

During wireline logging operations, tools occasionally become stuck in the borehole and require fishing. A typical fishing job can take anywhere from 1{1/2}--4 days. In the Gulf of Mexico, a fishing job can easily cost between $100,000 and $500,000. These costs result from nonproductive time during the fishing trip, associated wiper trip and relogging the well. Logging while fishing (LWF) technology is a patented system capable of retrieving a stuck fish and completing the logging run during the same pipe descent. Completing logging operations using LWF method saves time and money. The technique also provides well information where data maymore » not otherwise have been obtained. Other benefits include reduced fishing time and an increased level of safety.« less

The Foot’s Arch and the Energetics of Human Locomotion

PubMed Central

Stearne, Sarah M.; McDonald, Kirsty A.; Alderson, Jacqueline A.; North, Ian; Oxnard, Charles E.; Rubenson, Jonas

2016-01-01

The energy-sparing spring theory of the foot’s arch has become central to interpretations of the foot’s mechanical function and evolution. Using a novel insole technique that restricted compression of the foot’s longitudinal arch, this study provides the first direct evidence that arch compression/recoil during locomotion contributes to lowering energy cost. Restricting arch compression near maximally (~80%) during moderate-speed (2.7 ms−1) level running increased metabolic cost by + 6.0% (p < 0.001, d = 0.67; unaffected by foot strike technique). A simple model shows that the metabolic energy saved by the arch is largely explained by the passive-elastic work it supplies that would otherwise be done by active muscle. Both experimental and model data confirm that it is the end-range of arch compression that dictates the energy-saving role of the arch. Restricting arch compression had no effect on the cost of walking or incline running (3°), commensurate with the smaller role of passive-elastic mechanics in these gaits. These findings substantiate the elastic energy-saving role of the longitudinal arch during running, and suggest that arch supports used in some footwear and orthotics may increase the cost of running. PMID:26783259

Low-cost computer classification of land cover in the Portland area, Oregon, by signature extension techniques

USGS Publications Warehouse

Gaydos, Leonard

1978-01-01

The cost of classifying 5,607 square kilometers (2,165 sq. mi.) in the Portland area was less than 8 cents per square kilometer ($0.0788, or $0.2041 per square mile). Besides saving in costs, this and other signature extension techniques may be useful in completing land use and land cover mapping in other large areas where multispectral and multitemporal Landsat data are available in digital form but other source materials are generally lacking.

Selecting a software development methodology. [of digital flight control systems

NASA Technical Reports Server (NTRS)

Jones, R. E.

1981-01-01

The state of the art analytical techniques for the development and verification of digital flight control software is studied and a practical designer oriented development and verification methodology is produced. The effectiveness of the analytic techniques chosen for the development and verification methodology are assessed both technically and financially. Technical assessments analyze the error preventing and detecting capabilities of the chosen technique in all of the pertinent software development phases. Financial assessments describe the cost impact of using the techniques, specifically, the cost of implementing and applying the techniques as well as the relizable cost savings. Both the technical and financial assessment are quantitative where possible. In the case of techniques which cannot be quantitatively assessed, qualitative judgements are expressed about the effectiveness and cost of the techniques. The reasons why quantitative assessments are not possible will be documented.

Should radon be reduced in homes? A cost-effect analysis.

PubMed

Stigum, Hein; Strand, Terje; Magnus, Per

2003-02-01

Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m(-3)) and improving these, and protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean = 74.5 Bq m(-3), and 7.6% above 200 Bq m(-3). The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%). In cumulative present values the intervention would cost $238 (145, 310) million and save 892 (133, 1981) lives; each life saved costs $0.27 (0.09, 0.9) million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. This is above the upper uncertainty limit of the cost per life. The intervention against radon in homes, therefore, seems justifiable.

New trends in metal forming in the USA

NASA Astrophysics Data System (ADS)

1982-05-01

The use of lasers in sheet metal stamping, hydraulic presses, cold pressing, and deformation of titanium alloy to produce components which do not require subsequent machining are discussed. Superplastic deformation techniques could lead to cost savings of 90% in the aerospace industry. Precision forging and welding technologies can considerably reduce raw material costs, but investment costs are high.

Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

PubMed Central

Gonzalez, Tyler A.; Bluman, Eric M.; Palms, David; Smith, Jeremy T.; Chiodo, Christopher P.

2016-01-01

Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety. PMID:26894212

How to Survive in Industry. Cost Justifying Library Services

ERIC Educational Resources Information Center

Kramer, Joseph

1971-01-01

Two services provided by the Boeing Co. Aerospace Group Library-Literature searches and reference/publication identification activities-were evaluated by written and oral surveys of the library's users. The survey technique and cost savings reported by the two studies are discussed. (2 references) (Author/NH)

Lifting and protecting residential structures from subsidence damage using airbags

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

Triplett, T.L.; Bennett, R.M.

1998-12-31

Conventional practice in protecting residential structures from subsidence damage concentrates on saving the superstructure. The foundation is sacrificed, even though it represents the structural component with the greatest replacement cost. In this study, airbags were used to lift a 20 ft x 30 ft structure to test their ability to protect both the foundation and superstructure from ground settlement. Two contiguous sides of the test foundation were unreinforced, and the other two contiguous sides incorporated footing and wall reinforcement. The airbags successfully lifted the structure without causing damage, even on the unreinforced sides. This paper gives a procedure for determiningmore » airbag spacing, and describes installation and operation techniques of the airbags. The paper then focuses on the performance of the airbags in lifting the structure, and shows that airbags can preserve existing foundations during subsidence movements.« less

Economics in ground operations of the Space Shuttle

NASA Technical Reports Server (NTRS)

Gray, R. H.

1973-01-01

The physical configuration, task versatility, and typical mission profile of the Space Shuttle are illustrated and described, and a comparison of shuttle and expendable rocket costs is discussed, with special emphasis upon savings to be achieved in ground operations. A review of economies achieved by engineering design improvements covers the automated checkout by onboard shuttle systems, the automated launch processing system, the new maintenance concept, and the analogy of Space Shuttle and airline repetitive operations. The Space Shuttle is shown to represent a new level in space flight technology, particularly, the sophistication of the systems and procedures devised for its support and ground operations.

A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department.

PubMed

Hohl, Corinne Michèle; Nosyk, Bohdan; Sadatsafavi, Mohsen; Anis, Aslam Hayat

2008-01-01

To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED). The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation. Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of -$597.03 (95% credibility interval -$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed. These results indicate that using propofol for PS in the ED is a cost-saving strategy.

Cast Off expansion plan by rapid improvement through Optimization tool design, Tool Parameters and using Six Sigma’s ECRS Technique

NASA Astrophysics Data System (ADS)

Gopalakrishnan, T.; Saravanan, R.

2017-03-01

Powerful management concepts step-up the quality of the product, time saving in producing the product thereby increase the production rate, improves tools and techniques, work culture, work place and employee motivation and morale. In this paper discussed about the case study of optimizing the tool design, tool parameters to cast off expansion plan according ECRS technique. The proposed designs and optimal tool parameters yielded best results and meet the customer demand without expansion plan. Hence the work yielded huge savings of money (direct and indirect cost), time and improved the motivation and more of employees significantly.

Application of Energy Integration Techniques to the Design of Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Levri, Julie; Finn, Cory

2000-01-01

Exchanging heat between hot and cold streams within an advanced life support system can save energy. This savings will reduce the equivalent system mass (ESM) of the system. Different system configurations are examined under steady-state conditions for various percentages of food growth and waste treatment. The scenarios investigated represent possible design options for a Mars reference mission. Reference mission definitions are drawn from the ALSS Modeling and Analysis Reference Missions Document, which includes definitions for space station evolution, Mars landers, and a Mars base. For each scenario, streams requiring heating or cooling are identified and characterized by mass flow, supply and target temperatures and heat capacities. The Pinch Technique is applied to identify good matches for energy exchange between the hot and cold streams and to calculate the minimum external heating and cooling requirements for the system. For each pair of hot and cold streams that are matched, there will be a reduction in the amount of external heating and cooling required, and the original heating and cooling equipment will be replaced with a heat exchanger. The net cost savings can be either positive or negative for each stream pairing, and the priority for implementing each pairing can be ranked according to its potential cost savings. Using the Pinch technique, a complete system heat exchange network is developed and heat exchangers are sized to allow for calculation of ESM. The energy-integrated design typically has a lower total ESM than the original design with no energy integration. A comparison of ESM savings in each of the scenarios is made to direct future Pinch Analysis efforts.

Replacement of Expensive, Disposable Instruments With Old-fashioned Surgical Techniques for Improved Cost-effectiveness in Laparoscopic Hysterectomy

PubMed Central

Morrison, John E.

2004-01-01

Objective: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up ≥50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. Methods: We identified the 3 most expensive disposable devices: (1) an Endostapler, US $498 and 3 staple reloads, US $179 each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, US $853; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, US $321, and substituted them using classic conservative surgical techniques. Results: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were US $2209 per procedure; additional costs were US $266.33 for suture material and an Endopouch, resulting in an overall savings of US $50 509.42. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. Conclusion: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. PMID:15119671

A facility monitoring system: The single most valuable and cost-effective tool available to an energy manager

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

Holmes, W.A.

Energy engineering and management combines engineering problem-solving and financial management techniques to reduce utility costs. At present, substantial amounts of time and money are being spent in order to attempt to quantify energy consumption and costs and define opportunities for savings. Unfortunately, accurate verification of results is often overlooked. Advances in technology during the last few years have made the installation of a permanent, PC-based monitoring system possible for any facility, often for no more than the cost of a detailed study. By investing initially in a monitoring system rather than audits or studies, the actual consumption and cost datamore » will be available on a continuing basis and can be used to produce immediate operational savings, more accurately analyze opportunities requiring capital investments, and to verify actual savings resulting from changes. A permanent monitoring system, installed as the first step in a utility cost reduction effort, to identify where and how energy is used in a facility on a dynamic and real-time basis, can provide the most valuable and cost-effective tool available to an energy manager. The resulting data allows energy consumption patterns and utility costs to be understood and managed in the same manner as all other costs within a facility.« less

Automated Training Evaluation (ATE). Final Report.

ERIC Educational Resources Information Center

Charles, John P.; Johnson, Robert M.

The automation of weapons system training presents the potential for significant savings in training costs in terms of manpower, time, and money. The demonstration of the technical feasibility of automated training through the application of advanced digital computer techniques and advanced training techniques is essential before the application…

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

PubMed

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

2016-05-01

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

Innovative Ballasted Flat Roof Solar PV Racking System

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

Peek, Richard T.

2014-12-15

The objective of this project was to reduce the cost of racking for PV solar on flat commercial rooftops. Cost reductions would come from both labor savings and material savings related to the installation process. The rack would need to accommodate the majority of modules available on the market. Cascade Engineering has a long history of converting traditional metal type applications over to plastic. Injection molding of plastics have numerous advantages including selection of resin for the application, placing the material exactly where it is needed, designing in features that will speed up the installation process, and weight reduction ofmore » the array. A plastic rack would need to meet the requirements of UL2703, Mounting systems, mounting devices, clamping/retention devices, and ground lugs for use with flat-plate photovoltaic modules and panels. Comparing original data to the end of project racking design, racking material costs were reduced 50% and labor costs reduced 64%. The racking product accommodates all 60 and 72 cell panels on the market, meets UL2703 requirements, contributes only 1.3 pounds per square foot of weight to the array, requires little ballast to secure the array, automatically grounds the module when the module is secured, stacks/nests well for shipping/fewer lifts to the roof, provides integrated wire routing, allows water to drain on the roof, and accommodates various seismic roof connections. Project goals were achieved as noted in the original funding application.« less

Case Study for the ARRA-funded Ground Source Heat Pump (GSHP) Demonstration at Wilders Grove Solid Waste Service Center in Raleigh, NC

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

Liu, Xiaobing; Malhotra, Mini; Xiong, Zeyu

High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects have been competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This paper highlights the findings of a case study of one of the ARRA-funded GSHP demonstration projects, a distributed GSHP system for providing all the space conditioning, outdoor air ventilation, and 100% domestic hot water tomore » the Wilders Grove Solid Waste Service Center of City of Raleigh, North Carolina. This case study is based on the analysis of measured performance data, construction costs, and simulations of the energy consumption of conventional central heating, ventilation, and air-conditioning (HVAC) systems providing the same level of space conditioning and outdoor air ventilation as the demonstrated GSHP system. The evaluated performance metrics include the energy efficiency of the heat pump equipment and the overall GSHP system, pumping performance, energy savings, carbon emission reductions, and cost-effectiveness of the GSHP system compared with conventional HVAC systems. This case study also identified opportunities for reducing uncertainties in the performance evaluation and improving the operational efficiency of the demonstrated GSHP system.« less

Software engineering with application-specific languages

NASA Technical Reports Server (NTRS)

Campbell, David J.; Barker, Linda; Mitchell, Deborah; Pollack, Robert H.

1993-01-01

Application-Specific Languages (ASL's) are small, special-purpose languages that are targeted to solve a specific class of problems. Using ASL's on software development projects can provide considerable cost savings, reduce risk, and enhance quality and reliability. ASL's provide a platform for reuse within a project or across many projects and enable less-experienced programmers to tap into the expertise of application-area experts. ASL's have been used on several software development projects for the Space Shuttle Program. On these projects, the use of ASL's resulted in considerable cost savings over conventional development techniques. Two of these projects are described.

Parallel In Situ Screening of Remediation Strategies for Improved Decision Making, Remedial Design, and Cost Savings

DTIC Science & Technology

2012-11-01

vitamin B12. Additionally, a reductant reacts directly with hexavalent chromium to reduce it to the trivalent state. SRS®-M provides a readily...experiments ......................................................................... 27 Figure 8. Hexavalent chromium detected in ISMA effluent post in situ...ground surface cis-DCE cis-dichloroethene CERCLA Comprehensive Environmental Response, Compensation, and Liability Act Cr(VI) hexavalent chromium

Summary appraisals of the Nation's ground-water resources; Lower Colorado region

USGS Publications Warehouse

Davidson, E.S.

1979-01-01

The potential for greater development of ground water in the southwestern part of the region is constrained by land subsidence, earth cracks, increasing costs of pumping and transportation, and moderate to poor chemical quality of water. More ground water can be developed in the northeastern part of the region, where the major constraint is pumping cost owing to low to moderate well yields and depth to water. Some benefits can be realized everywhere in the region through changes in current use and greater efficiencies of use. Additional supplies may be made available by capture of natural evapotranspiration. Increasing the efficiency of use is possible hydrologically but, in the near term, is more expensive than increasing groundwater development. Decrease of irrigation, change to water-saving methods of irrigation, use of saline water, decrease of per capita public- supply use, and more reuse of water in almost every type of use could help extend the supply and thereby reduce the current rate of ground-water depletion. Financial problems have not yet caused an overall decrease in pumpage, but, locally, operating costs or partial dewatering of the aquifer has eliminated or decreased withdrawal. Current water laws in all States of the region, except Arizona, control or allocate the use of ground water.

Energy savings in Polish buildings

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

Markel, L.C.; Gula, A.; Reeves, G.

1995-12-31

A demonstration of low-cost insulation and weatherization techniques was a part of phase 1 of the Krakow Clean Fossil Fuels and Energy Efficient Project. The objectives were to identify a cost-effective set of measures to reduce energy used for space heating, determine how much energy could be saved, and foster widespread implementation of those measures. The demonstration project focused on 4 11-story buildings in a Krakow housing cooperative. Energy savings of over 20% were obtained. Most important, the procedures and materials implemented in the demonstration project have been adapted to Polish conditions and applied to other housing cooperatives, schools, andmore » hospitals. Additional projects are being planned, in Krakow and other cities, under the direction of FEWE-Krakow, the Polish Energie Cities Network, and Biuro Rozwoju Krakowa.« less

Spinoff 2015

NASA Technical Reports Server (NTRS)

2015-01-01

Topics covered include: 3D Endoscope to Boost Safety, Cut Cost of Surgery; Audio App Brings a Better Night's Sleep Liquid Cooling Technology Increases Exercise Efficiency; Algae-Derived Dietary Ingredients Nourish Animals; Space Grant Research Launches Rehabilitation Chair; Vision Trainer Teaches Focusing Techniques at Home; Aircraft Geared Architecture Reduces Fuel Cost and Noise; Ubiquitous Supercritical Wing Design Cuts Billions in Fuel Costs; Flight Controller Software Protects Lightweight Flexible Aircraft; Cabin Pressure Monitors Notify Pilots to Save Lives; Ionospheric Mapping Software Ensures Accuracy of Pilots' GPS; Water Mapping Technology Rebuilds Lives in Arid Regions; Shock Absorbers Save Structures and Lives during Earthquakes; Software Facilitates Sharing of Water Quality Data Worldwide; Underwater Adhesives Retrofit Pipelines with Advanced Sensors; Laser Imaging Video Camera Sees through Fire, Fog, Smoke; 3D Lasers Increase Efficiency, Safety of Moving Machines; Air Revitalization System Enables Excursions to the Stratosphere; Magnetic Fluids Deliver Better Speaker Sound Quality; Bioreactor Yields Extracts for Skin Cream; Private Astronaut Training Prepares Commercial Crews of Tomorrow; Activity Monitors Help Users Get Optimum Sun Exposure; LEDs Illuminate Bulbs for Better Sleep, Wake Cycles; Charged Particles Kill Pathogens and Round Up Dust; Balance Devices Train Golfers for a Consistent Swing; Landsat Imagery Enables Global Studies of Surface Trends; Ruggedized Spectrometers Are Built for Tough Jobs; Gas Conversion Systems Reclaim Fuel for Industry; Remote Sensing Technologies Mitigate Drought; Satellite Data Inform Forecasts of Crop Growth; Probes Measure Gases for Environmental Research; Cloud Computing Technologies Facilitate Earth Research; Software Cuts Homebuilding Costs, Increases Energy Efficiency; Portable Planetariums Teach Science; Schedule Analysis Software Saves Time for Project Planners; Sound Modeling Simplifies Vehicle Noise Management; Custom 3D Printers Revolutionize Space Supply Chain; Improved Calibration Shows Images' True Colors; Micromachined Parts Advance Medicine, Astrophysics, and More; Metalworking Techniques Unlock a Unique Alloy; Low-Cost Sensors Deliver Nanometer-Accurate Measurements; Electrical Monitoring Devices Save on Time and Cost; Dry Lubricant Smooths the Way for Space Travel, Industry; and Compact Vapor Chamber Cools Critical Components.

Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.

PubMed

Parker, Scott L; Grahovac, Gordan; Vukas, Duje; Ledic, Darko; Vilendecic, Milorad; McGirt, Matthew J

2013-09-01

Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy. Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost). Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs. Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication. Georg Thieme Verlag KG Stuttgart · New York.

Non-Toxic Orbiter Maneuvering System (OMS) and Reaction Control System

NASA Technical Reports Server (NTRS)

Hurlbert, Eric A.; Nicholson, Leonard S. (Technical Monitor)

1999-01-01

NASA is pursuing the technology and advanced development of a non-toxic (NT) orbital maneuvering system (OMS) and reaction control system (RCS) for shuttle upgrades, RLV, and reusable first stages. The primary objectives of the shuttle upgrades program are improved safety, improved reliability, reduced operations time and cost, improved performance or capabilities, and commonality with future space exploration needs. Non-Toxic OMS/RCS offers advantages in each of these categories. A non-toxic OMS/RCS eliminates the ground hazards and the flight safety hazards of the toxic and corrosive propellants. The cost savings for ground operations are over $24M per year for 7 flights, and the savings increase with increasing flight rate up to $44M per year. The OMS/RCS serial processing time is reduced from 65 days to 13 days. The payload capability can be increased up to 5100 Ibms. The non-toxic OMS/RCS also provides improved space station reboost capability up to 20 nautical miles over the current toxic system of 14 nautical miles. A NT OMS/RCS represents a clear advancement in the SOA over MMH/NTO. Liquid oxygen and ethanol are clean burning, high-density propellants that provide a high degree of commonality with other spacecraft subsystems including life support, power, and thermal control, and with future human exploration and development of space missions. The simple and reliable pressure-fed design uses sub-cooled liquid oxygen at 250 to 350 psia, which allows a propellant to remain cryogenic for longer periods of time. The key technologies are thermal insulation and conditioning techniques are used to maintain the sub-cooling. Phase I successfully defined the system architecture, designed an integrated OMS/RCS propellant tank, analyzed the feed system, built and tested the 870 lbf RCS thrusters, and tested the 6000 lbf OMS engine. Phase 11 is currently being planned for the development and test of full-scale prototype of the system in 1999 and 2000

Prototype Tsunami Evacuation Park in Padang, West Sumatra, Indonesia

NASA Astrophysics Data System (ADS)

Tucker, B. E.; Cedillos, V.; Deierlein, G.; Di Mauro, M.; Kornberg, K.

2012-12-01

Padang, Indonesia, a city of some 900,000 people, half of whom live close to the coast and within a five-meter elevation above sea level, has one of the highest tsunami risks in the world due to its close offshore thrust-fault seismic hazard, flat terrain and dense population. There is a high probability that a tsunami will strike the shores of Padang, flooding half of the area of the city, within the next 30 years. If that tsunami occurred today, it is estimated that several hundred thousand people would die, as they could not reach safe ground in the ~30 minute interval between the earthquake's occurrence and the tsunami's arrival. Padang's needs have been amply demonstrated: after earthquakes in 2007, 2009, 2011 and 2012, citizens, thinking that those earthquakes might cause a tsunami, tried to evacuate in cars and motorbikes, which created traffic jams, and most could not reach safe ground in 30 minutes. Since 2008, GeoHazards International (GHI) and Stanford University have studied a range of options for improving this situation, including ways to accelerate evacuation to high ground with pedestrian bridges and widened roads, and means of "vertical" evacuation in multi-story buildings, mosques, pedestrian overpasses, and Tsunami Evacuation Parks (TEPs), which are man-made hills with recreation facilities on top. TEPs proved most practical and cost-effective for Padang, given the available budget, technology and time. The Earth Observatory Singapore (EOS) developed an agent-based model that simulates pedestrian and vehicular evacuation to assess tsunami risk and risk reduction interventions in Southeast Asia. EOS applied this model to analyze the effectiveness in Padang of TEPs over other tsunami risk management approaches in terms of evacuation times and the number of people saved. The model shows that only ~24,000 people (20% of the total population) in the northern part of Padang can reach safe ground within 30 minutes, if people evacuate using cars and motorbikes immediately after the earthquake. If one TEP is built, ~46,000 could reach safe ground within 30 minutes, and if three were built ~72,000 could. GHI has acquired permission to build a prototype TEP in the northern part of Padang that would accommodate about 25,000 people during the time of a tsunami. This would cost about 4.7 million, amounting to a cost-per-life-saved of ~US200, far lower than the per capita cost of the other options. The cost of replication should be less. This interdisciplinary, international effort demonstrated that TEPs offer the best option for Padang because they have the potential to save thousands of lives, are relatively simple to build and maintain, invite everyday recreational use by the community, and have attracted strong Indonesian government support as a possible means to manage the country's tsunami risk.

Case Study for the ARRA-funded GSHP Demonstration at Furman University

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

Liu, Xiaobing; Malhotra, Mini

With funding provided by the American Recovery and Reinvestment Act, 26 ground source heat pump (GSHP) projects were competitively selected in 2009 to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. One of the selected demonstration projects was proposed by Furman University for ten student housing buildings—the North Village located on the campus in Greeneville, South Carolina. All ten buildings are identical in floor plan and construction. Each building is conditioned by an identical GSHP system consisting of 25 water-to-air heat pump (WAHP) units, a closed-loop vertical ground heat exchanger (GHX) installed undermore » an adjacent parking lot, and two redundant 7.5 hp variable-speed pumps to circulate water through the GHX and the WAHPs. The actual performance of the GSHP systems is analyzed with available measured data for 2014. The annual energy performance is compared with a baseline scenario in which the building is conditioned by air-source heat pumps (ASHPs) with the minimum allowed efficiencies specified in ASHRAE Standard 90.1-2013 (SEER 13 for cooling and 7.8 HSPF for heating) and supplemental electric heaters. The comparison is made in terms of energy savings, operating cost savings, cost-effectiveness, and environmental benefits. Finally, limitations in conducting this analysis are identified and recommendations for further improving the operational efficiency of the GSHP systems are made.« less

Case Study for the ARRA-funded GSHP Demonstration at University at Albany

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

Liu, Xiaobing; Malhotra, Mini; Xiong, Zeyu

High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects have been competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This report highlights the findings of a case study of one of the ARRA-funded GSHP demonstration projects—a distributed GSHP system at a new 500-bed apartment-style student residence hall at the University at Albany. This case studymore » is based on the analysis of detailed design documents, measured performance data, published catalog data of heat pump equipment, and actual construction costs. Simulations with a calibrated computer model are performed for both the demonstrated GSHP system and a baseline heating, ventilation, and airconditioning (HVAC) system to determine the energy savings and other related benefits achieved by the GSHP system. The evaluated performance metrics include the energy efficiency of the heat pump equipment and the overall GSHP system, as well as the pumping performance, energy savings, carbon emission reductions, and cost-effectiveness of the demonstrated GSHP system compared with the baseline HVAC system. This case study also identifies opportunities for improving the operational efficiency of the demonstrated GSHP system.« less

Development of low-cost silicon crystal growth techniques for terrestrial photovoltaic solar energy conversion

NASA Technical Reports Server (NTRS)

Zoutendyk, J. A.

1976-01-01

Because of the growing need for new sources of electrical energy, photovoltaic solar energy conversion is being developed. Photovoltaic devices are now being produced mainly from silicon wafers obtained from the slicing and polishing of cylindrically shaped single crystal ingots. Inherently high-cost processes now being used must either be eliminated or modified to provide low-cost crystalline silicon. Basic to this pursuit is the development of new or modified methods of crystal growth and, if necessary, crystal cutting. If silicon could be grown in a form requiring no cutting, a significant cost saving would potentially be realized. Therefore, several techniques for growth in the form of ribbons or sheets are being explored. In addition, novel techniques for low-cost ingot growth and cutting are under investigation.

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

Marathe, Aniruddha P.; Harris, Rachel A.; Lowenthal, David K.

The use of clouds to execute high-performance computing (HPC) applications has greatly increased recently. Clouds provide several potential advantages over traditional supercomputers and in-house clusters. The most popular cloud is currently Amazon EC2, which provides fixed-cost and variable-cost, auction-based options. The auction market trades lower cost for potential interruptions that necessitate checkpointing; if the market price exceeds the bid price, a node is taken away from the user without warning. We explore techniques to maximize performance per dollar given a time constraint within which an application must complete. Specifically, we design and implement multiple techniques to reduce expected cost bymore » exploiting redundancy in the EC2 auction market. We then design an adaptive algorithm that selects a scheduling algorithm and determines the bid price. We show that our adaptive algorithm executes programs up to seven times cheaper than using the on-demand market and up to 44 percent cheaper than the best non-redundant, auction-market algorithm. We extend our adaptive algorithm to incorporate application scalability characteristics for further cost savings. In conclusion, we show that the adaptive algorithm informed with scalability characteristics of applications achieves up to 56 percent cost savings compared to the expected cost for the base adaptive algorithm run at a fixed, user-defined scale.« less

Compressed air production with waste heat utilization in industry

NASA Astrophysics Data System (ADS)

Nolting, E.

1984-06-01

The centralized power-heat coupling (PHC) technique using block heating power stations, is presented. Compressed air production in PHC technique with internal combustion engine drive achieves a high degree of primary energy utilization. Cost savings of 50% are reached compared to conventional production. The simultaneous utilization of compressed air and heat is especially interesting. A speed regulated drive via an internal combustion motor gives a further saving of 10% to 20% compared to intermittent operation. The high fuel utilization efficiency ( 80%) leads to a pay off after two years for operation times of 3000 hr.

Economical ground data delivery

NASA Technical Reports Server (NTRS)

Markley, Richard W.; Byrne, Russell H.; Bromberg, Daniel E.

1994-01-01

Data delivery in the Deep Space Network (DSN) involves transmission of a small amount of constant, high-priority traffic and a large amount of bursty, low priority data. The bursty traffic may be initially buffered and then metered back slowly as bandwidth becomes available. Today both types of data are transmitted over dedicated leased circuits. The authors investigated the potential of saving money by designing a hybrid communications architecture that uses leased circuits for high-priority network communications and dial-up circuits for low-priority traffic. Such an architecture may significantly reduce costs and provide an emergency backup. The architecture presented here may also be applied to any ground station-to-customer network within the range of a common carrier. The authors compare estimated costs for various scenarios and suggest security safeguards that should be considered.

NASTRAN internal improvements for 1992 release

NASA Technical Reports Server (NTRS)

Chan, Gordon C.

1992-01-01

The 1992 NASTRAN release incorporates a number of improvements transparent to users. The NASTRAN executable was made smaller by 70 pct. for the RISC base Unix machines by linking NASTRAN into a single program, freeing some 33 megabytes of system disc space that can be used by NASTRAN for solving larger problems. Some basic matrix operations, such as forward-backward substitution (FBS), multiply-add (MPYAD), matrix transpose, and fast eigensolution extraction routine (FEER), have been made more efficient by including new methods, new logic, new I/O techniques, and, in some cases, new subroutines. Some of the improvements provide ground work ready for system vectorization. These are finite element basic operations, and are used repeatedly in a finite element program such as NASTRAN. Any improvements on these basic operations can be translated into substantial cost and cpu time savings. NASTRAN is also discussed in various computer platforms.

Reported Energy and Cost Savings from the DOE ESPC Program: FY 2014

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

Slattery, Bob S.

2015-03-01

The objective of this work was to determine the realization rate of energy and cost savings from the Department of Energy’s Energy Savings Performance Contract (ESPC) program based on information reported by the energy services companies (ESCOs) that are carrying out ESPC projects at federal sites. Information was extracted from 156 Measurement and Verification (M&V) reports to determine reported, estimated, and guaranteed cost savings and reported and estimated energy savings for the previous contract year. Because the quality of the reports varied, it was not possible to determine all of these parameters for each project. For all 156 projects, theremore » was sufficient information to compare estimated, reported, and guaranteed cost savings. For this group, the total estimated cost savings for the reporting periods addressed were $210.6 million, total reported cost savings were $215.1 million, and total guaranteed cost savings were $204.5 million. This means that on average: ESPC contractors guaranteed 97% of the estimated cost savings; projects reported achieving 102% of the estimated cost savings; and projects reported achieving 105% of the guaranteed cost savings. For 155 of the projects examined, there was sufficient information to compare estimated and reported energy savings. On the basis of site energy, estimated savings for those projects for the previous year totaled 11.938 million MMBtu, and reported savings were 12.138 million MMBtu, 101.7% of the estimated energy savings. On the basis of source energy, total estimated energy savings for the 155 projects were 19.052 million MMBtu, and reported saving were 19.516 million MMBtu, 102.4% of the estimated energy savings.« less

Commercial GSHPs: Benefits Belie Lack of Popularity

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

Cooperman, Alissa; Dieckmann, John; Brodrick, James

2012-05-31

This article discusses ground source heat pumps (GSHPs) for commercial building application as an alternative to conventional HVAC systems. A technology overview is presented as there are several types of GSHP and each has features making them better suited for certain building and lot types in addition to location climate. The article concludes with potential energy and cost savings offered by GSHPs and a brief market overview.

Case Study of The ARRA-Funded GSHP Demonstration at the Natural Sources Building, Montana Tech

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

Malhotra, Mini; Liu, Xiaobing

Under the American Recovery and Reinvestment Act (ARRA), 26 ground source heat pump (GSHP) projects were competitively selected in 2009 to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. One of the selected demonstration projects was proposed by Montana Tech of the University of Montana for a 56,000 sq ft, newly constructed, on-campus research facility – the Natural Resources Building (NRB) located in Butte, Montana. This demonstrated GSHP system consists of a 50 ton water-to-water heat pump and a closed-loop ground heat exchanger with two redundant 7.5 hp constant-speed pumps to use watermore » in the nearby flooded mines as a heat source or heat sink. It works in conjunction with the originally installed steam HX and an aircooled chiller to provide space heating and cooling. It is coupled with the existing hot water and chilled water piping in the building and operates in the heating or cooling mode based on the outdoor air temperature. The ground loop pumps operate in conjunction with the existing pumps in the building hot and chilled water loops for the operation of the heat pump unit. The goal of this demonstration project is to validate the technical and economic feasibility of the demonstrated commercial-scale GSHP system in the region, and illustrate the feasibility of using mine waters as the heat sink and source for GSHP systems. Should the demonstration prove satisfactory and feasible, it will encourage similar GSHP applications using mine water, thus help save energy and reduce carbon emissions. The actual performance of the system is analyzed with available measured data for January through July 2014. The annual energy performance is predicted and compared with a baseline scenario, with the heating and cooling provided by the originally designed systems. The comparison is made in terms of energy savings, operating cost savings, cost-effectiveness, and environmental benefits. Finally, limitations in conducting the analysis are identified and recommendations for improvement in the control and operation of such systems are made.« less

Determining if disease management saves money: an introduction to meta-analysis.

PubMed

Linden, Ariel; Adams, John L

2007-06-01

Disease management (DM) programmes have long been promoted as a major medical cost-saving mechanism, even though the scant research that exists on the topic has provided conflicting results. In a 2004 literature review, the Congressional Budget Office stated that 'there is insufficient evidence to conclude that disease management programs can generally reduce the overall cost of health care services'. To address this question more accurately, a meta-analysis was warranted. Meta-analysis is the quantitative technique used to pool the results of many studies on the same topic and summarize them statistically. This method is also quite suitable for individual DM firms to assess whether their programmes are effective at the aggregate level. This paper describes the elements of a rigorous meta-analytic process and discusses potential biases. A hypothetical DM organization is then evaluated with a specific emphasis on medical cost-savings, simulating a case in which different populations are served, evaluation methodologies are employed, and diseases are managed.

Use of ground-penetrating radar techniques in archaeological investigations

NASA Technical Reports Server (NTRS)

Doolittle, James A.; Miller, W. Frank

1991-01-01

Ground-penetrating radar (GPR) techniques are increasingly being used to aid reconnaissance and pre-excavation surveys at many archaeological sites. As a 'remote sensing' tool, GPR provides a high resolution graphic profile of the subsurface. Radar profiles are used to detect, identify, and locate buried artifacts. Ground-penetrating radar provides a rapid, cost effective, and nondestructive method for identification and location analyses. The GPR can be used to facilitate excavation strategies, provide greater areal coverage per unit time and cost, minimize the number of unsuccessful exploratory excavations, and reduce unnecessary or unproductive expenditures of time and effort.

The threshold rate of oral atypical anti-psychotic adherence at which paliperidone palmitate is cost saving.

PubMed

Edwards, Natalie C; Muser, Erik; Doshi, Dilesh; Fastenau, John

2012-01-01

To identify, estimate, and compare 'real world' costs and outcomes associated with paliperidone palmitate compared with branded oral atypical anti-psychotics, and to estimate the threshold rate of oral atypical adherence at which paliperidone palmitate is cost saving. Decision analytic modeling techniques developed by Glazer and Ereshefsky have previously been used to estimate the cost-effectiveness of depot haloperidol, LAI risperidone, and, more recently, LAI olanzapine. This study used those same techniques, along with updated comparative published clinical data, to evaluate paliperidone palmitate. Adherence rates were based on strict Medication Event Monitoring System (MEMS) criteria. The evaluation was conducted from the perspective of US healthcare payers. Paliperidone palmitate patients had fewer mean annual days of relapse (8.7 days; 6.0 requiring hospitalization, 2.7 not requiring hospitalization vs 17.8 days; 12.4 requiring hospitalization, 5.4 not requiring hospitalization), and lower annual total cost ($20,995) compared to oral atypicals (mean $22,481). Because paliperidone palmitate was both more effective and less costly, it is considered economically dominant. Paliperidone palmitate saved costs when the rate of adherence of oral atypical anti-psychotics was below 44.9% using strict MEMS criteria. Sensitivity analyses showed results were robust to changes in parameter values. For patients receiving 156 mg paliperidone palmitate, the annual incremental cost was $1216 per patient (ICER = $191 per day of relapse averted). Inclusion of generic risperidone (market share 18.6%) also resulted in net incremental cost for paliperidone palmitate ($120; ICER = $13). Limitations of this evaluation include use of simplifying assumptions, data from multiple sources, and generalizability of results. Although uptake of LAIs in the US has not been as rapid as elsewhere, many thought leaders emphasize their importance in optimizing outcomes in patients with adherence problems. The findings of this analysis support the cost-effectiveness of paliperidone palmitate in these patients.

Development of low cost custom hybrid microcircuit technology

NASA Technical Reports Server (NTRS)

Perkins, K. L.; Licari, J. J.

1981-01-01

Selected potentially low cost, alternate packaging and interconnection techniques were developed and implemented in the manufacture of specific NASA/MSFC hardware, and the actual cost savings achieved by their use. The hardware chosen as the test bed for this evaluation ws the hybrids and modules manufactured by Rockwell International fo the MSFC Flight Accelerometer Safety Cut-Off System (FASCOS). Three potentially low cost packaging and interconnection alternates were selected for evaluation. This study was performed in three phases: hardware fabrication and testing, cost comparison, and reliability evaluation.

Effects of road decommissioning on carbon stocks, losses, and emissions in north coastal California

USGS Publications Warehouse

Madej, Mary Ann; Seney, Joseph; van Mantgem, Philip

2013-01-01

During the last 3 decades, many road removal projects have been implemented on public and private lands in the United States to reduce erosion and other impacts from abandoned or unmaintained forest roads. Although effective in decreasing sediment production from roads, such activities have a carbon (C) cost as well as representing a carbon savings for an ecosystem. We assessed the carbon budget implications of 30 years of road decommissioning in Redwood National Park in north coastal California. Road restoration techniques, which evolved during the program, were associated with various carbon costs and savings. Treatment of 425 km of logging roads from 1979 to 2009 saved 72,000 megagrams (Mg) C through on-site soil erosion prevention, revegetation, and soil development on formerly compacted roads. Carbon sequestration will increase in time as forests and soils develop more fully on the restored sites. The carbon cost for this road decommissioning work, based on heavy equipment and vehicle fuel emissions, short-term soil loss, and clearing of vegetation, was 23,000 Mg C, resulting in a net carbon savings of 49,000 Mg C to date. Nevertheless, the degree to which soil loss is a carbon sink or source in steep mountainous watersheds needs to be further examined. The ratio of carbon costs to savings will differ by ecosystem and road removal methodology, but the procedure outlined here to assess carbon budgets on restoration sites should be transferable to other systems.

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

PubMed

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

2014-06-01

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

Application of High Speed Digital Image Correlation in Rocket Engine Hot Fire Testing

NASA Technical Reports Server (NTRS)

Gradl, Paul R.; Schmidt, Tim

2016-01-01

Hot fire testing of rocket engine components and rocket engine systems is a critical aspect of the development process to understand performance, reliability and system interactions. Ground testing provides the opportunity for highly instrumented development testing to validate analytical model predictions and determine necessary design changes and process improvements. To properly obtain discrete measurements for model validation, instrumentation must survive in the highly dynamic and extreme temperature application of hot fire testing. Digital Image Correlation has been investigated and being evaluated as a technique to augment traditional instrumentation during component and engine testing providing further data for additional performance improvements and cost savings. The feasibility of digital image correlation techniques were demonstrated in subscale and full scale hotfire testing. This incorporated a pair of high speed cameras to measure three-dimensional, real-time displacements and strains installed and operated under the extreme environments present on the test stand. The development process, setup and calibrations, data collection, hotfire test data collection and post-test analysis and results are presented in this paper.

The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century.

PubMed

Ochiai, Derek H; Adib, Farshad

2015-04-01

Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible. From 2003 to 2012, the Spin Move was performed in 1,725 consecutive procedures with no complication. The estimated average time was 5.3 and 7.8 seconds for the Spin Move and traditional gowning, respectively. The estimated time saving for the senior author during this period was 71.875 minutes. Approximately 20,000 orthopaedic surgeons practice in the United States. If this technique had been used, 23,958 hours could have been saved. The money saving could have been $14,374,800.00 (23,958 hours × $600/operating room hour) during the past 10 years. The Spin Move is easy to perform and reproducible. It saves operating room time and increases ORE.

The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century

PubMed Central

Ochiai, Derek H.; Adib, Farshad

2015-01-01

Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible. From 2003 to 2012, the Spin Move was performed in 1,725 consecutive procedures with no complication. The estimated average time was 5.3 and 7.8 seconds for the Spin Move and traditional gowning, respectively. The estimated time saving for the senior author during this period was 71.875 minutes. Approximately 20,000 orthopaedic surgeons practice in the United States. If this technique had been used, 23,958 hours could have been saved. The money saving could have been $14,374,800.00 (23,958 hours × $600/operating room hour) during the past 10 years. The Spin Move is easy to perform and reproducible. It saves operating room time and increases ORE. PMID:26052490

Exploiting Redundancy and Application Scalability for Cost-Effective, Time-Constrained Execution of HPC Applications on Amazon EC2

DOE PAGES

Marathe, Aniruddha P.; Harris, Rachel A.; Lowenthal, David K.; ...

2015-12-17

The use of clouds to execute high-performance computing (HPC) applications has greatly increased recently. Clouds provide several potential advantages over traditional supercomputers and in-house clusters. The most popular cloud is currently Amazon EC2, which provides fixed-cost and variable-cost, auction-based options. The auction market trades lower cost for potential interruptions that necessitate checkpointing; if the market price exceeds the bid price, a node is taken away from the user without warning. We explore techniques to maximize performance per dollar given a time constraint within which an application must complete. Specifically, we design and implement multiple techniques to reduce expected cost bymore » exploiting redundancy in the EC2 auction market. We then design an adaptive algorithm that selects a scheduling algorithm and determines the bid price. We show that our adaptive algorithm executes programs up to seven times cheaper than using the on-demand market and up to 44 percent cheaper than the best non-redundant, auction-market algorithm. We extend our adaptive algorithm to incorporate application scalability characteristics for further cost savings. In conclusion, we show that the adaptive algorithm informed with scalability characteristics of applications achieves up to 56 percent cost savings compared to the expected cost for the base adaptive algorithm run at a fixed, user-defined scale.« less

Endovascular training with animals versus virtual reality systems: an economic analysis.

PubMed

Berry, Max; Hellström, Mikael; Göthlin, Jan; Reznick, Richard; Lönn, Lars

2008-02-01

To assess the relative costs of a virtual reality (VR) laboratory and an animal laboratory for endovascular skills training. Cost data extracted from a previous experiment was used to perform a financial analysis according to the guidelines published by the National Institutes of Health. The analysis compared the purchase or rental of a Procedicus Vascular Interventional System Trainer to the rental of an animal laboratory. The VR laboratory course cost $3,434 per trainee versus $4,634 in the animal laboratory according to the purchase-versus-rental analysis. The cost ratio was 0.74 in favor of the VR laboratory. Cost ratio sensitivity analysis ranged from 0.25 in favor of the VR laboratory to 2.22 in favor of the animal laboratory. The first-year potential savings were $62,410 assuming exclusive use of the VR laboratory. The 5-year training savings totaled $390,376, excluding the $60,000 residual value of the simulator. Simulator rental reduced the course price to $1,076 per trainee and lowered the cost ratio to 0.23 in favor of the VR laboratory. Findings of sensitivity analysis ranged from 0.08 to 0.70 in favor of the VR laboratory. The first-year and 5-year potential national savings increased to $185,026 and $1,013,238, respectively. Although evidence remains sparse that the training of interventional skills in artificial environments translates to better performance in human procedures, there are good pedagogic grounds on which to believe that such training will become increasingly important. The present comparison of the direct costs of two such models suggests that VR training is less expensive than live animal training.

Productivity and cost estimators for conventional ground-based skidding on steep terrain using preplanned skid roads

Treesearch

Michael D. Erickson; Curt C. Hassler; Chris B. LeDoux

1991-01-01

Continuous time and motion study techniques were used to develop productivity and cost estimators for the skidding component of ground-based logging systems, operating on steep terrain using preplanned skid roads. Comparisons of productivity and costs were analyzed for an overland random access skidding method, verses a skidding method utilizing a network of preplanned...

Modeling the cost-effectiveness of insect rearing on artificial diets: A test with a tephritid fly used in the sterile insect technique.

PubMed

Pascacio-Villafán, Carlos; Birke, Andrea; Williams, Trevor; Aluja, Martín

2017-01-01

We modeled the cost-effectiveness of rearing Anastrepha ludens, a major fruit fly pest currently mass reared for sterilization and release in pest control programs implementing the sterile insect technique (SIT). An optimization model was generated by combining response surface models of artificial diet cost savings with models of A. ludens pupation, pupal weight, larval development time and adult emergence as a function of mixtures of yeast, a costly ingredient, with corn flour and corncob fractions in the diet. Our model revealed several yeast-reduced mixtures that could be used to prepare diets that were considerably cheaper than a standard diet used for mass rearing. Models predicted a similar production of insects (pupation and adult emergence), with statistically similar pupal weights and larval development times between yeast-reduced diets and the standard mass rearing diet formulation. Annual savings from using the modified diets could be up to 5.9% of the annual cost of yeast, corn flour and corncob fractions used in the standard diet, representing a potential saving of US $27.45 per ton of diet (US $47,496 in the case of the mean annual production of 1,730.29 tons of artificial diet in the Moscafrut mass rearing facility at Metapa, Chiapas, Mexico). Implementation of the yeast-reduced diet on an experimental scale at mass rearing facilities is still required to confirm the suitability of new mixtures of artificial diet for rearing A. ludens for use in SIT. This should include the examination of critical quality control parameters of flies such as adult flight ability, starvation resistance and male sexual competitiveness across various generations. The method used here could be useful for improving the cost-effectiveness of invertebrate or vertebrate mass rearing diets worldwide.

Modeling the cost-effectiveness of insect rearing on artificial diets: A test with a tephritid fly used in the sterile insect technique

PubMed Central

Birke, Andrea; Williams, Trevor; Aluja, Martín

2017-01-01

We modeled the cost-effectiveness of rearing Anastrepha ludens, a major fruit fly pest currently mass reared for sterilization and release in pest control programs implementing the sterile insect technique (SIT). An optimization model was generated by combining response surface models of artificial diet cost savings with models of A. ludens pupation, pupal weight, larval development time and adult emergence as a function of mixtures of yeast, a costly ingredient, with corn flour and corncob fractions in the diet. Our model revealed several yeast-reduced mixtures that could be used to prepare diets that were considerably cheaper than a standard diet used for mass rearing. Models predicted a similar production of insects (pupation and adult emergence), with statistically similar pupal weights and larval development times between yeast-reduced diets and the standard mass rearing diet formulation. Annual savings from using the modified diets could be up to 5.9% of the annual cost of yeast, corn flour and corncob fractions used in the standard diet, representing a potential saving of US $27.45 per ton of diet (US $47,496 in the case of the mean annual production of 1,730.29 tons of artificial diet in the Moscafrut mass rearing facility at Metapa, Chiapas, Mexico). Implementation of the yeast-reduced diet on an experimental scale at mass rearing facilities is still required to confirm the suitability of new mixtures of artificial diet for rearing A. ludens for use in SIT. This should include the examination of critical quality control parameters of flies such as adult flight ability, starvation resistance and male sexual competitiveness across various generations. The method used here could be useful for improving the cost-effectiveness of invertebrate or vertebrate mass rearing diets worldwide. PMID:28257496

Low-cost sustainable wall construction system

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

Vohra, A.; Rosenfeld, A.H.

1998-07-01

Houses with no wall cavities, such as those made of adobe, stone, brick, or block, have poor thermal properties but are rarely insulated because of the cost and difficulty of providing wall insulation. A simple, low-cost technique using loose-fill indigenous materials has been demonstrated for the construction of highly insulated walls or the retrofit of existing walls in such buildings. Locally available pumice, in sandbags stacked along the exterior wall of an adobe house in New Mexico, added a thermal resistance (R) of 16 F{sm{underscore}bullet}ft{sup 2}{sm{underscore}bullet}h/Btu (2.8 m{sup 2}{sm{underscore}bullet}K/W). The total cost of the sandbag insulation wall retrofit wasmore » $3.76 per square foot ($$40.50/m{sup 2}). Computer simulations of the adobe house using DOE 2.1E show savings of $$275 per year, corresponding to 50% reduction in heating energy consumption. The savings-to-investment ratio ranges from 1.1 to 3.2, so the cost of conserved energy is lower than the price of propane, natural gas and electric heat, making the system cost-effective. Prototype stand-alone walls were also constructed using fly ash and sawdust blown into continuous polypropylene tubing, which was folded between corner posts as it was filled to form the shape of the wall. Other materials could also be used. The inexpensive technique solves the problem of insulating solid-wall hours and constructing new houses without specialized equipment and skills, thereby saving energy, reducing greenhouse gas emissions, and improving comfort for people in many countries. The US Department of Energy (DOE) has filed patent applications on this technology, which is part of a DOE initiative on sustainable building envelope materials and systems.« less

Developing NDE Techniques for Large Cryogenic Tanks

NASA Technical Reports Server (NTRS)

Parker, Don; Starr, Stan; Arens, Ellen

2011-01-01

The Shuttle Program requires very large cryogenic ground storage tanks in which to store liquid oxygen and hydrogen. The existing Pads A and B Launch Complex-39 tanks, which will be passed onto future launch programs, are 45 years old and have received minimal refurbishment and only external inspections over the years. The majority of the structure is inaccessible without a full system drain of cryogenic liquid and granular insulation in the annular region. It was previously thought that there was a limit to the number of temperature cycles that the tanks could handle due to possible insulation compaction before undergoing a costly and time consuming complete overhaul; therefore the tanks were not drained and performance issues with these tanks, specifically the Pad B liquid hydrogen tank, were accepted. There is a needind an opportunity, as the Shuttle program ends and work to upgrade the launch pads progresses, to develop innovative non-destructive evaluation (NDE) techniques to analyze the current tanks. Techniques are desired that can aid in determining the extent of refurbishment required to keep the tanks in service for another 20+ years. A nondestructive technique would also be a significant aid in acceptance testing of new and refurbished tanks, saving significant time and money, if corrective actions can be taken before cryogen is introduced to the systems.

Evaluating winds aloft by a simplified field technique

Treesearch

Melvin K. Hull

1966-01-01

A field technique for evaluating winds aloft is described. It can be used at remote places--even at the site of a wildfire. It has proved accurate as any known single theodolite technique, and is time-saving because the winds aloft are evaluated in miles per hour from direct readout. The tools required are much lower in cost, more portable, and more multi-purpose than...

Autonomy-Enabled Fuel Savings for Military Vehicles: Report on 2016 Aberdeen Test Center Testing

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

Ragatz, Adam; Prohaska, Robert; Gonder, Jeff

Fuel savings have never been the primary focus for autonomy-enabled military vehicles. However, studies have estimated that autonomy in passenger and commercial vehicles could improve fuel economy by as much as 22%-33% over various drive cycles. If even a fraction of this saving could be realized in military vehicles, significant cost savings could be realized each year through reduced fuel transport missions, reduced fuel purchases, less maintenance, fewer required personnel, and increased vehicle range. Researchers from the National Renewable Energy Laboratory installed advanced data logging equipment and instrumentation on two autonomy-enabled convoy vehicles configured with Lockheed Martin's Autonomous Mobility Appliquemore » System to determine system performance and improve on the overall vehicle control strategies of the vehicles. Initial test results from testing conducted at the U.S. Army Aberdeen Test Center at the Aberdeen Proving Grounds are included in this report. Lessons learned from in-use testing and performance results have been provided to the project partners for continued system refinement.« less

Case Study for the ARRA-Funded Ground Source Heat Pump Demonstration at Ball State University

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

Im, Piljae; Liu, Xiaobing; Henderson, Jr., Hugh

With funding provided by the American Recovery and Reinvestment Act (ARRA), 26 ground-source heat pump (GSHP) projects were competitively selected in 2009 to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. One of the selected demonstration projects is a district central GSHP system installed at Ball State University (BSU) in Muncie, IN. Prior to implementing the district GSHP system, 47 major buildings in BSU were served by a central steam plant with four coal-fired and three natural-gas-fired steam boilers. Cooling was provided by five water-cooled centrifugal chillers at the District Energy Station Southmore » (DESS). The new district GSHP system replaced the existing coal-fired steam boilers and conventional water-cooled chillers. It uses ground-coupled heat recovery (HR) chillers to meet the simultaneous heating and cooling demands of the campus. The actual performance of the GSHP system was analyzed based on available measured data from August 2015 through July 2016, construction drawings, maintenance records, personal communications, and construction costs. Since Phase 1 was funded in part by the ARRA grant, it is the focus of this case study. The annual energy consumption of the GSHP system was calculated based on the available measured data and other related information. It was compared with the performance of a baseline scenario— a conventional water-cooled chiller and natural-gas-fired boiler system, both of which meet the minimum energy efficiencies allowed by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE 90.1-2013). The comparison was made to determine source energy savings, energy cost savings, and CO2 emission reductions achieved by the GSHP system. A cost analysis was performed to evaluate the simple payback of the GSHP system. The following sections summarize the results of the analysis, the lessons learned, and recommendations for improvement in the operation of this district GSHP system.« less

Estimating health benefits and cost-savings for achieving the Healthy People 2020 objective of reducing invasive colorectal cancer.

PubMed

Hung, Mei-Chuan; Ekwueme, Donatus U; White, Arica; Rim, Sun Hee; King, Jessica B; Wang, Jung-Der; Chang, Su-Hsin

2018-01-01

This study aims to quantify the aggregate potential life-years (LYs) saved and healthcare cost-savings if the Healthy People 2020 objective were met to reduce invasive colorectal cancer (CRC) incidence by 15%. We identified patients (n=886,380) diagnosed with invasive CRC between 2001 and 2011 from a nationally representative cancer dataset. We stratified these patients by sex, race/ethnicity, and age. Using these data and data from the 2001-2011 U.S. life tables, we estimated a survival function for each CRC group and the corresponding reference group and computed per-person LYs saved. We estimated per-person annual healthcare cost-savings using the 2008-2012 Medical Expenditure Panel Survey. We calculated aggregate LYs saved and cost-savings by multiplying the reduced number of CRC patients by the per-person LYs saved and lifetime healthcare cost-savings, respectively. We estimated an aggregate of 84,569 and 64,924 LYs saved for men and women, respectively, accounting for healthcare cost-savings of $329.3 and $294.2 million (in 2013$), respectively. Per person, we estimated 6.3 potential LYs saved related to those who developed CRC for both men and women, and healthcare cost-savings of $24,000 for men and $28,000 for women. Non-Hispanic whites and those aged 60-64 had the highest aggregate potential LYs saved and cost-savings. Achieving the HP2020 objective of reducing invasive CRC incidence by 15% by year 2020 would potentially save nearly 150,000 life-years and $624 million on healthcare costs. Copyright © 2017. Published by Elsevier Inc.

The economic value of remote sensing of earth resources from space: An ERTS overview and the value of continuity of service. Volume 8: Atmosphere

NASA Technical Reports Server (NTRS)

Miles, R.; Fawkes, G.

1974-01-01

The economic value of an ERS system in the resource area of atmosphere is determined. Benefits which arise from air pollution and cloud observations correlated to ground stations are discussed along with cost savings associated with air pollution monitoring by satellite. Social benefits due to more precise knowledge of the effects of pollution are presented.

Fiber optic cables for severe environment

NASA Astrophysics Data System (ADS)

Massarani, M. G.

1982-10-01

The most severe challenges to the fiber optic cable are related to nuclear weapons testing and other military applications. Nuclear experiments are conducted in deep underground holes. Cables connect the experimental device to recording stations positioned at a certain distance from ground zero. Attractive features provided by fiber optic cable technology include large cost advantages in cable purchase price, savings in handling cost due to the lighter weight, immunity to electromagnetic pulses (EMP), and the capability to transmit high data rates. Details of underground nuclear testing are discussed, taking into account the underground nuclear test environment, and questions of fiber optic cable design for the underground experiments. The use of fiber optics for the Ground Launched Cruise Missile Weapons System (GLCM) is also considered. Attention is given to the GLCM environment, and the proposed cable for GLCM application.

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

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

Pellerin, Olivier, E-mail: olivier.pellerin@egp.aphp.f; Caruba, Thibaud; Kandounakis, Yanis

2008-11-15

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 {+-} 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in sevenmore » patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 Euro , whereas in group C patients, an average of 7 {+-} 3 coils were used, accounting for a mean cost of 1,745 Euro . Mean average cost savings using the AVP was 1,239 Euro . When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.« less

LEO Download Capacity Analysis for a Network of Adaptive Array Ground Stations

NASA Technical Reports Server (NTRS)

Ingram, Mary Ann; Barott, William C.; Popovic, Zoya; Rondineau, Sebastien; Langley, John; Romanofsky, Robert; Lee, Richard Q.; Miranda, Felix; Steffes, Paul; Mandl, Dan

2005-01-01

To lower costs and reduce latency, a network of adaptive array ground stations, distributed across the United States, is considered for the downlink of a polar-orbiting low earth orbiting (LEO) satellite. Assuming the X-band 105 Mbps transmitter of NASA s Earth Observing 1 (EO-1) satellite with a simple line-of-sight propagation model, the average daily download capacity in bits for a network of adaptive array ground stations is compared to that of a single 11 m dish in Poker Flats, Alaska. Each adaptive array ground station is assumed to have multiple steerable antennas, either mechanically steered dishes or phased arrays that are mechanically steered in azimuth and electronically steered in elevation. Phased array technologies that are being developed for this application are the space-fed lens (SFL) and the reflectarray. Optimization of the different boresight directions of the phased arrays within a ground station is shown to significantly increase capacity; for example, this optimization quadruples the capacity for a ground station with eight SFLs. Several networks comprising only two to three ground stations are shown to meet or exceed the capacity of the big dish, Cutting the data rate by half, which saves modem costs and increases the coverage area of each ground station, is shown to increase the average daily capacity of the network for some configurations.

Optimization in the design of a 12 gigahertz low cost ground receiving system for broadcast satellites. Volume 2: Antenna system and interference

NASA Technical Reports Server (NTRS)

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

1972-01-01

The antenna characteristics are analyzed of a low cost mass-producible ground station to be used in broadcast satellite systems. It is found that a prime focus antenna is sufficient for a low-cost but not a low noise system. For the antenna feed waveguide systems are the best choice for the 12 GHz band, while printed-element systems are recommended for the 2.6 GHz band. Zoned reflectors are analyzed and appear to be attractive from the standpoint of cost. However, these reflectors suffer a gain reduction of about one db and a possible increase in sidelobe levels. The off-axis gain of a non-auto-tracking station can be optimized by establishing a special illumination function at the reflector aperture. A step-feed tracking system is proposed to provide automatic procedures for searching for peak signal from a geostationary satellite. This system uses integrated circuitry and therefore results in cost saving under mass production. It is estimated that a complete step-track system would cost only $512 for a production quantity of 1000 units per year.

Early Lessons on Bundled Payment at an Academic Medical Center.

PubMed

Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

2017-09-01

Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate. Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.

Mission science value-cost savings from the Advanced Imaging Communication System (AICS)

NASA Technical Reports Server (NTRS)

Rice, R. F.

1984-01-01

An Advanced Imaging Communication System (AICS) was proposed in the mid-1970s as an alternative to the Voyager data/communication system architecture. The AICS achieved virtually error free communication with little loss in the downlink data rate by concatenating a powerful Reed-Solomon block code with the Voyager convolutionally coded, Viterbi decoded downlink channel. The clean channel allowed AICS sophisticated adaptive data compression techniques. Both Voyager and the Galileo mission have implemented AICS components, and the concatenated channel itself is heading for international standardization. An analysis that assigns a dollar value/cost savings to AICS mission performance gains is presented. A conservative value or savings of $3 million for Voyager, $4.5 million for Galileo, and as much as $7 to 9.5 million per mission for future projects such as the proposed Mariner Mar 2 series is shown.

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

PubMed

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

2012-01-01

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

Three-Catheter Technique for Ablation of Left-Sided Accessory Pathways in Wolff-Parkinson-White is Less Expensive and Equally Successful When Compared to a Five-Catheter Technique.

PubMed

Capone, Christine A; Ceresnak, Scott R; Nappo, Lynn; Gates, Gregory J; Schechter, Clyde B; Pass, Robert H

2015-12-01

To compare the efficacy, safety, and cost-effectiveness of a three-catheter approach with a conventional five-catheter approach for the mapping and ablation of supraventricular tachycardia in pediatric patients with Wolff-Parkinson-White Syndrome (WPW) and concealed accessory pathways (APs). A retrospective review from 2008 to 2012 of patients less than 21 years with WPW who underwent a three-catheter radiofrequency (RF) ablation of a left-sided AP (ablation, right ventricular [RV] apical, and coronary sinus [CS] decapolar catheters) was performed. The three-catheter group was compared to a control group who underwent a standard five-catheter (ablation, RV apical, CS decapolar, His catheter, and right atrial catheter) ablation for the treatment of left-sided WPW or concealed AP. Demographics, ablation outcomes, and costs were compared between groups. Twenty-eight patients met inclusion criteria with 28 control patients. The groups did not differ in gender, age, weight, or body surface area. Locations of the AP on the mitral annulus were similar between the groups. All patients were ablated via transseptal approach. Note that 28 of 28 in the three-catheter group (100%) and 27 of 28 (96%) controls were acutely successfully ablated (P = 0.31). No complications were encountered. There was no difference in procedural time, time to loss of AP conduction, or number of RF applications. Use of the three-catheter technique resulted in a total savings of $2,465/case, which includes the $680 savings from using fewer catheters as well as the savings from a shortened procedure time. Ablation in patients with WPW and a left-sided AP can be performed using three catheters with similar efficacy and safety while offering significant cost savings compared to a conventional five-catheter approach. © 2015 Wiley Periodicals, Inc.

Space Transfer Concepts and Analyses for Exploration Missions. Technical Directive 12: Beamed Power Systems Study

NASA Technical Reports Server (NTRS)

Eder, D.

1992-01-01

Parametric models were constructed for Earth-based laser powered electric orbit transfer from low Earth orbit to geosynchronous orbit. These models were used to carry out performance, cost/benefit, and sensitivity analyses of laser-powered transfer systems including end-to-end life cycle cost analyses for complete systems. Comparisons with conventional orbit transfer systems were made indicating large potential cost savings for laser-powered transfer. Approximate optimization was done to determine best parameter values for the systems. Orbit transfer flights simulations were conducted to explore effects of parameters not practical to model with a spreadsheet. The simulations considered view factors that determine when power can be transferred from ground stations to an orbit transfer vehicle and conducted sensitivity analyses for numbers of ground stations, Isp including dual-Isp transfers, and plane change profiles. Optimal steering laws were used for simultaneous altitude and plane change. Viewing geometry and low-thrust orbit raising were simultaneously simulated. A very preliminary investigation of relay mirrors was made.

Perceived barriers among physicians for stopping non-cost-effective blood-saving measures in total hip and total knee arthroplasties.

PubMed

Voorn, Veronique M A; Marang-van de Mheen, Perla J; Wentink, Manon M; Kaptein, Ad A; Koopman-van Gemert, Ankie W M M; So-Osman, Cynthia; Vliet Vlieland, Thea P M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

2014-10-01

Despite evidence that the blood-saving measures (BSMs) erythropoietin (EPO) and intra- and postoperative blood salvage are not (cost-)effective in primary elective total hip and knee arthroplasties, they are used frequently in Dutch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSMs. A survey among 400 orthopedic surgeons and 400 anesthesiologists within the Netherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSMs. A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO, perioperative blood salvage, or a combination. After reading the evidence on non-cost-effective BSMs, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. Physicians experience barriers to stop using BSMs, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost-effective. © 2014 AABB.

The cost-effectiveness of life-saving interventions in Japan. Do chemical regulations cost too much?

PubMed

Kishimoto, Atsuo; Oka, Tosihiro; Nakanishi, Junko

2003-10-01

This paper compares the cost-effectiveness of life-saving interventions in Japan, based on information collected from the health, safety and environmental literature. More than 50 life-saving interventions are analyzed. Cost-effectiveness is defined as the cost per life-year saved or as the cost per quality-adjusted life-year saved. Finding a large cost-effectiveness disparity between chemical controls and health care intervention, we raise the question of whether chemical regulations cost society too much. We point out the limitations of this study and propose a way to improve the incorporation of morbidity effects in cost-effectiveness analysis.

Cost Benefit Analysis Modeling Tool for Electric vs. ICE Airport Ground Support Equipment – Development and Results

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

James Francfort; Kevin Morrow; Dimitri Hochard

2007-02-01

This report documents efforts to develop a computer tool for modeling the economic payback for comparative airport ground support equipment (GSE) that are propelled by either electric motors or gasoline and diesel engines. The types of GSE modeled are pushback tractors, baggage tractors, and belt loaders. The GSE modeling tool includes an emissions module that estimates the amount of tailpipe emissions saved by replacing internal combustion engine GSE with electric GSE. This report contains modeling assumptions, methodology, a user’s manual, and modeling results. The model was developed based on the operations of two airlines at four United States airports.

2008 United States National Seismic Hazard Maps

USGS Publications Warehouse

Petersen, M.D.; ,

2008-01-01

The U.S. Geological Survey recently updated the National Seismic Hazard Maps by incorporating new seismic, geologic, and geodetic information on earthquake rates and associated ground shaking. The 2008 versions supersede those released in 1996 and 2002. These maps are the basis for seismic design provisions of building codes, insurance rate structures, earthquake loss studies, retrofit priorities, and land-use planning. Their use in design of buildings, bridges, highways, and critical infrastructure allows structures to better withstand earthquake shaking, saving lives and reducing disruption to critical activities following a damaging event. The maps also help engineers avoid costs from over-design for unlikely levels of ground motion.

Ground Penetrating Radar technique for railway track characterization in Portugal

NASA Astrophysics Data System (ADS)

De Chiara, Francesca; Fontul, Simona; Fortunato, Eduardo; D'Andrea, Antonio

2013-04-01

Maintenance actions are significant for transport infrastructures but, today, costs have to be necessary limited. A proper quality control since the construction phase is a key factor for a long life cycle and for a good economy policy. For this reason, suitable techniques have to be chosen and non-destructive tests represent an efficient solution, as they allow to evaluate infrastructure characteristics in a continuous or quasi-continuous way, saving time and costs, enabling to make changes if tests results do not comply with the project requirements. Ground Penetrating Radar (GPR) is a quick and effective technique to evaluate infrastructure condition in a continuous manner, replacing or reducing the use of traditional drilling method. GPR application to railways infrastructures, during construction and monitoring phase, is relatively recent. It is based on the measuring of layers thicknesses and detection of structural changes. It also enables the assessment of materials properties that constitute the infrastructure and the evaluation of the different types of defects such as ballast pockets, fouled ballast, poor drainage, subgrade settlement and transitions problems. These deteriorations are generally the causes of vertical deviations in track geometry and they cannot be detected by the common monitoring procedures, namely the measurements of track geometry. Moreover, the development of new GPR systems with higher antenna frequencies, better data acquisition systems, more user friendly software and new algorithms for calculation of materials properties can lead to a regular use of GPR. Therefore, it represents a reliable technique to assess track geometry problems and consequently to improve maintenance planning. In Portugal, rail inspection is performed with Plasser & Theurer EM120 equipment and recently 400 MHz IDS antennas were installed on it. GPR tests were performed on the Portuguese rail network and, as case study in this paper, a renewed track was considered. The aim was to detect, along the track, changes of the layers in terms of both thicknesses and materials characteristics by using specific software, Railwaydoctor. Different test campaigns were studied in order to determine and compare the materials dielectric constants that can be influenced by water content values, due to measurements performed in different seasons.

Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

PubMed Central

2011-01-01

Introduction Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors. Methods This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (< 5%, 5% to 40% and >40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved. Results Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for <5%, 5% to 40% and >40% predicted mortality, respectively. Average cost per life saved for all patients was $103,771 (€82,358) and cost per life-year saved was $7,065 (€5,607). These figures decreased substantially for patients with predicted mortality higher than 40%, $60,046 (€47,656) and $4,088 (€3,244), respectively. Results were very similar when considering three-month mortality. Sensitivity analyses performed to assess the robustness of the results provided findings similar to the main analyses. Conclusions Not only does ICU appear to produce an improvement in survival, but the cost per life saved falls for patients with greater severity of illness. This suggests that intensive care is similarly cost effective to other therapies that are generally regarded as essential. PMID:21306645

The costs of turnover in nursing homes.

PubMed

Mukamel, Dana B; Spector, William D; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-10-01

Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The instrumental variable estimate of turnover costs was negative and significant (P = 0.039). The marginal cost savings associated with a 10% point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs.

Virtualization - A Key Cost Saver in NASA Multi-Mission Ground System Architecture

NASA Technical Reports Server (NTRS)

Swenson, Paul; Kreisler, Stephen; Sager, Jennifer A.; Smith, Dan

2014-01-01

With science team budgets being slashed, and a lack of adequate facilities for science payload teams to operate their instruments, there is a strong need for innovative new ground systems that are able to provide necessary levels of capability processing power, system availability and redundancy while maintaining a small footprint in terms of physical space, power utilization and cooling.The ground system architecture being presented is based off of heritage from several other projects currently in development or operations at Goddard, but was designed and built specifically to meet the needs of the Science and Planetary Operations Control Center (SPOCC) as a low-cost payload command, control, planning and analysis operations center. However, this SPOCC architecture was designed to be generic enough to be re-used partially or in whole by other labs and missions (since its inception that has already happened in several cases!)The SPOCC architecture leverages a highly available VMware-based virtualization cluster with shared SAS Direct-Attached Storage (DAS) to provide an extremely high-performing, low-power-utilization and small-footprint compute environment that provides Virtual Machine resources shared among the various tenant missions in the SPOCC. The storage is also expandable, allowing future missions to chain up to 7 additional 2U chassis of storage at an extremely competitive cost if they require additional archive or virtual machine storage space.The software architecture provides a fully-redundant GMSEC-based message bus architecture based on the ActiveMQ middleware to track all health and safety status within the SPOCC ground system. All virtual machines utilize the GMSEC system agents to report system host health over the GMSEC bus, and spacecraft payload health is monitored using the Hammers Integrated Test and Operations System (ITOS) Galaxy Telemetry and Command (TC) system, which performs near-real-time limit checking and data processing on the downlinked data stream and injects messages into the GMSEC bus that are monitored to automatically page the on-call operator or Systems Administrator (SA) when an off-nominal condition is detected. This architecture, like the LTSP thin clients, are shared across all tenant missions.Other required IT security controls are implemented at the ground system level, including physical access controls, logical system-level authentication authorization management, auditing and reporting, network management and a NIST 800-53 FISMA-Moderate IT Security plan Risk Assessment Contingency Plan, helping multiple missions share the cost of compliance with agency-mandated directives.The SPOCC architecture provides science payload control centers and backup mission operations centers with a cost-effective, standardized approach to virtualizing and monitoring resources that were traditionally multiple racks full of physical machines. The increased agility in deploying new virtual systems and thin client workstations can provide significant savings in personnel costs for maintaining the ground system. The cost savings in procurement, power, rack footprint and cooling as well as the shared multi-mission design greatly reduces upfront cost for missions moving into the facility. Overall, the authors hope that this architecture will become a model for how future NASA operations centers are constructed!

Comparing terrestrial laser scanning with ground and UAV-based imaging for national-level assessment of upland soil erosion

NASA Astrophysics Data System (ADS)

McShane, Gareth; Farrow, Luke; Morgan, David; Glendell, Miriam; James, Mike; Quinton, John; Evans, Martin; Anderson, Karen; Rawlins, Barry; Quine, Timothy; Debell, Leon; Benaud, Pia; Jones, Lee; Kirkham, Matthew; Lark, Murray; Rickson, Jane; Brazier, Richard

2015-04-01

Quantifying soil loss through erosion processes at a high resolution can be a time consuming and costly undertaking. In this pilot study 'a cost effective framework for monitoring soil erosion in England and Wales', funded by the UK Department for Environment, Food and Rural Affairs (Defra), we compare methods for collecting suitable topographic measurements via remote sensing. The aim is to enable efficient but detailed site-scale studies of erosion forms in inaccessible UK upland environments, to quantify dynamic processes, such as erosion and mass movement. The techniques assessed are terrestrial laser scanning (TLS), and unmanned aerial vehicle (UAV) photography and ground-based photography, both processed using structure-from-motion (SfM) 3D reconstruction software. Compared to other established techniques, such as expensive TLS, SfM offers a potentially low-cost alternative for the reconstruction of 3D high-resolution micro-topographic models from photographs taken with consumer grade cameras. However, whilst an increasing number of research papers examine the relative merits of these novel versus more established survey techniques, no study to date has compared both ground-based and aerial SfM photogrammetry with TLS scanning across a range of scales (from m2 to 16ha). The evaluation of these novel low cost techniques is particularly relevant in upland landscapes, where the remoteness and inaccessibility of field sites may render some of the more established survey techniques impractical. Volumetric estimates of soil loss are quantified using the digital surface models (DSMs) derived from the data from each technique and subtracted from a modelled pre-erosion surface. The results from each technique are compared. The UAV was able to capture information over a wide area, a range of altitudes and angles over the study area. Combined with automated SfM-based processing, this technique was able to produce rapid orthophotos to support ground-based data acquisition, as well as a DSM for volume loss measurement in larger features. However, the DSM of erosion features lacked the detail of those captured using the ground-based methods. Terrestrial laser scanning provided detailed, accurate, high density measurements of the ground surface over long (100s m) distances, but size and weight of the instrument made it difficult to use in mountainous environments. In addition, deriving a reliable bare-earth digital terrain model (DTM) from TLS was at times problematic due to the presence of tall shrubby vegetation. Ground-based photography produced comparable data sets to terrestrial laser scanning and was the most useful for characterising small and difficult to view features. The relative advantages, limitations and cost-effectiveness of each approach at 5 upland sites across the UK are discussed.

Constructing Inexpensive, Flexible, and Versatile Microdialysis Probes in an Undergraduate Microdialysis Research Lab

PubMed Central

Steffes, Sally; Sandstrom, Michael

2008-01-01

Several challenges await new assistant professors setting up a neuroscience lab, and obtaining sufficient research help is typically a top priority. A secondary, but no less daunting, challenge is juggling accuracy and reliability with costs and limited start-up funds. These concerns are particularly crucial for those engaging technically sophisticated measurements, such as microdialysis. We have developed straightforward procedures that our undergraduate students have utilized to successfully construct high-quality, low-cost microdialysis probes. Students mastering the various steps involved have also gained valuable insight into their use, troubleshooting, and the implications of data obtained from these constructed probes. These procedures are explained here to foster increased use in neuroscience labs that involve undergraduates, along with pointers about teaching the technique to newcomers. Students who master the techniques can pass them on to new students easily. These procedures train students in the overall research technique of microdialysis more thoroughly than when manufactured probes are used, they save money, and will eventually save the principal investigator time when students develop independence with troubleshooting and repairs. PMID:23493044

Cost Avoidance Techniques for RC-135 Program Flying Training

DTIC Science & Technology

2013-06-01

135, age has an even greater impact . Built in the 1960’s, RC-135s have covered tours 8 over Vietnam and Operations Southern/Northern Watch. Over...of one PFT done on a weekly basis, although seemingly insignificant, could have enormous impact over time. Even the smallest regular cost savings...Force Flying Hour Costs Four variables make up the flying hour program. They are supplies (tools used to repair aircraft), impact card (purchases by

Are cooler surfaces a cost-effect mitigation of urban heat islands?

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

Pomerantz, Melvin

Much research has gone into technologies to mitigate urban heat islands by making urban surfaces cooler by increasing their albedos. To be practical, the benefit of the technology must be greater than its cost. Here, this report provides simple methods for quantifying the maxima of some benefits that albedo increases may provide. The method used is an extension of an earlier paper that estimated the maximum possible electrical energy saving achievable in an entire city in a year by a change of albedo of its surfaces. The present report estimates the maximum amounts and monetary savings of avoided CO 2more » emissions and the decreases in peak power demands. As examples, for several warm cities in California, a 0.2 increase in albedo of pavements is found to reduce CO 2 emissions by < 1 kg per m 2 per year. At the current price of CO 2 reduction in California, the monetary saving is < US$ 0.01 per year per m 2 modified. The resulting maximum peak-power reductions are estimated to be < 7% of the base power of the city. In conclusion, the magnitudes of the savings are such that decision-makers should choose carefully which urban heat island mitigation techniques are cost effective.« less

Are cooler surfaces a cost-effect mitigation of urban heat islands?

DOE PAGES

Pomerantz, Melvin

2017-04-20

Much research has gone into technologies to mitigate urban heat islands by making urban surfaces cooler by increasing their albedos. To be practical, the benefit of the technology must be greater than its cost. Here, this report provides simple methods for quantifying the maxima of some benefits that albedo increases may provide. The method used is an extension of an earlier paper that estimated the maximum possible electrical energy saving achievable in an entire city in a year by a change of albedo of its surfaces. The present report estimates the maximum amounts and monetary savings of avoided CO 2more » emissions and the decreases in peak power demands. As examples, for several warm cities in California, a 0.2 increase in albedo of pavements is found to reduce CO 2 emissions by < 1 kg per m 2 per year. At the current price of CO 2 reduction in California, the monetary saving is < US$ 0.01 per year per m 2 modified. The resulting maximum peak-power reductions are estimated to be < 7% of the base power of the city. In conclusion, the magnitudes of the savings are such that decision-makers should choose carefully which urban heat island mitigation techniques are cost effective.« less

An alternative approach for estimating above ground biomass using Resourcesat-2 satellite data and artificial neural network in Bundelkhand region of India.

PubMed

Deb, Dibyendu; Singh, J P; Deb, Shovik; Datta, Debajit; Ghosh, Arunava; Chaurasia, R S

2017-10-20

Determination of above ground biomass (AGB) of any forest is a longstanding scientific endeavor, which helps to estimate net primary productivity, carbon stock and other biophysical parameters of that forest. With advancement of geospatial technology in last few decades, AGB estimation now can be done using space-borne and airborne remotely sensed data. It is a well-established, time saving and cost effective technique with high precision and is frequently applied by the scientific community. It involves development of allometric equations based on correlations of ground-based forest biomass measurements with vegetation indices derived from remotely sensed data. However, selection of the best-fit and explanatory models of biomass estimation often becomes a difficult proposition with respect to the image data resolution (spatial and spectral) as well as the sensor platform position in space. Using Resourcesat-2 satellite data and Normalized Difference Vegetation Index (NDVI), this pilot scale study compared traditional linear and nonlinear models with an artificial intelligence-based non-parametric technique, i.e. artificial neural network (ANN) for formulation of the best-fit model to determine AGB of forest of the Bundelkhand region of India. The results confirmed the superiority of ANN over other models in terms of several statistical significance and reliability assessment measures. Accordingly, this study proposed the use of ANN instead of traditional models for determination of AGB and other bio-physical parameters of any dry deciduous forest of tropical sub-humid or semi-arid area. In addition, large numbers of sampling sites with different quadrant sizes for trees, shrubs, and herbs as well as application of LiDAR data as predictor variable were recommended for very high precision modelling in ANN for a large scale study.

Automatic dependent surveillance broadcast via GPS-Squitter: a major upgrade to the national airspace system

NASA Astrophysics Data System (ADS)

Jones, Ronnie D.; Knittel, George H.; Orlando, Vincent A.

1995-06-01

GPS-Squitter is a technology for surveillance of aircraft via broadcast of their GPS-determined positions to all listeners, using the Mode S data link. It can be used to provide traffic displays, on the ground for controllers and in the cockpit for pilots, and will enhance TCAS performance. It is compatible with the existing ground-based beacon interrogator radar system and is an evolutionary way to more from ground-based-radar surveillance to satellite-based surveillance. GPS-Squitter takes advantage of the substantial investment made by the U.S. in the powerful GPS position-determining system and has the potential to free the Federal Aviation Administration from having to continue maintaining a precise position-determining capability in ground-based radar. This would permit phasing out the ground-based secondary surveillance radar system over a period of 10 to 20 years and replacing it with much simpler ground stations, resulting in cost savings of hundreds of millions of dollars.

High-speed machining of Space Shuttle External Tank (ET) panels

NASA Technical Reports Server (NTRS)

Miller, J. A.

1983-01-01

Potential production rates and project cost savings achieved by converting the conventional machining process in manufacturing shuttle external tank panels to high speed machining (HSM) techniques were studied. Savings were projected from the comparison of current production rates with HSM rates and with rates attainable on new conventional machines. The HSM estimates were also based on rates attainable by retrofitting existing conventional equipment with high speed spindle motors and rates attainable using new state of the art machines designed and built for HSM.

Planning and Implementing a Hospital Recycling Program at Naval Hospital, Camp Pendleton, California

DTIC Science & Technology

1992-08-01

communities have refused to license incinerators, saying "not in my back yard!" Recycling is quick, it’s economical, it can save natural resources, and...total costs - total credits) 4. Net Savings <Costs>: Present disposal Net recycling Net savings costs program costs <costs> * Assign only a...RECYCLING PROGRAM COSTS $ 9,739 (total costs - total credits) 4. Net Savings <Costs>: $ 9.287 _ $ 9.739 - S > Present disposal Net recycling Net

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

PubMed Central

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-01-01

Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

Energy Efficiency in Libraries.

ERIC Educational Resources Information Center

Lewis, Eleanor J.; And Others

1993-01-01

Shows how libraries can save money and energy with energy-efficient technologies, improving maintenance, and encouraging staff efforts to conserve energy. Specific techniques such as life-cycle cost analysis and energy audits focusing on lighting, heating, ventilation, air conditioning, and water efficiency are described. Funding options and…

Inducing Stable α + β Microstructures during Selective Laser Melting of Ti-6Al-4V Using Intensified Intrinsic Heat Treatments.

PubMed

Barriobero-Vila, Pere; Gussone, Joachim; Haubrich, Jan; Sandlöbes, Stefanie; Da Silva, Julio Cesar; Cloetens, Peter; Schell, Norbert; Requena, Guillermo

2017-03-07

Selective laser melting is a promising powder-bed-based additive manufacturing technique for titanium alloys: near net-shaped metallic components can be produced with high resource-efficiency and cost savings [...].

Comparative data compression techniques and multi-compression results

NASA Astrophysics Data System (ADS)

Hasan, M. R.; Ibrahimy, M. I.; Motakabber, S. M. A.; Ferdaus, M. M.; Khan, M. N. H.

2013-12-01

Data compression is very necessary in business data processing, because of the cost savings that it offers and the large volume of data manipulated in many business applications. It is a method or system for transmitting a digital image (i.e., an array of pixels) from a digital data source to a digital data receiver. More the size of the data be smaller, it provides better transmission speed and saves time. In this communication, we always want to transmit data efficiently and noise freely. This paper will provide some compression techniques for lossless text type data compression and comparative result of multiple and single compression, that will help to find out better compression output and to develop compression algorithms.

Accrued Cost Savings of a Free Clinic Using Quality-Adjusted Life Years Saved and Return on Investment.

PubMed

Sanders, Jim; Lacey, Marcus; Guse, Clare E

2017-01-01

Savings garnered through the provision of preventive services is a form of profit for health systems. Free clinics have been using this logic to demonstrate their cost-savings. The Community-Based Chronic Disease Management (CCDM) clinic treats hypertension using nurse-led teams, clinical protocols, and community-based settings. We calculated CCDM's cost-effectiveness from 2007 to 2013 using 2 metrics: Quality-adjusted life years (QALYs) saved and return on investment (ROI). QALYs were calculated using the Clinical Preventive Burden (CPB) score for hypertension care. ROI was calculated by tallying the savings from prevented heart attacks, strokes, and emergency department visits against the total operating costs. Using conservative assumptions for cost estimates, hypertension care resulted in a value of QALYs saved of $711,000 to $2,133,000 and an ROI ratio range of 0.35 to 1.20. Our study shows that when using conservative assumptions to calculate cost-savings, our free clinic did not save money. Cost-savings did occur, but the amount was modest, was less than that of cost-inputs, and was not likely captured by any single health entity. Although free clinics remain a vital health care access point for many Americans, it has yet to be demonstrated that they generate a net savings. © Copyright 2017 by the American Board of Family Medicine.

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Life Cycle Cost Analyses § 436.20 Net savings. For a retrofit project, net savings may be found by subtracting life cycle costs based on the proposed project from life cycle costs based on not having it. For a new building design, net savings is the difference between the life cycle costs of an alternative...

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Life Cycle Cost Analyses § 436.20 Net savings. For a retrofit project, net savings may be found by subtracting life cycle costs based on the proposed project from life cycle costs based on not having it. For a new building design, net savings is the difference between the life cycle costs of an alternative...

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Life Cycle Cost Analyses § 436.20 Net savings. For a retrofit project, net savings may be found by subtracting life cycle costs based on the proposed project from life cycle costs based on not having it. For a new building design, net savings is the difference between the life cycle costs of an alternative...

ResStock - Targeting Energy and Cost Savings for U.S. Homes | NREL

Science.gov Websites

ResStock - Targeting Energy and Cost Savings for U.S. Homes Science and Technology Highlights Highlights in Research & Development ResStock - Targeting Energy and Cost Savings for U.S. Homes Key discovered $49 billion in potential annual utility bill savings through cost-effective energy efficiency

24 CFR 242.43 - Application of cost savings.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Application of cost savings. 242.43... MORTGAGE INSURANCE FOR HOSPITALS Endorsement for Insurance § 242.43 Application of cost savings. At the sole discretion of HUD, any cost savings shall be used to: (a) Reduce the principal amount of the...

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Life Cycle Cost Analyses § 436.20 Net savings. For a retrofit project, net savings may be found by subtracting life cycle costs based on the proposed project from life cycle costs based on not having it. For a new building design, net savings is the difference between the life cycle costs of an alternative...

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Life Cycle Cost Analyses § 436.20 Net savings. For a retrofit project, net savings may be found by subtracting life cycle costs based on the proposed project from life cycle costs based on not having it. For a new building design, net savings is the difference between the life cycle costs of an alternative...

Cost-savings for biosimilars in the United States: a theoretical framework and budget impact case study application using filgrastim.

PubMed

Grewal, Simrun; Ramsey, Scott; Balu, Sanjeev; Carlson, Josh J

2018-05-18

Biosimilars can directly reduce the cost of treating patients for whom a reference biologic is indicated by offering a highly similar, lower priced alternative. We examine factors related to biosimilar regulatory approval, uptake, pricing, and financing and the potential impact on drug expenditures in the U.S. We developed a framework to illustrate how key factors including regulatory policies, provider and patient perception, pricing, and payer policies impact biosimilar cost-savings. Further, we developed a budget impact cost model to estimate savings from filgrastim biosimilars under various scenarios. The model uses publicly available data on disease incidence, treatment patterns, market share, and drug prices to estimate the cost-savings over a 5-year time horizon. We estimate five-year cost savings of $256 million, of which 18% ($47 million) are from reduced patient out-of-pocket costs, 34% ($86 million) are savings to commercial payers, and 48% ($123 million) are savings for Medicare. Additional scenarios demonstrate the impact of uncertain factors, including price, uptake, and financing policies. A variety or interrelated factors influence the development, uptake, and cost-savings for Biosimilars use in the U.S. The filgrastim case is a useful example that illustrates these factors and the potential magnitude of costs savings.

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

PubMed

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

2017-03-01

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

Baker-Barry Tunnel Lighting: Evaluation of a Potential GATEWAY Demonstrations Project

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

Tuenge, Jason R.

2011-06-28

The U.S. Department of Energy is evaluating the Baker-Barry Tunnel as a potential GATEWAY Demonstrations project for deployment of solid-state lighting (SSL) technology. The National Park Service views this project as a possible proving ground and template for implementation of light-emitting diode (LED) luminaires in other tunnels, thereby expanding the estimated 40% energy savings from 132 MWh/yr to a much larger figure nationally. Most of the energy savings in this application is attributable to the instant-restrike capability of LED products and to their high tolerance for frequent on/off switching, used here to separately control either end of the tunnel duringmore » daytime hours. Some LED luminaires rival or outperform their high-intensity discharge (HID) counterparts in terms of efficacy, but options are limited, and smaller lumen packages preclude true one-for-one equivalence. However, LED products continue to improve in efficacy and affordability at a rate unmatched by other light source technologies; the estimated simple payback period of eight years (excluding installation costs and maintenance savings) can be expected to improve with time. The proposed revisions to the existing high-pressure sodium (HPS) lighting system would require slightly increased controls complexity and significantly increased luminaire types and quantities. In exchange, substantial annual savings (from reduced maintenance and energy use) would be complemented by improved quantity and quality of illumination. Although advanced lighting controls could offer additional savings, it is unclear whether such a system would prove cost-effective; this topic may be explored in future work.« less

Cost effectiveness of bisphosphonates in the management of breast cancer patients with bone metastases.

PubMed

Botteman, M; Barghout, V; Stephens, J; Hay, J; Brandman, J; Aapro, M

2006-07-01

Bisphosphonates are recommended to prevent skeletal related events (SREs) in patients with breast cancer and bone metastases (BCBM). However, their clinical and economic profiles vary from one agent to the other. Using modeling techniques, we simulated from the perspective of the UK's National Health Service (NHS) the cost and quality adjusted survival (QALY) associated with five commonly-used bisphosphonates or no therapy in this patient population. The simulation followed patients into several health states (i.e. alive or dead, experiencing an SRE or no SRE, and receiving first or second line therapy). Drugs costs, infusion costs, SREs costs, and utility values were estimated from published sources. Utilities were applied to time with and without SREs to capture the impact on quality of life. Compared to no therapy, all bisphosphonates are either cost saving or highly cost-effective (with a cost per QALY < or = 6126 pounds sterlings). Within this evaluation, zoledronic acid was more effective and less expensive than all other options. Based on our model, the use of bisphosphonates in breast cancer patients with bone metastases should lead to improved patient outcomes and cost savings to the NHS and possibly other similar entities.

Can IR scene projectors reduce total system cost?

NASA Astrophysics Data System (ADS)

Ginn, Robert; Solomon, Steven

2006-05-01

There is an incredible amount of system engineering involved in turning the typical infrared system needs of probability of detection, probability of identification, and probability of false alarm into focal plane array (FPA) requirements of noise equivalent irradiance (NEI), modulation transfer function (MTF), fixed pattern noise (FPN), and defective pixels. Unfortunately, there are no analytic solutions to this problem so many approximations and plenty of "seat of the pants" engineering is employed. This leads to conservative specifications, which needlessly drive up system costs by increasing system engineering costs, reducing FPA yields, increasing test costs, increasing rework and the never ending renegotiation of requirements in an effort to rein in costs. These issues do not include the added complexity to the FPA factory manager of trying to meet varied, and changing, requirements for similar products because different customers have made different approximations and flown down different specifications. Scene generation technology may well be mature and cost effective enough to generate considerable overall savings for FPA based systems. We will compare the costs and capabilities of various existing scene generation systems and estimate the potential savings if implemented at several locations in the IR system fabrication cycle. The costs of implementing this new testing methodology will be compared to the probable savings in systems engineering, test, rework, yield improvement and others. The diverse requirements and techniques required for testing missile warning systems, missile seekers, and FLIRs will be defined. Last, we will discuss both the hardware and software requirements necessary to meet the new test paradigm and discuss additional cost improvements related to the incorporation of these technologies.

Health economics evaluation of a gastric cancer early detection and treatment program in China.

PubMed

Li, Dan; Yuan, Yuan; Sun, Li-Ping; Fang, Xue; Zhou, Bao-Sen

2014-01-01

To use health economics methodology to assess the screening program on gastric cancer in Zhuanghe, China, so as to provide the basis for health decision on expanding the program of early detection and treatment. The expense of an early detection and treatment program for gastric cancer in patients found by screening, and also costs of traditional treatment in a hospital of Zhuanghe were assessed. Three major techniques of medical economics, namely cost-effective analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA), were used to assess the screening program. RESULTS from CEA showed that investing every 25, 235 Yuan on screening program in Zhuanghe area, one gastric cancer patient could be saved. Data from CUA showed that it was cost 1, 370 Yuan per QALY saved. RESULTS from CBA showed that: the total cost was 1,945,206 Yuan with a benefit as 8,669,709 Yuan and an CBR of 4.46. The early detection and treatment program of gastric cancer appears economic and society-beneficial. We suggest that it should be carry out in more high risk areas for gastric cancer.

An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta

PubMed Central

Thanh, Nguyen X.; Chuck, Anderson W.; Wasylak, Tracy; Lawrence, Jeannette; Faris, Peter; Ljungqvist, Olle; Nelson, Gregg; Gramlich, Leah M.

2016-01-01

Background In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000–$3 391 000), or $1768 (range $920–$2619) per patient. The probability for the program to be cost-saving was 73%–83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4–$5.1) in return. Conclusion The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites. PMID:28445024

Modular space station phase B extension program cost and schedules. Volume 1: Cost and schedule estimating process and results

NASA Technical Reports Server (NTRS)

Frassinelli, G. J.

1972-01-01

Cost estimates and funding schedules are presented for a given configuration and costing ground rules. Cost methodology is described and the cost evolution from a baseline configuration to a selected configuration is given, emphasizing cases in which cost was a design driver. Programmatic cost avoidance techniques are discussed.

36 CFR 72.45 - Fundable elements: Innovation grants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... management techniques. (2) Adaptive reuse. In addition to providing services for areas or facilities already... service structure of a neighborhood, or between neighborhoods. (2) New management and cost-saving or service-efficient approaches for improving the delivery of recreation services should be fundamental to...

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

PubMed

Wen, Zongguo; Xu, Chang; Zhang, Xueying

2015-03-17

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

Tooling Converts Stock Bearings To Custom Bearings

NASA Technical Reports Server (NTRS)

Fleenor, E. N., Jr.

1983-01-01

Technique for reworking stock bearings saves time and produces helicopter-rotor bearings ground more precisely. Split tapered ring at one end of threaded bolt expands to hold inside of inner race bearing assembly; nut, at other end of bolt, adjusts amount of spring tension. Piece of hardware grasps bearing firmly without interfering with grinding operation. Operation produces bearing of higher quality than commercially available bearings.

Feedback control for fuel-optimal descents using singular perturbation techniques

NASA Technical Reports Server (NTRS)

Price, D. B.

1984-01-01

In response to rising fuel costs and reduced profit margins for the airline companies, the optimization of the paths flown by transport aircraft has been considered. It was found that application of optimal control theory to the considered problem can result in savings in fuel, time, and direct operating costs. The best solution to the aircraft trajectory problem is an onboard real-time feedback control law. The present paper presents a technique which shows promise of becoming a part of a complete solution. The application of singular perturbation techniques to the problem is discussed, taking into account the benefits and some problems associated with them. A different technique for handling the descent part of a trajectory is also discussed.

Option pricing: a flexible tool to disseminate shared savings contracts.

PubMed

Friedberg, Mark W; Buendia, Anthony M; Lauderdale, Katherine E; Hussey, Peter S

2013-08-01

Due to volatility in healthcare costs, shared savings contracts can create systematic financial losses for payers, especially when contracting with smaller providers. To improve the business case for shared savings, we calculated the prices of financial options that payers can "sell" to providers to offset these losses. Using 2009 to 2010 member-level total cost of care data from a large commercial health plan, we calculated option prices by applying a bootstrap simulation procedure. We repeated these simulations for providers of sizes ranging from 500 to 60,000 patients and for shared savings contracts with and without key design features (minimum savings thresholds,bonus caps, cost outlier truncation, and downside risk) and under assumptions of zero, 1%, and 2% real cost reductions due to the shared savings contracts. Assuming no real cost reduction and a 50% shared savings rate, per patient option prices ranged from $225 (3.1% of overall costs) for 500-patient providers to $23 (0.3%) for 60,000-patient providers. Introducing minimum savings thresholds, bonus caps, cost outlier truncation, and downside risk reduced these option prices. Option prices were highly sensitive to the magnitude of real cost reductions. If shared savings contracts cause 2% reductions in total costs, option prices fall to zero for all but the smallest providers. Calculating the prices of financial options that protect payers and providers from downside risk can inject flexibility into shared savings contracts, extend such contracts to smaller providers, and clarify the tradeoffs between different contract designs, potentially speeding the dissemination of shared savings.

B-737 flight test of curved-path and steep-angle approaches using MLS guidance

NASA Technical Reports Server (NTRS)

Branstetter, J. R.; White, W. F.

1989-01-01

A series of flight tests were conducted to collect data for jet transport aircraft flying curved-path and steep-angle approaches using Microwave Landing System (MLS) guidance. During the test, 432 approaches comprising seven different curved-paths and four glidepath angles varying from 3 to 4 degrees were flown in NASA Langley's Boeing 737 aircraft (Transport Systems Research Vehicle) using an MLS ground station at the NASA Wallops Flight Facility. Subject pilots from Piedmont Airlines flew the approaches using conventional cockpit instrumentation (flight director and Horizontal Situation Indicator (HSI). The data collected will be used by FAA procedures specialists to develop standards and criteria for designing MLS terminal approach procedures (TERPS). The use of flight simulation techniques greatly aided the preliminary stages of approach development work and saved a significant amount of costly flight time. This report is intended to complement a data report to be issued by the FAA Office of Aviation Standards which will contain all detailed data analysis and statistics.

New workers' compensation legislation: expected pharmaceutical cost savings.

PubMed

Wilson, Leslie; Gitlin, Matthew

2005-10-01

California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.

LITHIUM REVISITED: SAVINGS BROUGHT ABOUT BY THE USE OF LITHIUM, 1970–1991

PubMed Central

Wyatt, Richard Jed; Henter, Ioline D.; Jamison, Julian C.

2015-01-01

Background Recent estimates of the cost of manic-depressive illness totaled roughly $45 billion in 1991. Using data from the Epidemiological Catchment Area (ECA) study, this study estimates the savings brought about by the use of lithium between 1970 and 1991. Methods Total savings are the difference between estimated actual costs and projected costs had lithium never been introduced. Actual yearly costs were interpolated from data for 1970 and 1991, and projected costs were obtained by adjusting 1970 costs with Consumer Price Index (CPI) and population inflaters. All costs for 1970 were obtained using methods almost identical to those used to calculate the 1991 costs of manic-depressive illness, presented in a previous publication. All savings are presented in 1991 dollars. Results Between 1970 and 1991, lithium saved over $170 billion, or roughly over $8 billion per year. Approximately $15 billion in direct costs, which included inpatient and outpatient care as well as research, was saved between 1970 and 1991. The savings are more dramatic for indirect costs, which include the lost productivity of wage-earners, homemakers, family caregivers, and individuals who are in institutions or who committed suicide; these totaled roughly $155 billion. Conclusions Our results suggest that, although manic-depressive illness is still costly, lithium has been tremendously successful in treating the illness, and has provided enormous financial savings in the process. PMID:11433880

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

PubMed

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-06-23

This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Champlain health region in Eastern Ontario, Canada. Primary care providers and specialists registered to use the eConsult service. Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Do kidney transplantations save money? A study using a before-after design and multiple register-based data from Sweden.

PubMed

Jarl, Johan; Desatnik, Peter; Peetz Hansson, Ulrika; Prütz, Karl Göran; Gerdtham, Ulf-G

2018-04-01

The health care costs of kidney transplantation and dialysis are generally unknown. This study estimates the Swedish health care costs of kidney transplantation and dialysis over 10 years from a health care perspective. A before-after design was used, in which the patients served as their own controls. Health care costs the year before transplantation were assumed to continue in the absence of a transplant and the cost savings was therefore calculated as the difference between the expected costs and the actual costs during the 10-year follow-up period. Factors associated with the size of the cost savings were studied using ordinary least-squares regression. Altogether 66-79% of the expected health care costs over 10 years were avoided through kidney transplantation, resulting in a cost savings of €380 000 (2012 price-year) per patient. Savings were the highest for successful transplantations, but on average the treatment was cost-saving also for patients who returned to dialysis. No gender or age differences could be found, with the exception of a higher cost of transplantation for children and a generally higher cost for younger compared with older patients on dialysis. A negative association was also found between age at the time of transplantation and the size of the cost savings for the younger part of the sample. Kidney transplantations have led to substantial cost savings for the Swedish health care system. An increase in donated kidneys has the potential to further reduce the cost of renal replacement therapy.

A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital.

PubMed

Jameson, K; Averley, P A; Shackley, P; Steele, J

2007-09-22

To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children.

PubMed

Brown, Vicki; Ananthapavan, Jaithri; Veerman, Lennert; Sacks, Gary; Lal, Anita; Peeters, Anna; Backholer, Kathryn; Moodie, Marjory

2018-05-15

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M⁻AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m²). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372⁻25,155); total cost-savings AUD126.3M (95% UI AUD58.7M⁻196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812⁻15,679); total cost-savings AUD90.9M (95% UI AUD44.3M⁻136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP.

The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children

PubMed Central

Veerman, Lennert; Lal, Anita; Peeters, Anna; Backholer, Kathryn; Moodie, Marjory

2018-01-01

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M–AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m2). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372–25,155); total cost-savings AUD126.3M (95% UI AUD58.7M–196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812–15,679); total cost-savings AUD90.9M (95% UI AUD44.3M–136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP. PMID:29762517

Optimizing Wellfield Operation in a Variable Power Price Regime.

PubMed

Bauer-Gottwein, Peter; Schneider, Raphael; Davidsen, Claus

2016-01-01

Wellfield management is a multiobjective optimization problem. One important objective has been energy efficiency in terms of minimizing the energy footprint (EFP) of delivered water (MWh/m(3) ). However, power systems in most countries are moving in the direction of deregulated markets and price variability is increasing in many markets because of increased penetration of intermittent renewable power sources. In this context the relevant management objective becomes minimizing the cost of electric energy used for pumping and distribution of groundwater from wells rather than minimizing energy use itself. We estimated EFP of pumped water as a function of wellfield pumping rate (EFP-Q relationship) for a wellfield in Denmark using a coupled well and pipe network model. This EFP-Q relationship was subsequently used in a Stochastic Dynamic Programming (SDP) framework to minimize total cost of operating the combined wellfield-storage-demand system over the course of a 2-year planning period based on a time series of observed price on the Danish power market and a deterministic, time-varying hourly water demand. In the SDP setup, hourly pumping rates are the decision variables. Constraints include storage capacity and hourly water demand fulfilment. The SDP was solved for a baseline situation and for five scenario runs representing different EFP-Q relationships and different maximum wellfield pumping rates. Savings were quantified as differences in total cost between the scenario and a constant-rate pumping benchmark. Minor savings up to 10% were found in the baseline scenario, while the scenario with constant EFP and unlimited pumping rate resulted in savings up to 40%. Key factors determining potential cost savings obtained by flexible wellfield operation under a variable power price regime are the shape of the EFP-Q relationship, the maximum feasible pumping rate and the capacity of available storage facilities. © 2015 The Authors. Groundwater published by Wiley Periodicals, Inc. on behalf of National Ground Water Association.

Evaluation of emission control strategies for airfield operations at the Los Angeles and San Francisco International Airports. Final report

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

Gelinas, C.G.

1978-08-01

This report reviews potential air pollutant emission reductions which could be achieved by various strategies to control airfield operations at Los Angeles and San Francisco International Airports, and examines safety problems, cost impacts, potential fuel savings, time frame for strategy implementation, and potential regulatory and jurisdictional conflicts associated with each strategy. Airfield emission sources studied included aircraft operation in the idle, taxi, takeoff, and landing modes; ground service vehicles; fuel handling and storage; and aircraft engine maintenance. Nineteen potential strategies were identified, and seven strategies were selected for detailed analysis and examination after a preliminary evaluation. Two strategies, aircraft towingmore » and reducing the number of operating engines on the ground, appear to provide the most significant emission reduction. Both of these strategies offer potential reductions in the range of 20 to 40 percent of the carbon monoxide and nitrogen oxides which are currently emitted by ground operations. The aircraft towing strategy also offers a comparable improvement in suspended particulate matter emissions. When the overall feasibility of each strategy is evaluated, the strategy to reduce the number of operating engines appears to be the most viable since its implementation would result in fuel savings, no apparent safety problems, and it can be implemented immediately.« less

The costs of turnover in nursing homes

PubMed Central

Mukamel, Dana B.; Spector, William D.; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-01-01

Background Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. Objectives To estimate the net costs associated with turnover of direct care staff in nursing homes. Data and sample 902 nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set (MDS), Medicare enrollment files, Census and Area Resource File (ARF). Research Design We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable (IV) limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. Results The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The IV estimate of turnover costs was negative and significant (p=0.039). The marginal cost savings associated with a 10 percentage point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. Conclusion The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs. PMID:19648834

Cost savings of outpatient versus standard inpatient total knee arthroplasty

PubMed Central

Huang, Adrian; Ryu, Jae-Jin; Dervin, Geoffrey

2017-01-01

Background With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies. Methods This prospective case–control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls. Results In every case–control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group. Conclusion Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period. PMID:28234591

Assessment of transparency of cost estimates in economic evaluations of patient safety programmes.

PubMed

Fukuda, Haruhisa; Imanaka, Yuichi

2009-06-01

Transparency of costing is essential for decision-makers who require information on the efficiency of a health care programme, because effective decisions depend largely on applicability to their settings. The main objectives of this study were to assess published studies for transparency of cost estimates. We first developed criteria with two axes by reviewing publications dealing with economic evaluations and cost accounting studies: clarification of the scope of costing and accuracy of method evaluating costs. We then performed systematic searches of the literature for studies which estimated prevention costs and assessed the transparency and accuracy of costing based on our criteria. Forty studies met the inclusion criteria. Half of the studies reported data for both the quantity and unit price of programmes in regard to prevention costs. Although 30 studies estimated costs of adverse events, 19 of these described the scope of costing only, and just five studies used a micro-costing method. Among 30 studies that estimated 'gross cost savings' and 'net cost savings', there was a huge discrepancy in labels. Even if a cost study was conducted in accordance with existing techniques of economic evaluation which mostly paid attention to internal validity of cost estimates, without adequate explanation of the process of costing, reproducibility cannot be assured and the study may lose its value as scientific information. This study found that there is tremendous room for improvement.

Portfolio Analysis of Renewable Energy Opportunities: Preprint

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

Richards, Allison; Deprizio, Jodi; Anderson, Kate

Time Warner Cable (TWC), now Charter Communications (CC), partnered with the National Renewable Energy Laboratory (NREL) to assess the technical and economic potential for solar photovoltaic (PV), wind, and ground-source heat-pump systems at 696 TWC facilities. NREL identified 306 sites where adding a renewable energy system would provide cost savings over the project life-cycle. In general, the top sites have some combination of high electricity rates ($0.16-$0.29/kWh), significant state incentives, and favorable net-metering policies. If all projects were implemented via third-party power purchase agreements, TWC/CC would save $37 million over 25 years and meet 10.5% of their energy consumption withmore » renewable energy. This paper describes the portfolio screening methodology used to identify and prioritize renewable energy opportunities across the TWC sites, as well as a summary of the potential cost savings that may be realized by implementing these projects. This may provide a template for other companies interested in identifying and prioritizing renewable energy opportunities across a large number of geographically dispersed sites. Following this initial portfolio analysis, NREL will be conducting in-depth analysis of project development opportunities at ten sites and evaluating off-grid solutions that may enable carbon emission reduction and grid independence at select facilities.« less

Cogeneration Technology Alternatives Study (CTAS). Volume 3: Industrial processes

NASA Technical Reports Server (NTRS)

Palmer, W. B.; Gerlaugh, H. E.; Priestley, R. R.

1980-01-01

Cogenerating electric power and process heat in single energy conversion systems rather than separately in utility plants and in process boilers is examined in terms of cost savings. The use of various advanced energy conversion systems are examined and compared with each other and with current technology systems for their savings in fuel energy, costs, and emissions in individual plants and on a national level. About fifty industrial processes from the target energy consuming sectors were used as a basis for matching a similar number of energy conversion systems that are considered as candidate which can be made available by the 1985 to 2000 time period. The sectors considered included food, textiles, lumber, paper, chemicals, petroleum, glass, and primary metals. The energy conversion systems included steam and gas turbines, diesels, thermionics, stirling, closed cycle and steam injected gas turbines, and fuel cells. Fuels considered were coal, both coal and petroleum based residual and distillate liquid fuels, and low Btu gas obtained through the on site gasification of coal. An attempt was made to use consistent assumptions and a consistent set of ground rules specified by NASA for determining performance and cost. Data and narrative descriptions of the industrial processes are given.

COST Action TU1206 "SUB-URBAN - A European network to improve understanding and use of the ground beneath our cities"

NASA Astrophysics Data System (ADS)

Campbell, Diarmad; de Beer, Johannes; Lawrence, David; van der Meulen, Michiel; Mielby, Susie; Hay, David; Scanlon, Ray; Campenhout, Ignace; Taugs, Renate; Eriksson, Ingelov

2014-05-01

Sustainable urbanisation is the focus of SUB-URBAN, a European Cooperation in Science and Technology (COST) Action TU1206 - A European network to improve understanding and use of the ground beneath our cities. This aims to transform relationships between experts who develop urban subsurface geoscience knowledge - principally national Geological Survey Organisations (GSOs), and those who can most benefit from it - urban decision makers, planners, practitioners and the wider research community. Under COST's Transport and Urban Development Domain, SUB-URBAN has established a network of GSOs and other researchers in over 20 countries, to draw together and evaluate collective urban geoscience research in 3D/4D characterisation, prediction and visualisation. Knowledge exchange between researchers and City-partners within 'SUB-URBAN' is already facilitating new city-scale subsurface projects, and is developing a tool-box of good-practice guidance, decision-support tools, and cost-effective methodologies that are appropriate to local needs and circumstances. These are intended to act as catalysts in the transformation of relationships between geoscientists and urban decision-makers more generally. As a result, the importance of the urban sub-surface in the sustainable development of our cities will be better appreciated, and the conflicting demands currently placed on it will be acknowledged, and resolved appropriately. Existing city-scale 3D/4D model exemplars are being developed by partners in the UK (Glasgow, London), Germany (Hamburg) and France (Paris). These draw on extensive ground investigation (10s-100s of thousands of boreholes) and other data. Model linkage enables prediction of groundwater, heat, SuDS, and engineering properties. Combined subsurface and above-ground (CityGML, BIMs) models are in preparation. These models will provide valuable tools for more holistic urban planning; identifying subsurface opportunities and saving costs by reducing uncertainty in ground conditions. A key area of interest, and one of potential collaboration with COST Action TU1208, is in characterising and parameterising the very near urban subsurface, and especially the anthropogenic deposits, to assist decision-making by civil engineers, and others. Anthropogenic deposits may be many metres thick, are typically very heterogeneous, have complex histories of accumulation, and may including important archaeological assets. They display complex stratigraphies which are difficult to resolve using traditional methodologies, even with extensive invasive ground investigation. Ground Penetrating Radar, and other non-destructive methods of ground investigation hold considerable promise in greatly improving the resolution, understanding, and modelling, of these and other near-surface deposits in particular. This work is a contribution both to COST Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar" and to COST Action TU1206 "SUB-URBAN - A European network to improve understanding and use of the ground beneath our cities"

Targeted Provision of Oral Iron: The Evolution of a Practical Screening Option123

PubMed Central

Crowley, Caitlin R.; Solomons, Noel W.; Schümann, Klaus

2012-01-01

Universal oral iron supplementation, undertaken according to 1998 WHO guidelines, produced adverse consequences among some children in malaria-endemic areas. Prompted by the Pemba trial, which revealed excessive hospitalizations and deaths, WHO advised that iron supplementation in such regions be accompanied by previous screening for iron deficiency. This agenda, however, poses issues of cost, benefit, acceptability, technical feasibility, and reliability of such screening. The cost of equipment and personnel is balanced against savings from iron supplements spared and treatment for morbidity averted. Costs aside, the most efficacious acceptable screening approach for avoiding hospitalization and deaths must be fielded. Screening before supplementation can be used to assess hematological, iron, and possible inflammatory status to differentiate the source of decreased hemoglobin concentration. Iron deficiency has often been inferred from hematological status markers. The need for extraction of blood, albeit capillary in origin, and high assay costs limit the use of validated methods in screening. Noninvasive methods, i.e., not requiring the extraction of blood, provide the most acceptable and potentially least expensive approach for determining hematological or iron status. Although a noninvasive technique for iron and inflammatory status would be the ideal, it is unattained. Field-friendly, skin-probe hemoglobin devices, derived from instruments for clinical settings, are being developed and tested for eventual rollout in malarial areas. Given a firm grounding for the theoretical requirements needed to advance the screening agenda, evaluation and monitoring of the performance of screening devices can proceed hand in hand. PMID:22797993

Hydraulic hoisting and backfilling

NASA Astrophysics Data System (ADS)

Sauermann, H. B.

In a country such as South Africa, with its large deep level mining industry, improvements in mining and hoisting techniques could result in substantial savings. Hoisting techniques, for example, may be improved by the introduction of hydraulic hoisting. The following are some of the advantages of hydraulic hoisting as against conventional skip hoisting: (1) smaller shafts are required because the pipes to hoist the same quantity of ore hydraulically require less space in the shaft than does skip hoisting equipment; (2) the hoisting capacity of a mine can easily be increased without the necessity of sinking new shafts. Large savings in capital costs can thus be made; (3) fully automatic control is possible with hydraulic hoisting and therefore less manpower is required; and (4) health and safety conditions will be improved.

Advanced control for ground source heat pump systems

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

Hughes, Patrick; Gehl, Anthony C.; Liu, Xiaobing

Ground source heat pumps (GSHP), also known as geothermal heat pumps (GHP), are proven advanced HVAC systems that utilize clean and renewable geothermal energy, as well as the massive thermal storage capacity of the ground, to provide space conditioning and water heating for both residential and commercial buildings. GSHPs have higher energy efficiencies than conventional HVAC systems. It is estimated, if GSHPs achieve a 10% market share in the US, in each year, 0.6 Quad Btu primary energy consumption can be saved and 36 million tons carbon emissions can be avoided (Liu et al. 2017). However, the current market sharemore » of GSHPs is less than 1%. The foremost barrier preventing wider adoption of GSHPs is their high installation costs. To enable wider adoption of GSHPs, the costeffectiveness of GSHP applications must be improved.« less

Energy Savings Measure Packages. Existing Homes

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

Casey, Sean; Booten, Chuck

2011-11-01

This document presents the most cost effective Energy Savings Measure Packages (ESMP) for existing mixed-fuel and all electric homes to achieve 15% and 30% savings for each BetterBuildings grantee location across the United States. These packages are optimized for minimum cost to homeowners for source energy savings given the local climate and prevalent building characteristics (i.e. foundation types). Maximum cost savings are typically found between 30% and 50% energy savings over the reference home; this typically amounts to $300 - $700/year.

Cost-effectiveness of oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin in the emergency department.

PubMed

Rudis, Maria I; Touchette, Daniel R; Swadron, Stuart P; Chiu, Amy P; Orlinsky, Michael

2004-03-01

Oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin are all commonly used for loading phenytoin in the emergency department (ED). The cost-effectiveness of each was compared for patients presenting with seizures and subtherapeutic phenytoin concentrations. A simple decision tree was developed to determine the treatment costs associated with each of 3 loading techniques. We determined effectiveness by comparing adverse event rates and by calculating the time to safe ED discharge. Time to safe ED discharge was defined as the time at which therapeutic concentrations of phenytoin (>or=10 mg/L) were achieved with an absence of any adverse events that precluded discharge. The comparative cost-effectiveness of alternatives to oral phenytoin was determined by combining net costs and number of adverse events, expressed as cost per adverse events avoided. Cost-effectiveness was also determined by comparing the net costs of each loading technique required to achieve the time to safe ED discharge, expressed as cost per hour of ED time saved. The outcomes and costs were primarily derived from a prospective, randomized controlled trial, augmented by time-motion studies and alternate-cost sources. Costs included the cost of drugs, supplies, and personnel. Analyses were also performed in scenarios incorporating labor costs and savings from using a lower-urgency area of the ED. The mean number of adverse events per patient for oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin was 1.06, 1.93, and 2.13, respectively. Mean time to safe ED discharge in the 3 groups was 6.4 hours, 1.7 hours, and 1.3 hours. Cost per patient was 2.83 dollars, 21.16 dollars, and 175.19 dollars, respectively, and did not differ substantially in the Labor and Triage (lower-urgency area of ED) scenarios. When the measure of effectiveness was adverse events, oral phenytoin dominated intravenous phenytoin and intravenous fosphenytoin, with a lower cost and number of adverse events. With time to safe ED discharge as the outcome measure, the incremental cost-effectiveness ratios were 3.90 dollars and 387.27 dollars per hour of ED time saved for oral phenytoin versus intravenous phenytoin and for intravenous fosphenytoin versus intravenous phenytoin, respectively. Oral phenytoin is the most cost-effective loading method in most settings. Intravenous phenytoin is preferred if one is willing to pay an additional 20.65 dollars to 44.25 dollars per patient and willing to have more adverse events for a quicker average time to safe ED discharge. It is unlikely that intravenous fosphenytoin is justifiable in any setting.

A Cost Estimation Analysis of U.S. Navy Ship Fuel-Savings Techniques and Technologies

DTIC Science & Technology

2009-09-01

readings to the boiler operator. The PLC will provide constant automatic trimming of the excess oxygen based upon real time SGA readings. An SCD...the author): The Aegis Combat System is controlled by an advanced, automatic detect-and-track, multi-function three-dimensional passive...subsequently offloaded. An Online Wash System would reduce these maintenance costs and improve fuel efficiency of these engines by keeping the engines

Simplified energy design economics: Principles of economics applied to energy conservation and solar energy investments in buildings

NASA Astrophysics Data System (ADS)

Marshall, H. E.; Ruegg, R. T.; Wilson, F.

1980-01-01

Economic analysis techniques for evaluating alternative energy conservation investments in buildings are presented. Life cycle cost, benefit cost, savings to investment, payback, and rate of return analyses are explained and illustrated. The procedure for discounting is described for a heat pump investment. Formulas, tables of discount factors, and detailed instructions are provided to give all information required to make economic evaluations of energy conserving building designs.

Potential for the Use of Energy Savings Performance Contracts to Reduce Energy Consumption and Provide Energy and Cost Savings in Non-Building Applications

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

Williams, Charles; Green, Andrew S.; Dahle, Douglas

2013-08-01

The findings of this study indicate that potential exists in non-building applications to save energy and costs. This potential could save billions of federal dollars, reduce reliance on fossil fuels, increase energy independence and security, and reduce greenhouse gas emissions. The Federal Government has nearly twenty years of experience with achieving similar energy cost reductions, and letting the energy costs savings pay for themselves, by applying energy savings performance contracts (ESPC) inits buildings. Currently, the application of ESPCs is limited by statute to federal buildings. This study indicates that ESPCs can be a compatible and effective contracting tool for achievingmore » savings in non-building applications.« less

Demonstration of wetland vegetation mapping in Florida from computer-processed satellite and aircraft multispectral scanner data

NASA Technical Reports Server (NTRS)

Butera, M. K.

1979-01-01

The success of remotely mapping wetland vegetation of the southwestern coast of Florida is examined. A computerized technique to process aircraft and LANDSAT multispectral scanner data into vegetation classification maps was used. The cost effectiveness of this mapping technique was evaluated in terms of user requirements, accuracy, and cost. Results indicate that mangrove communities are classified most cost effectively by the LANDSAT technique, with an accuracy of approximately 87 percent and with a cost of approximately 3 cent per hectare compared to $46.50 per hectare for conventional ground survey methods.

A Cost-Benefit Analysis for Revision and Reimplementation of the Office Paper Recycling Program at the Naval Postgraduate School, Monterey

DTIC Science & Technology

1992-12-01

whether they will accept out-of- state waste. Residents of these states complain that they are becoming a dumping ground . Without legislation, these...reducing paper coffee cups or mandating two-sided copying, not only save money but are perceived by the population as a job well done. F. CURRENT...reduction, recycling and composting activities. Under some conditions, these goals can be modified. These conditions are fairly specific. First, the

An aircraft measurement technique for formaldehyde and soluble carbonyl compounds

NASA Astrophysics Data System (ADS)

Lee, Yin-Nan; Zhou, Xianliang; Leaitch, W. Richard; Banic, Catharine M.

1996-12-01

An aircraft technique was developed for measuring ambient concentrations of formaldehyde and a number of soluble carbonyl compounds, including glycolaldehyde, glyoxal, methylglyoxal, glyoxylic acid, and pyruvic acid. Sampling was achieved by liquid scrubbing using a glass coil scrubber in conjunction with an autosampler which collected 5-min integrated liquid samples in septum-sealed vials. Analysis was performed on the ground after flight using high-performance liquid chromatography following derivatization of the carbonyl analytes with 2,4-dinitrophenylhydrazine; the limit of detection was 0.01 to 0.02 parts per billion by volume (ppbv) in the gas phase. Although lacking a real-time capability, this technique offers the advantage of simultaneously measuring six carbonyl compounds, savings in space and power on the aircraft, and a dependable ground-based analysis. This technique was deployed on the Canadian National Research Council DHC-6 Twin Otter during the 1993 summer intensive of the North Atlantic Regional Experiment. The data obtained on August 28, 1993, during a pollutant transport episode are presented as an example of the performance and capability of this technique.

Alternative Fuels Data Center: Minnesota School District Finds Cost

Science.gov Websites

Savings, Cold-Weather Reliability with Propane Buses Minnesota School District Finds Cost Center: Minnesota School District Finds Cost Savings, Cold-Weather Reliability with Propane Buses on Facebook Tweet about Alternative Fuels Data Center: Minnesota School District Finds Cost Savings, Cold

Impact of low cost refurbishable and standard spacecraft upon future NASA space programs. Payload effects follow-on study

NASA Technical Reports Server (NTRS)

1972-01-01

The study has concluded that there are very large space program cost savings to be obtained by use of low cost, refurbishable, and standard spacecraft in conjunction with the shuttle transportation system. The range of space program cost savings for three different groups of programs are shown in quantitative terms. The total savings for the 91 programs will range from $13.4 billion to $18.0 billion depending on the degree of hardware standardization. These savings, principally resulting from payload cost reductions, tangibly support the development costs of the shuttle system.

Solar augmentation for process heat with central receiver technology

NASA Astrophysics Data System (ADS)

Kotzé, Johannes P.; du Toit, Philip; Bode, Sebastian J.; Larmuth, James N.; Landman, Willem A.; Gauché, Paul

2016-05-01

Coal fired boilers are currently one of the most widespread ways to deliver process heat to industry. John Thompson Boilers (JTB) offer industrial steam supply solutions for industry and utility scale applications in Southern Africa. Transport cost add significant cost to the coal price in locations far from the coal fields in Mpumalanga, Gauteng and Limpopo. The Helio100 project developed a low cost, self-learning, wireless heliostat technology that requires no ground preparation. This is attractive as an augmentation alternative, as it can easily be installed on any open land that a client may have available. This paper explores the techno economic feasibility of solar augmentation for JTB coal fired steam boilers by comparing the fuel savings of a generic 2MW heliostat field at various locations throughout South Africa.

Energy savings opportunity survey at Walter Reed Army Medical Center, Washington, DC. Final Submittal report

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

NONE

1987-10-22

This Energy Savings Opportunity Survey (ESOS) was performed for sixteen (16) buildings at Walter Reed Army Medical Center (WPAMC) in Washington, D.C. This survey was intended to reevaluate and update projects from a previous Energy Engineering Analysis Program (EEAP) survey performed at WRAMC. However, the previous EEAP survey was determined by the contracting officer to be incomplete and not worthy of further consideration. Therefore, this survey involved the complete reevaluation of the buildings to determine their potential energy cost savings. Six (6) projects and nine (9) low cost/no cost energy conservation opportunities (ECO`s) are recommended for implementation in the buildings.more » These projects and ECO`s are projected to annually save $448,263 at an implementation cost of $891,659. The simple payback (i.e., implementation cost divided by cost savings) for the recommendations in the survey is 1.99 years. The two (2) projects with the greatest cost savings are a stack heat recovery system (Project Number 5) and HVAC modifications (Project Number 1). These two (2) projects will provide 67% of the projected total savings for the survey. The sixteen (16) buildings in this survey represent only 22% of the total floor area of the Walter Reed Army Medical Center complex. It is believed that significant potential energy cost savings amounting to two (2) million dollars may be achieved in the remaining buildings in the complex not included in this survey. Specifically it is believed the main hospital building contains many opportunities for substantial cost savings.« less

A study of the use of linear programming techniques to improve the performance in design optimization problems

NASA Technical Reports Server (NTRS)

Young, Katherine C.; Sobieszczanski-Sobieski, Jaroslaw

1988-01-01

This project has two objectives. The first is to determine whether linear programming techniques can improve performance when handling design optimization problems with a large number of design variables and constraints relative to the feasible directions algorithm. The second purpose is to determine whether using the Kreisselmeier-Steinhauser (KS) function to replace the constraints with one constraint will reduce the cost of total optimization. Comparisons are made using solutions obtained with linear and non-linear methods. The results indicate that there is no cost saving using the linear method or in using the KS function to replace constraints.

A cost comparison analysis of adjuvant radiation therapy techniques after breast-conserving surgery.

PubMed

Lanni, Thomas; Keisch, Martin; Shah, Chirag; Wobb, Jessica; Kestin, Larry; Vicini, Frank

2013-01-01

The aim of this study is to perform a cost analysis to compare adjuvant radiation therapy schedules following breast conserving surgery. Treatment planning and delivery utilization data were modeled for a series of 10 different breast RT techniques. The whole breast (WB) regimens consisted of: (1) Wedge based WB (25 fractions [fx]), (2) WB using IMRT, (3) WBRT with a boost (B), (4) WBRT using IMRT with a B, (5) Canadian WB (16 fx) with 3D-CRT, and (6) Canadian using IMRT. The accelerated partial breast irradiation (APBI) regimens included (7): APBI using 3D-CRT, (8) IMRT, (9) single channel balloon, and (10) multi-channel balloon. Costs incurred by the payer (i.e., direct medical costs) were taken from the 2011 Medicare Fee Schedule. Among all the different regimens examined, Canadian 3D-CRT and APBI 3D-CRT were the least costly whereas WB using IMRT with a B was the most expensive. Both APBI brachytherapy techniques were less costly than conventional WB with a B. In terms of direct medical costs, the technical component accounted for most, if not all, of the disparity among the various treatments. A general trend of decreasing RT costs was observed with further reductions in overall treatment time for WBRT techniques, but not all of the alternative treatment regimens led to similar total cost savings. APBI using brachytherapy techniques was less costly than conventional WBRT with a standard boost. © 2013 Wiley Periodicals, Inc.

Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States.

PubMed

Cawley, John; Meyerhoefer, Chad; Gillingham, Leah G; Kris-Etherton, Penny; Jones, Peter J H

2017-02-01

Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats. A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000-2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS. Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ∼ $25.7 billion (95% CI = $6.0-$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI = $1.8-$14.0 billion), Medicare saving $9.4 billion (95% CI = $2.1-$16.7 billion), Medicaid saving $1.4 billion (95% CI = $0.2-$2.5 billion), and patients saving $2.2 billion (95% CI = $0.5-$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI = $100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI = $0.2-$2.1 billion) for 2010. The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home. Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.

Value-based assessment of robotic pancreas and liver surgery

PubMed Central

Patti, James C.; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic

2017-01-01

Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies must incorporate (I) quality of life, survival, and return to independent function alongside data such as (II) intent-to-treat analysis of minimally-invasive surgery accounting for conversions to open, (III) surgeon and institution experience and operative time as surrogates for the learning curve; and (IV) amortization and maintenance costs as well as direct costs of disposables and instruments. PMID:28848747

Value-based assessment of robotic pancreas and liver surgery.

PubMed

Patti, James C; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic; Moser, A James

2017-08-01

Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies must incorporate (I) quality of life, survival, and return to independent function alongside data such as (II) intent-to-treat analysis of minimally-invasive surgery accounting for conversions to open, (III) surgeon and institution experience and operative time as surrogates for the learning curve; and (IV) amortization and maintenance costs as well as direct costs of disposables and instruments.

Development of an automated energy audit protocol for office buildings

NASA Astrophysics Data System (ADS)

Deb, Chirag

This study aims to enhance the building energy audit process, and bring about reduction in time and cost requirements in the conduction of a full physical audit. For this, a total of 5 Energy Service Companies in Singapore have collaborated and provided energy audit reports for 62 office buildings. Several statistical techniques are adopted to analyse these reports. These techniques comprise cluster analysis and development of prediction models to predict energy savings for buildings. The cluster analysis shows that there are 3 clusters of buildings experiencing different levels of energy savings. To understand the effect of building variables on the change in EUI, a robust iterative process for selecting the appropriate variables is developed. The results show that the 4 variables of GFA, non-air-conditioning energy consumption, average chiller plant efficiency and installed capacity of chillers should be taken for clustering. This analysis is extended to the development of prediction models using linear regression and artificial neural networks (ANN). An exhaustive variable selection algorithm is developed to select the input variables for the two energy saving prediction models. The results show that the ANN prediction model can predict the energy saving potential of a given building with an accuracy of +/-14.8%.

Costs and savings associated with community water fluoridation programs in Colorado.

PubMed

O'Connell, Joan M; Brunson, Diane; Anselmo, Theresa; Sullivan, Patrick W

2005-11-01

Local, state, and national health policy makers require information on the economic burden of oral disease and the cost-effectiveness of oral health programs to set policies and allocate resources. In this study, we estimate the cost savings associated with community water fluoridation programs (CWFPs) in Colorado and potential cost savings if Colorado communities without fluoridation programs or naturally high fluoride levels were to implement CWFPs. We developed an economic model to compare the costs associated with CWFPs with treatment savings achieved through averted tooth decay. Treatment savings included those associated with direct medical costs and indirect nonmedical costs (i.e., patient time spent on dental visit). We estimated program costs and treatment savings for each water system in Colorado in 2003 dollars. We obtained parameter estimates from published studies, national surveys, and other sources. We calculated net costs for Colorado water systems with existing CWFPs and potential net costs for systems without CWFPs. The analysis includes data for 172 public water systems in Colorado that serve populations of 1000 individuals or more. We used second-order Monte Carlo simulations to evaluate the inherent uncertainty of the model assumptions on the results and report the 95% credible range from the simulation model. We estimated that Colorado CWFPs were associated with annual savings of 148.9 million dollars (credible range, 115.1 million dollars to 187.2 million dollars) in 2003, or an average of 60.78 dollars per person (credible range, 46.97 dollars dollars to 76.41 dollars). We estimated that Colorado would save an additional 46.6 million dollars (credible range, 36.0 dollars to 58.6 dollars million) annually if CWFPs were implemented in the 52 water systems without such programs and for which fluoridation is recommended. Colorado realizes significant annual savings from CWFPs; additional savings and reductions in morbidity could be achieved if fluoridation programs were implemented in other areas.

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.

Manned Mars mission cost estimate

NASA Technical Reports Server (NTRS)

Hamaker, Joseph; Smith, Keith

1986-01-01

The potential costs of several options of a manned Mars mission are examined. A cost estimating methodology based primarily on existing Marshall Space Flight Center (MSFC) parametric cost models is summarized. These models include the MSFC Space Station Cost Model and the MSFC Launch Vehicle Cost Model as well as other modes and techniques. The ground rules and assumptions of the cost estimating methodology are discussed and cost estimates presented for six potential mission options which were studied. The estimated manned Mars mission costs are compared to the cost of the somewhat analogous Apollo Program cost after normalizing the Apollo cost to the environment and ground rules of the manned Mars missions. It is concluded that a manned Mars mission, as currently defined, could be accomplished for under $30 billion in 1985 dollars excluding launch vehicle development and mission operations.

Numerical modelling of GPR ground-matching enhancement by a chirped multilayer structure - output of cooperation within COST Action TU1208

NASA Astrophysics Data System (ADS)

Baghdasaryan, Hovik V.; Knyazyan, Tamara M.; Hovhannisyan, Tamara. T.; Marciniak, Marian; Pajewski, Lara

2016-04-01

As is well know, Ground Penetrating Radar (GPR) is an electromagnetic technique for the detection and imaging of buried objects, with resolution ranging from centimeters to few meters [1, 2]. Though this technique is mature enough and different types of GPR devices are already in use, some problems are still waiting for their solution [3]. One of them is to achieve a better matching of transmitting GPR antenna to the ground, that will increase the signal penetration depth and the signal/noise ratio at the receiving end. In the current work, a full-wave electromagnetic modelling of the interaction of a plane wave with a chirped multilayered structure on the ground is performed, via numerical simulation. The method of single expression is used, which is a suitable technique for multi-boundary problems solution [4, 5]. The considered multilayer consists of two different dielectric slabs of low and high permittivity, where the highest value of permittivity doesn't exceed the permittivity of the ground. The losses in the ground are suitably taken into account. Two types of multilayers are analysed. Numerical results are obtained for the reflectance from the structure, as well as for the distributions of electric field components and power flow density in both the considered structures and the ground. The obtained results indicate that, for a better matching with the ground, the layer closer to the ground should be the high-permittivity one. Acknowledgement This work benefited from networking activities carried out within the EU funded COST Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar" (www.GPRadar.eu, www.cost.eu). Part of this work was developed during the Short-Term Scientific Mission COST-STSM-TU1208-25016, carried out by Prof. Baghdasaryan in the National Institute of Telecommunications in Warsaw, Poland. References [1] H. M. Jol. Ground Penetrating Radar: Theory and Applications. Elsevier, 2009. 509 pp. [2] R. Persico. Introduction to Ground Penetrating Radar. IEEE Press, Wiley, 2014. 368 pp. [3] A. Benedetto, L. Pajewski. Civil Engineering Applications of Ground Penetrating Radar. Springer, 2015. 371 pp. [4] H.V. Baghdasaryan, T.M. Knyazyan, "Problem of Plane EM-Wave Self-action in Multilayer Structure: an Exact Solution", Optical and Quantum Electronics, vol. 31, 1999, pp. 1059-1072. [5] H.V. Baghdasaryan, "Basics of the Method of Single Expression: New Approach for Solving Boundary Problems in Classical Electrodynamics", Yerevan, Chartaraget, 2013.

Crushing leads to waste disposal savings for FUSRAP

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

Darby, J.

1997-02-01

In this article the author discusses the application of a rock crusher as a means of implementing cost savings in the remediation of FUSRAP sites. Transportation and offsite disposal costs are at present the biggest cost items in the remediation of FUSRAP sites. If these debris disposal problems can be handled in different manners, then remediation savings are available. Crushing can result in the ability to handle some wastes as soil disposal problems, which have different disposal regulations, thereby permitting cost savings.

Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program

PubMed Central

McCarthy, Ian M; Robinson, Chessie; Huq, Sakib; Philastre, Martha; Fine, Robert L

2015-01-01

Objectives To quantify the cost savings of palliative care (PC) and identify differences in savings according to team structure, patient diagnosis, and timing of consult. Data Sources Hospital administrative records on all inpatient stays at five hospital campuses from January 2009 through June 2012. Study Design The analysis matched PC patients to non-PC patients (separately by discharge status) using propensity score methods. Weighted generalized linear model regressions of hospital costs were estimated for the matched groups. Data Collection Data were restricted to patients at least 18 years old with inpatient stays of between 7 and 30 days. Variables available included patient demographics, primary and secondary diagnoses, hospital costs incurred for the inpatient stay, and when/if the patient had a PC consult. Principal Findings We found overall cost savings from PC of $3,426 per patient for those dying in the hospital. No significant cost savings were found for patients discharged alive; however, significant cost savings for patients discharged alive could be achieved for certain diagnoses, PC team structures, or if consults occurred within 10 days of admission. Conclusions Appropriately selected and timed PC consults with physician and RN involvement can help ensure a financially viable PC program via cost savings to the hospital. PMID:25040226

Can disease management reduce health care costs by improving quality?

PubMed

Fireman, Bruce; Bartlett, Joan; Selby, Joe

2004-01-01

Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

Percutaneous coronary intervention with second-generation drug-eluting stent versus bare-metal stent: Systematic review and cost-benefit analysis.

PubMed

Poder, Thomas G; Erraji, Jihane; Coulibaly, Lucien P; Koffi, Kouamé

2017-01-01

Drug-eluting stents (DESs) were considered as ground-breaking technology promising to eradicate restenosis and the necessity to perform multiple revascularization procedures subsequent to percutaneous coronary intervention. Soon after DESs were released on the market, however, there were reports of a potential increase in mortality and of early or late thrombosis. In addition, DESs are far more expensive than bare-metal stents (BMSs), which has led to their limited use in many countries. The technology has improved over the last few years with the second generation of DESs (DES-2). Moreover, costs have come down and an improved safety profile with decreased thrombosis has been reported. Perform a cost-benefit analysis of DES-2s versus BMSs in the context of a publicly funded university hospital in Quebec, Canada. A systematic review of meta-analyses was conducted between 2012 and 2016 to extract data on clinical effectiveness. The clinical outcome of interest for the cost-benefit analysis was target-vessel revascularization (TVR). Cost units are those used in the Quebec health-care system. The cost-benefit analysis was based on a 2-year perspective. Deterministic and stochastic models (discrete-event simulation) were used, and various risk factors of reintervention were considered. DES-2s are much more effective than BMSs with respect to TVR rate ratio (i.e., 0.29 to 0.62 in more recent meta-analyses). DES-2s seem to cause fewer deaths and in-stent thrombosis than BMSs, but results are rarely significant, with the exception of the cobalt-chromium everolimus DES. The rate ratio of myocardial infraction is systematically in favor of DES-2s and very often significant. Despite the higher cost of DES-2s, fewer reinterventions can lead to huge savings (i.e., -$479 to -$769 per patient). Moreover, the higher a patient's risk of reintervention, the higher the savings associated with the use of DES-2s. Despite the higher purchase cost of DES-2s compared to BMSs, generalizing their use, in particular for patients at high risk of reintervention, should enable significant savings.

An Analysis of Variance Framework for Matrix Sampling.

ERIC Educational Resources Information Center

Sirotnik, Kenneth

Significant cost savings can be achieved with the use of matrix sampling in estimating population parameters from psychometric data. The statistical design is intuitively simple, using the framework of the two-way classification analysis of variance technique. For example, the mean and variance are derived from the performance of a certain grade…

Effect of remission definition on healthcare cost savings estimates for patients with rheumatoid arthritis treated with biologic therapies.

PubMed

Barnabe, Cheryl; Thanh, Nguyen Xuan; Ohinmaa, Arto; Homik, Joanne; Barr, Susan G; Martin, Liam; Maksymowych, Walter P

2014-08-01

Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.

Cost savings at the end of life. What do the data show?

PubMed

Emanuel, E J

1996-06-26

Medical care at the end of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget. Many people claim that increased use of hospice and advance directives and lower use of high-technology interventions for terminally ill patients will produce significant cost savings. However, the studies on cost savings from hospice and advance directives are not definitive. The 3 randomized trials show no savings from these interventions, but either they are too small for confidence in their negative results or their intervention and cost accounting are flawed. The nonrandomized trials of hospice and advance directives show a wide range of savings, from 68% to none. Five methodological issues obscure the assessment of these studies: (1) selection bias in those patients who use hospice and advance directives, (2) the different time frames of assessing the costs, (3) the limited types of medical costs evaluated, (4) the variability of reporting the savings, and (5) the lack of generalizability of the findings to other patient populations. A more definitive study that assessed patients' end-of-life care preferences, use of hospice and advance directives, and direct and indirect costs would be desirable. In the absence of such a study, the existing data suggest that hospice and advance directives can save between 25% and 40% of health care costs during the last month of life, with savings decreasing to 10% to 17% over the last 6 months of life and decreasing further to 0% to 10% over the last 12 months of life. These savings are less than most people anticipate. Nevertheless, they do indicate that hospice and advance directives should be encouraged because they certainly do not cost more and they provide a means for patients to exercise their autonomy over end-of-life decisions.

Costs And Savings Associated With Community Water Fluoridation In The United States.

PubMed

O'Connell, Joan; Rockell, Jennifer; Ouellet, Judith; Tomar, Scott L; Maas, William

2016-12-01

The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs. Project HOPE—The People-to-People Health Foundation, Inc.

Process cost and facility considerations in the selection of primary cell culture clarification technology.

PubMed

Felo, Michael; Christensen, Brandon; Higgins, John

2013-01-01

The bioreactor volume delineating the selection of primary clarification technology is not always easily defined. Development of a commercial scale process for the manufacture of therapeutic proteins requires scale-up from a few liters to thousands of liters. While the separation techniques used for protein purification are largely conserved across scales, the separation techniques for primary cell culture clarification vary with scale. Process models were developed to compare monoclonal antibody production costs using two cell culture clarification technologies. One process model was created for cell culture clarification by disc stack centrifugation with depth filtration. A second process model was created for clarification by multi-stage depth filtration. Analyses were performed to examine the influence of bioreactor volume, product titer, depth filter capacity, and facility utilization on overall operating costs. At bioreactor volumes <1,000 L, clarification using multi-stage depth filtration offers cost savings compared to clarification using centrifugation. For bioreactor volumes >5,000 L, clarification using centrifugation followed by depth filtration offers significant cost savings. For bioreactor volumes of ∼ 2,000 L, clarification costs are similar between depth filtration and centrifugation. At this scale, factors including facility utilization, available capital, ease of process development, implementation timelines, and process performance characterization play an important role in clarification technology selection. In the case study presented, a multi-product facility selected multi-stage depth filtration for cell culture clarification at the 500 and 2,000 L scales of operation. Facility implementation timelines, process development activities, equipment commissioning and validation, scale-up effects, and process robustness are examined. © 2013 American Institute of Chemical Engineers.

Reducing the length of postnatal hospital stay: implications for cost and quality of care.

PubMed

Bowers, John; Cheyne, Helen

2016-01-15

UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care. We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women's experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care. Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality and safety of care would also require corresponding increases in community based postnatal care. Simply reducing staffing in proportion to the length of stay increases the workload for each staff member resulting in poorer quality of care and increased staff stress. Many policy debates, such as that about the length of postnatal hospital-stay, demand consideration of multiple dimensions. This paper demonstrates how diverse data sources and techniques can be integrated to provide a more holistic analysis. Our study suggests that while earlier discharge from the postnatal ward may achievable, it may not generate all of the anticipated cost savings. Some useful savings may be realised but if staff and bed capacity are simply reduced in proportion to the length of stay, care quality may be compromised.

Domestic water conservation potential in Saudi Arabia

NASA Astrophysics Data System (ADS)

Abdulrazzak, Mohammed J.; Khan, Muhammad Z. A.

1990-03-01

Domestic water conservation in arid climates can result in efficient utilization of existing water supplies. The impacts of conservation measures such as the installation of water-saving devices, water metering and pricing schemes, water rationing and public awareness programs, strict plumbing codes, penalties for wasting water, programs designed to reduce leakage from public water lines and within the home, water-efficient landscaping, economic and ethical incentives are addressed in detail. Cost savings in arid climates, with particular reference to Saudi Arabia, in relation to some conservation techniques, are presented. Water conservation technology and tentative demonstration and implementation of water conservation programs are discussed.

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

PubMed

Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

2010-04-01

Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

Strategy on energy saving reconstruction of distribution networks based on life cycle cost

NASA Astrophysics Data System (ADS)

Chen, Xiaofei; Qiu, Zejing; Xu, Zhaoyang; Xiao, Chupeng

2017-08-01

Because the actual distribution network reconstruction project funds are often limited, the cost-benefit model and the decision-making method are crucial for distribution network energy saving reconstruction project. From the perspective of life cycle cost (LCC), firstly the research life cycle is determined for the energy saving reconstruction of distribution networks with multi-devices. Then, a new life cycle cost-benefit model for energy-saving reconstruction of distribution network is developed, in which the modification schemes include distribution transformers replacement, lines replacement and reactive power compensation. In the operation loss cost and maintenance cost area, the operation cost model considering the influence of load season characteristics and the maintenance cost segmental model of transformers are proposed. Finally, aiming at the highest energy saving profit per LCC, a decision-making method is developed while considering financial and technical constraints as well. The model and method are applied to a real distribution network reconstruction, and the results prove that the model and method are effective.

Reducing energy costs in nursing homes

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

Not Available

The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryersmore » to gas was analyzed. (MCW)« less

Solar energy system economic evaluation. Final report for SEECO Lincoln, Lincoln, Nebraska

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

None

1980-09-01

The economic analysis of the solar energy system that was installed at Lincoln, Nebraska is developed for this and four other sites typical of a wide range of environmental and economic conditions in the continental United States. This analysis is accomplished based on the technical and economic models in the f-chart design procedure with inputs based on the characteristics of the installed system and local conditions. The results are expressed in terms of the economic parameters of present worth of system cost over a projected twenty year life: life cycle savings, year of positive savings and year of payback formore » the optimized solar energy system at each of the analysis sites. The sensitivity of the economic evaluation to uncertainties in constituent system and economic variables is also investigated. Although budget constraints preclude an economic reevaluation of each of the sites, a similar site, Carlsbad, New Nexico, was done. When 1985 escalated values for fuel, costs, mass production, and improved design and installation techniques were applied, a significantly higher degree of savings was realized.« less

Testing methods and techniques: Testing electrical and electronic devices: A compilation

NASA Technical Reports Server (NTRS)

1972-01-01

The methods, techniques, and devices used in testing various electrical and electronic apparatus are presented. The items described range from semiconductor package leak detectors to automatic circuit analyzer and antenna simulators for system checkout. In many cases the approaches can result in considerable cost savings and improved quality control. The testing of various electronic components, assemblies, and systems; the testing of various electrical devices; and the testing of cables and connectors are explained.

Faith community nursing demonstrates good stewardship of community benefit dollars through cost savings and cost avoidance.

PubMed

Brown, Ameldia R; Coppola, Patricia; Giacona, Marian; Petriches, Anne; Stockwell, Mary Ann

2009-01-01

Health systems seeking responsible stewardship of community benefit dollars supporting Faith Community Nursing Networks require demonstration of positive measurable health outcomes. Faith Community Nurses (FCNs) answer the call for measurable outcomes by documenting cost savings and cost avoidances to families, communities, and health systems associated with their interventions. Using a spreadsheet tool based on Medicare reimbursements and diagnostic-related groupings, 3 networks of FCNs have together shown more than 600 000 (for calendar year 2008) healthcare dollars saved by avoidance of unnecessary acute care visits and extended care placements. The cost-benefit ratio of support dollars to cost savings and cost avoidance demonstrates that support of FCNs is good stewardship of community benefit dollars.

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.

Cost savings from a telemedicine model of care in northern Queensland, Australia.

PubMed

Thaker, Darshit A; Monypenny, Richard; Olver, Ian; Sabesan, Sabe

2013-09-16

To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services. Retrospective cost-savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings. Records of all patients managed by means of teleoncology at the Townsville Cancer Centre (TCC) and its six rural satellite centres in northern Queensland, Australia between 1 March 2007 and 30 November 2011. Costs for set-up and staffing to manage the service, and savings from avoidance of travel expenses for specialist oncologists, patients and their escorts, and for aeromedical retrievals. There were 605 teleoncology consultations with 147 patients over 56 months, at a total cost of $442 276. The cost for project establishment was $36 000, equipment/maintenance was $143 271, and staff was $261 520. The estimated travel expense avoided was $762 394; this figure included the costs of travel for patients and escorts of $658 760, aeromedical retrievals of $52 400 and travel for specialists of $47 634, as well as an estimate of accommodation costs for a proportion of patients of $3600. This resulted in a net saving of $320 118. Costs would have to increase by 72% to negate the savings. The teleoncology model of care at the TCC resulted in net savings, mainly due to avoidance of travel costs. Such savings could be redirected to enhancing rural resources and service capabilities. This teleoncology model is applicable to geographically distant areas requiring lengthy travel.

Costs and benefits of bicycling investments in Portland, Oregon.

PubMed

Gotschi, Thomas

2011-01-01

Promoting bicycling has great potential to increase overall physical activity; however, significant uncertainty exists with regard to the amount and effectiveness of investment needed for infrastructure. The objective of this study is to assess how costs of Portland's past and planned investments in bicycling relate to health and other benefits. Costs of investment plans are compared with 2 types of monetized health benefits, health care cost savings and value of statistical life savings. Levels of bicycling are estimated using past trends, future mode share goals, and a traffic demand model. By 2040, investments in the range of $138 to $605 million will result in health care cost savings of $388 to $594 million, fuel savings of $143 to $218 million, and savings in value of statistical lives of $7 to $12 billion. The benefit-cost ratios for health care and fuel savings are between 3.8 and 1.2 to 1, and an order of magnitude larger when value of statistical lives is used. This first of its kind cost-benefit analysis of investments in bicycling in a US city shows that such efforts are cost-effective, even when only a limited selection of benefits is considered.

Probabilistic modeling of condition-based maintenance strategies and quantification of its benefits for airliners

NASA Astrophysics Data System (ADS)

Pattabhiraman, Sriram

Airplane fuselage structures are designed with the concept of damage tolerance, wherein small damage are allowed to remain on the airplane, and damage that otherwise affect the safety of the structure are repaired. The damage critical to the safety of the fuselage are repaired by scheduling maintenance at pre-determined intervals. Scheduling maintenance is an interesting trade-off between damage tolerance and cost. Tolerance of larger damage would require less frequent maintenance and hence, a lower cost, to maintain a certain level of reliability. Alternatively, condition-based maintenance techniques have been developed using on-board sensors, which track damage continuously and request maintenance only when the damage size crosses a particular threshold. This effects a tolerance of larger damage than scheduled maintenance, leading to savings in cost. This work quantifies the savings of condition-based maintenance over scheduled maintenance. The work also quantifies converting the cost savings into weight savings. Structural health monitoring will need time to be able to establish itself as a stand-alone system for maintenance, due to concerns on its diagnosis accuracy and reliability. This work also investigates the effect of synchronizing structural health monitoring system with scheduled maintenance. This work uses on-board SHM equipment skip structural airframe maintenance (a subsect of scheduled maintenance), whenever deemed unnecessary while maintain a desired level of safety of structure. The work will also predict the necessary maintenance for a fleet of airplanes, based on the current damage status of the airplanes. The work also analyses the possibility of false alarm, wherein maintenance is being requested with no critical damage on the airplane. The work use SHM as a tool to identify lemons in a fleet of airplanes. Lemons are those airplanes that would warrant more maintenance trips than the average behavior of the fleet.

Effect of rising chemotherapy costs on the cost savings of colorectal cancer screening.

PubMed

Lansdorp-Vogelaar, Iris; van Ballegooijen, Marjolein; Zauber, Ann G; Habbema, J Dik F; Kuipers, Ernst J

2009-10-21

Although colorectal cancer screening is cost-effective, it requires a considerable net investment by governments or insurance companies. If screening was cost saving, governments and insurance companies might be more inclined to invest in colorectal cancer screening programs. We examined whether colorectal cancer screening would become cost saving with the widespread use of the newer, more expensive chemotherapies. We used the MISCAN-Colon microsimulation model to assess whether widespread use of new chemotherapies would affect the treatment savings of colorectal cancer screening in the general population. We considered three scenarios for chemotherapy use: the past, the present, and the near future. We assumed that survival improved and treatment costs for patients diagnosed with advanced stages of colorectal cancer increased over the scenarios. Screening strategies considered were annual guaiac fecal occult blood testing (FOBT), annual immunochemical FOBT, sigmoidoscopy every 5 years, colonoscopy every 10 years, and the combination of sigmoidoscopy every 5 years and annual guaiac FOBT. Analyses were conducted from the perspective of the health-care system for a cohort of 50-year-old individuals who were at average risk of colorectal cancer and were screened with 100% adherence from age 50 years to age 80 years and followed up until death. Compared with no screening, the treatment savings from preventing advanced colorectal cancer and colorectal cancer deaths by screening more than doubled with the widespread use of new chemotherapies. The lifetime average treatment savings were larger than the lifetime average screening costs for screening with Hemoccult II, immunochemical FOBT, sigmoidoscopy, and the combination of sigmoidoscopy and Hemoccult II (average savings vs costs per individual in the population: Hemoccult II, $1398 vs $859; immunochemical FOBT, $1756 vs $1565; sigmoidoscopy, $1706 vs $1575; sigmoidoscopy and Hemoccult II $1931 vs $1878). Colonoscopy did not become cost saving, but the total net costs of this strategy decreased from $1317 to $296 per individual in the population. With the increase in chemotherapy costs for advanced colorectal cancer, most colorectal cancer screening strategies have become cost saving. As a consequence, screening is a desirable approach not only to reduce colorectal cancer incidence and mortality but also to control the costs of colorectal cancer treatment.

Low-cost method for producing extreme ultraviolet lithography optics

DOEpatents

Folta, James A [Livermore, CA; Montcalm, Claude [Fort Collins, CO; Taylor, John S [Livermore, CA; Spiller, Eberhard A [Mt. Kisco, NY

2003-11-21

Spherical and non-spherical optical elements produced by standard optical figuring and polishing techniques are extremely expensive. Such surfaces can be cheaply produced by diamond turning; however, the roughness in the diamond turned surface prevent their use for EUV lithography. These ripples are smoothed with a coating of polyimide before applying a 60 period Mo/Si multilayer to reflect a wavelength of 134 .ANG. and have obtained peak reflectivities close to 63%. The savings in cost are about a factor of 100.

Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour

PubMed Central

Dahlen, Hannah G; Smith, Caroline A; Finlayson, Kenneth William; Downe, Soo

2018-01-01

Objective To assess whether the multitherapy antenatal education ‘CTLB’ (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. Design Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. Methods We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. Results If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group. Conclusion The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. Trial registration number ACTRN12611001126909. PMID:29439002

Enhanced ground bounce noise reduction in a low-leakage CMOS multiplier

NASA Astrophysics Data System (ADS)

Verma, Bipin Kumar; Akashe, Shyam; Sharma, Sanjay

2015-09-01

In this paper, various parameters are used to reduce leakage power, leakage current and noise margin of circuits to enhance their performance. A multiplier is proposed with low-leakage current and low ground bounce noise for the microprocessor, digital signal processors (DSP) and graphics engines. The ground bounce noise problem appears when a conventional power-gating circuit transits from sleep-to-active mode. This paper discusses a reduction in leakage current in the stacking power-gating technique by three modes - sleep, active and sleep-to-active. The simulation results are performed on a 4 × 4 carry-save multiplier for leakage current, active power, leakage power and ground bounce noise, and comparison made for different nanoscales. Ground bounce noise is limited to 90%. The leakage current of the circuit is decimated up to 80% and the active power is reduced to 31%. We performed simulations using cadence virtuoso 180 and 45 nm at room temperature at various supply voltages.

49 CFR 526.1 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of the Motor Vehicle Information and Cost Savings Act, 15 U.S.C. 2001 et seq. (b) Address. Each... Information and Cost Savings Act must be addressed to the Administrator, National Highway Traffic Safety... plan must specify the specific provision of the Motor Vehicle Information and Cost Savings Act under...

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

PubMed

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

2017-01-01

Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. Level III, therapeutic study.

"Men Are in Front at Eating Time, but Not When It Comes to Rearing the Chicken": Unpacking the Gendered Benefits and Costs of Livestock Ownership in Kenya.

PubMed

Dumas, Sarah E; Maranga, Abena; Mbullo, Patrick; Collins, Shalean; Wekesa, Pauline; Onono, Maricianah; Young, Sera L

2018-03-01

Livestock can promote resilience in low-income communities through a number of pathways. Livestock development programs seek to amplify these benefits but often fail to consider the costs to intended beneficiaries or the effect of prevailing gender norms. To explore perceptions of livestock ownership among female smallholder livestock keepers in Nyanza Region, Kenya, and unpack how the distribution of livestock benefits and investments varies by gender within households. We used multiple ethnographic techniques, including Photovoice, a photo-elicitation interview method, focus group discussions, and pile sorts, with female smallholder livestock owners (n = 18) participating in an ongoing cohort study. Transcripts were coded using a combination of a priori constructs and grounded theory. We found that livestock benefited households by providing financial security, food security, social benefits, and human time and labor savings. However, these benefits largely promoted long-term household resilience rather than immediate gains. Livestock ownership also had major costs to household time and labor, which were overwhelmingly borne by women and children. Despite this investment, women had limited livestock ownership rights, decision-making power, control over income, or access to meat. Our findings suggest that livestock ownership requires significant investments of household time and labor, which disproportionately burden women. Prevailing gender inequalities may therefore constrain the net benefit of livestock ownership for many women and their households in some contexts. Livestock development programs must assess both program benefits and costs at multiple levels to ensure that women's participation in livestock production leads to improved individual and household outcomes.

A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial.

PubMed

Adelson, Pamela L; Wedlock, Garry R; Wilkinson, Chris S; Howard, Kirsten; Bryce, Robert L; Turnbull, Deborah A

2013-09-01

To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI -$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI -$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming.

Design optimization of aircraft landing gear assembly under dynamic loading

NASA Astrophysics Data System (ADS)

Wong, Jonathan Y. B.

As development cycles and prototyping iterations begin to decrease in the aerospace industry, it is important to develop and improve practical methodologies to meet all design metrics. This research presents an efficient methodology that applies high-fidelity multi-disciplinary design optimization techniques to commercial landing gear assemblies, for weight reduction, cost savings, and structural performance dynamic loading. Specifically, a slave link subassembly was selected as the candidate to explore the feasibility of this methodology. The design optimization process utilized in this research was sectioned into three main stages: setup, optimization, and redesign. The first stage involved the creation and characterization of the models used throughout this research. The slave link assembly was modelled with a simplified landing gear test, replicating the behavior of the physical system. Through extensive review of the literature and collaboration with Safran Landing Systems, dynamic and structural behavior for the system were characterized and defined mathematically. Once defined, the characterized behaviors for the slave link assembly were then used to conduct a Multi-Body Dynamic (MBD) analysis to determine the dynamic and structural response of the system. These responses were then utilized in a topology optimization through the use of the Equivalent Static Load Method (ESLM). The results of the optimization were interpreted and later used to generate improved designs in terms of weight, cost, and structural performance under dynamic loading in stage three. The optimized designs were then validated using the model created for the MBD analysis of the baseline design. The design generation process employed two different approaches for post-processing the topology results produced. The first approach implemented a close replication of the topology results, resulting in a design with an overall peak stress increase of 74%, weight savings of 67%, and no apparent cost savings due to complex features present in the design. The second design approach focused on realizing reciprocating benefits for cost and weight savings. As a result, this design was able to achieve an overall peak stress increase of 6%, weight and cost savings of 36%, and 60%, respectively.

Why bundled payments could drive innovation: an example from interventional oncology.

PubMed

Steele, Joseph R; Jones, A Kyle; Ninan, Elizabeth P; Clarke, Ryan K; Odisio, Bruno C; Avritscher, Rony; Murthy, Ravi; Mahvash, Armeen

2015-03-01

Some have suggested that the current fee-for-service health care payment system in the United States stifles innovation. However, there are few published examples supporting this concept. We implemented an innovative temporary balloon occlusion technique for yttrium 90 radioembolization of nonresectable liver cancer. Although our balloon occlusion technique was associated with similar patient outcomes, lower cost, and faster procedure times compared with the standard-of-care coil embolization technique, our technique failed to gain widespread acceptance. Financial analysis revealed that because the balloon occlusion technique avoided a procedural step associated with a lucrative Current Procedural Terminology billing code, this new technique resulted in a significant decrease in hospital and physician revenue in the current fee-for-service payment system, even though the new technique would provide a revenue enhancement through cost savings in a bundled payment system. Our analysis illustrates how in a fee-for-service payment system, financial disincentives can stifle innovation and advancement of health care delivery. Copyright © 2015 by American Society of Clinical Oncology.

Stratified charge rotary engine for general aviation

NASA Technical Reports Server (NTRS)

Mount, R. E.; Parente, A. M.; Hady, W. F.

1986-01-01

A development history, a current development status assessment, and a design feature and performance capabilities account are given for stratified-charge rotary engines applicable to aircraft propulsion. Such engines are capable of operating on Jet-A fuel with substantial cost savings, improved altitude capability, and lower fuel consumption by comparison with gas turbine powerplants. Attention is given to the current development program of a 400-hp engine scheduled for initial operations in early 1990. Stratified charge rotary engines are also applicable to ground power units, airborne APUs, shipboard generators, and vehicular engines.

Managing design excellence tools during the development of new orthopaedic implants.

PubMed

Défossez, Henri J P; Serhan, Hassan

2013-11-01

Design excellence (DEX) tools have been widely used for years in some industries for their potential to facilitate new product development. The medical sector, targeted by cost pressures, has therefore started adopting them. Numerous tools are available; however only appropriate deployment during the new product development stages can optimize the overall process. The primary study objectives were to describe generic tools and illustrate their implementation and management during the development of new orthopaedic implants, and compile a reference package. Secondary objectives were to present the DEX tool investment costs and savings, since the method can require significant resources for which companies must carefully plan. The publicly available DEX method "Define Measure Analyze Design Verify Validate" was adopted and implemented during the development of a new spinal implant. Several tools proved most successful at developing the correct product, addressing clinical needs, and increasing market penetration potential, while reducing design iterations and manufacturing validations. Cost analysis and Pugh Matrix coupled with multi generation planning enabled developing a strong rationale to activate the project, set the vision and goals. improved risk management and product map established a robust technical verification-validation program. Design of experiments and process quantification facilitated design for manufacturing of critical features, as early as the concept phase. Biomechanical testing with analysis of variance provided a validation model with a recognized statistical performance baseline. Within those tools, only certain ones required minimum resources (i.e., business case, multi generational plan, project value proposition, Pugh Matrix, critical To quality process validation techniques), while others required significant investments (i.e., voice of customer, product usage map, improved risk management, design of experiments, biomechanical testing techniques). All used techniques provided savings exceeding investment costs. Some other tools were considered and found less relevant. A matrix summarized the investment costs and generated estimated savings. Globally, all companies can benefit from using DEX by smartly selecting and estimating those tools with best return on investment at the start of the project. For this, a good understanding of the available company resources, background and development strategy are needed. In conclusion, it was possible to illustrate that appropriate management of design excellence tools can greatly facilitate the development of new orthopaedic implant systems.

24 CFR 221.1 - Savings clause.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Savings clause. 221.1 Section 221.1... MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES LOW COST AND MODERATE INCOME MORTGAGE INSURANCE-SAVINGS CLAUSE Eligibility Requirements-Low Cost Homes-Savings Clause § 221.1...

Use of benchmarking techniques to justify the evolution of antibiotic management programs in healthcare systems.

PubMed

Schentag, J J; Paladino, J A; Birmingham, M C; Zimmer, G; Carr, J R; Hanson, S C

1995-01-01

To apply basic benchmarking techniques to hospital antibiotic expenditures and clinical pharmacy personnel and their duties, to identify cost savings strategies for clinical pharmacy services. Prospective survey of 18 hospitals ranging in size from 201 to 942 beds. Each was asked to provide antibiotic expenditures, an overview of their clinical pharmacy services, and to describe the duties of clinical pharmacists involved in antibiotic management activities. Specific information was sought on the use of pharmacokinetic dosing services, antibiotic streamlining, and oral switch in each of the hospitals. Most smaller hospitals (< 300 beds) did not employ clinical pharmacists with the specific duties of antibiotic management or streamlining. At these institutions, antibiotic management services consisted of formulary enforcement and aminoglycoside and/or vancomycin dosing services. The larger hospitals we surveyed employed clinical pharmacists designated as antibiotic management specialists, but their usual activities were aminoglycoside and/or vancomycin dosing services and formulary enforcement. In virtually all hospitals, the yearly expenses for antibiotics exceeded those of Millard Fillmore Hospitals by $2,000-3,000 per occupied bed. In a 500-bed hospital, this difference in expenditures would exceed $1.5 million yearly. Millard Fillmore Health System has similar types of patients, but employs clinical pharmacists to perform streamlining and/or switch functions at days 2-4, when cultures come back from the laboratory. The antibiotic streamlining and oral switch duties of clinical pharmacy specialists are associated with the majority of cost savings in hospital antibiotic management programs. The savings are considerable to the extent that most hospitals with 200-300 beds could readily cost-justify a full-time clinical pharmacist to perform these activities on a daily basis. Expenses of the program would be offset entirely by the reduction in the actual pharmacy expenditures on antibiotics.

Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model.

PubMed

Brown, Jack; Paladino, Joseph A

2010-01-01

Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literature-derived model. A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an MRSA prevalence of 30%, the numbers of patients needed to test in order to save one life were 14 and 16 compared with empiric vancomycin and SSP, respectively. The absolute mortality difference for MRSA prevalence rates of 80% and 5% favoured the PCR testing group at 2% and 10%, respectively, compared with empiric vancomycin and 18% and 1%, respectively, compared with empiric SSP. In the EU, the cost-effectiveness ratios for empiric vancomycin- and SSP-treated patients were Euro 695 and Euro 687 per life-year saved, respectively, compared with Euro 636 per life-year saved for rapid PCR testing. In the US, the cost-effectiveness ratio was $US 898 per life-year saved for empiric vancomycin and $US 820 per life-year saved for rapid PCR testing. ICERs demonstrated dominance of the PCR test in all instances. Threshold analysis revealed that PCR testing would be less costly overall, even at greatly inflated assay prices. Rapid PCR testing for MRSA appears to have the potential to reduce mortality rates while being less costly than empiric therapy in the EU and US, across a wide range of MRSA prevalence rates and PCR test costs.

Life Cycle Cost Growth Study for the Discovery and New Frontiers Program Office

NASA Technical Reports Server (NTRS)

Barley, Bryan; Gilbert, Paul; Newhouse, Marilyn

2010-01-01

The D&NF Program Office LCC Management Study provides a detailed look at the drivers underlying cost overruns and schedule delays for five D&NF missions. While none of the findings are new, the study underlines the importance of continued emphasis on sound project management techniques: a clean project management structure with a clear definition of roles and responsibilities across the various partners in a project, an understanding of institutional standards and procedures and any differences among the partners, and the critical need for a comprehensive IMS that can be used easily and routinely to identify potential threats to the critical path. The study also highlights the continuing need for realistic estimates of the total LCC. Sufficient time and resources must be allocated early in a project to ensure that the appropriate trade studies and analyses are performed across all aspects of a mission: spacecraft, ground system, operations concept, and fault management, to ensure that proposed and confirmed costs truly reflect the resource requirements over the entire mission life cycle. These studies need to include a realistic review of the assumptions underlying the use of new technologies, the integration of heritage and new hardware and software into the total mission environment, and any development and test savings based on heritage technology and lessons learned. Finally, the LCC Management Study stresses the need to listen to, carefully consider, and take positive action regarding the issues raised during reviews by the expert review teams.

Energy Savings Lifetimes and Persistence

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

Hoffman, Ian M.; Schiller, Steven R.; Todd, Annika

2016-02-01

This technical brief explains the concepts of energy savings lifetimes and savings persistence and discusses how program administrators use these factors to calculate savings for efficiency measures, programs and portfolios. Savings lifetime is the length of time that one or more energy efficiency measures or activities save energy, and savings persistence is the change in savings throughout the functional life of a given efficiency measure or activity. Savings lifetimes are essential for assessing the lifecycle benefits and cost effectiveness of efficiency activities and for forecasting loads in resource planning. The brief also provides estimates of savings lifetimes derived from amore » national collection of costs and savings for electric efficiency programs and portfolios.« less

Nondestructive Methods for Detecting Defects in Softwood Logs

Treesearch

Kristin C. Schad; Daniel L. Schmoldt; Robert J. Ross

1996-01-01

Wood degradation and defects, such as voids and knots, affect the quality and processing time of lumber. The ability to detect internal defects in the log can save mills time and processing costs. In this study, we investigated three nondestructive evaluation techniques for detecting internal wood defects. Sound wave transmission, x-ray computed tomography, and impulse...

Post-evaluation of a ground source heat pump system for residential space heating in Shanghai China

NASA Astrophysics Data System (ADS)

Lei, Y.; Tan, H. W.; Wang, L. Z.

2017-11-01

Residents of Southern China are increasingly concerned about the space heating in winter. The chief aim of the present work is to find a cost-effective way for residential space heating in Shanghai, one of the biggest city in south China. Economic and energy efficiency of three residential space heating ways, including ground source heat pump (GSHP), air source heat pump (ASHP) and wall-hung gas boiler (WHGB), are assessed based on Long-term measured data. The results show that the heat consumption of the building is 120 kWh/m2/y during the heating season, and the seasonal energy efficiency ratio (SEER) of the GSHP, ASHP and WHGB systems are 3.27, 2.30, 0.88 respectively. Compared to ASHP and WHGB, energy savings of GSHP during the heating season are 6.2 kgce/(m2.y) and 2.2 kgce/(m2.y), and the payback period of GSHP are 13.3 and 7.6 years respectively. The sensitivity analysis of various factors that affect the payback period is carried out, and the results suggest that SEER is the most critical factor affecting the feasibility of ground source heat pump application, followed by building load factor and energy price factor. These findings of the research have led the author to the conclusion that ground source heat pump for residential space heating in Shanghai is a good alternative, which can achieve significant energy saving benefits, and a good system design and operation management are key factors that can shorten the payback period.

Industry survey of space system cost benefits from New Ways Of Doing Business

NASA Technical Reports Server (NTRS)

Rosmait, Russell L.

1992-01-01

The cost of designing, building and operating space system hardware has always been expensive. Small quantities of specialty parts escalate engineering design, production and operations cost. Funding cutbacks and shrinking revenues dictate aggressive cost saving programs. NASA's highest priority is providing economical transportation to and from space. Over the past three decades NASA has seen technological advances that provide grater efficiencies in designing, building, and operating of space system hardware. As future programs such as NLS, LUTE and SEI begin, these greater efficiencies and cost savings should be reflected in the cost models. There are several New Ways Of Doing Business (NWODB) which, when fully implemented will reduce space system costs. These philosophies and/or culture changes are integrated in five areas: (1) More Extensive Pre-Phase C/D & E, (2) Multi Year Funding Stability, (3) Improved Quality, Management and Procurement Processes, (4) Advanced Design Methods, and (5) Advanced Production Methods. Following is an overview of NWODB and the Cost Quantification Analysis results using an industry survey, one of the four quantification techniques used in the study. The NWODB Cost Quantification Analysis is a study performed at Marshall Space Flight Center by the Engineering Cost Group, Applied Research Incorporated and Pittsburg State University. This study took place over a period of four months in mid 1992. The purpose of the study was to identify potential NWODB which could lead to improved cost effectiveness within NASA and to quantify potential cost benefits that might accrue if these NWODB were implemented.

Economic impact of thermostable vaccines.

PubMed

Lee, Bruce Y; Wedlock, Patrick T; Haidari, Leila A; Elder, Kate; Potet, Julien; Manring, Rachel; Connor, Diana L; Spiker, Marie L; Bonner, Kimberly; Rangarajan, Arjun; Hunyh, Delphine; Brown, Shawn T

2017-05-25

While our previous work has shown that replacing existing vaccines with thermostable vaccines can relieve bottlenecks in vaccine supply chains and thus increase vaccine availability, the question remains whether this benefit would outweigh the additional cost of thermostable formulations. Using HERMES simulation models of the vaccine supply chains for the Republic of Benin, the state of Bihar (India), and Niger, we simulated replacing different existing vaccines with thermostable formulations and determined the resulting clinical and economic impact. Costs measured included the costs of vaccines, logistics, and disease outcomes averted. Replacing a particular vaccine with a thermostable version yielded cost savings in many cases even when charging a price premium (two or three times the current vaccine price). For example, replacing the current pentavalent vaccine with a thermostable version without increasing the vaccine price saved from $366 to $10,945 per 100 members of the vaccine's target population. Doubling the vaccine price still resulted in cost savings that ranged from $300 to $10,706, and tripling the vaccine price resulted in cost savings from $234 to $10,468. As another example, a thermostable rotavirus vaccine (RV) at its current (year) price saved between $131 and $1065. Doubling and tripling the thermostable rotavirus price resulted in cost savings ranging from $102 to $936 and $73 to $808, respectively. Switching to thermostable formulations was highly cost-effective or cost-effective in most scenarios explored. Medical cost and productivity savings could outweigh even significant price premiums charged for thermostable formulations of vaccines, providing support for their use. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

When does mass screening for open neural tube defects in low-risk pregnancies result in cost savings?

PubMed Central

Tosi, L L; Detsky, A S; Roye, D P; Morden, M L

1987-01-01

Using a decision analysis model, we estimated the savings that might be derived from a mass prenatal screening program aimed at detecting open neural tube defects (NTDs) in low-risk pregnancies. Our baseline analysis showed that screening v. no screening could be expected to save approximately $8 per pregnancy given a cost of $7.50 for the maternal serum alpha-feto-protein (MSAFP) test and a cost of $42,507 for hospital and rehabilitation services for the first 10 years of life for a child with spina bifida. When a more liberal estimate of the costs of caring for such a child was used, the savings with the screening program were more substantial. We performed extensive sensitivity analyses, which showed that the savings were somewhat sensitive to the cost of the MSAFP test and highly sensitive to the specificity (but not the sensitivity) of the test. A screening program for NTDs in low-risk pregnancies may result in substantial savings in direct health care costs if the screening protocol is followed rigorously and efficiently. PMID:2433011

Autonomous Aerobraking Development Software: Phase One Performance Analysis at Mars, Venus, and Titan

NASA Technical Reports Server (NTRS)

Maddock, Robert W.; Bowes, Angela; Powell, Richard W.; Prince, Jill L. H.; Cianciolo, Alicia Dwyer

2012-01-01

When entering orbit about a planet or moon with an appreciable atmosphere, instead of using only the propulsion system to insert the spacecraft into its desired orbit, aerodynamic drag can be used after the initial orbit insertion to further decelerate the spacecraft. Several past NASA missions have used this aerobraking technique to reduce the fuel required to deliver a spacecraft into a desired orbit. Aerobraking was first demonstrated at Venus with Magellan in 1993 and then was used to achieve the science orbit of three Mars orbiters: Mars Global Surveyor in 1997, Mars Odyssey in 2001, and Mars Reconnaissance Orbiter in 2006. Although aerobraking itself reduces the propellant required to reach a final low period orbit, it does so at the expense of additional mission time to accommodate the aerobraking operations phase (typically 3-6 months), a large mission operations staff, and significant Deep Space Network (DSN) coverage. By automating ground based tasks and analyses associated with aerobraking and moving these onboard the spacecraft, a flight project could save millions of dollars in operations staffing and DSN costs (Ref. 1).

Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes.

PubMed

Finkelstein, Eric A; Allaire, Benjamin T; DiBonaventura, Marco DaCosta; Burgess, Somali M

2011-09-01

To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from $26570 (±$9000) to $34160 (±$10 380) when indirect costs are included. This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure. (C)2011The American College of Occupational and Environmental Medicine

Changing concepts in long-term central venous access: catheter selection and cost savings.

PubMed

Horattas, M C; Trupiano, J; Hopkins, S; Pasini, D; Martino, C; Murty, A

2001-02-01

Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed ports. Furthermore, in an effort to control costs, many traditionally inpatient therapies have moved to an outpatient setting. This raises many questions regarding catheter selection. Which catheter will result in the best outcome at the least cost? It has become apparent in our hospital that traditionally placed surgical catheters (ie, Hickmans and central venous ports) may no longer be the only options. The objective of this study was to explore the various modalities for establishing central venous access comparing indications, costs, and complications to guide the clinician in choosing the appropriate catheter with the best outcome at the least cost. We evaluated our institution's central venous catheter use during a 3-year period from 1995 through 1997. Data was obtained retrospectively through chart review. In addition to demographic data, specific information regarding catheter type, placement technique, indications, complications, and catheter history were recorded. Cost data were obtained from several departments including surgery, radiology, nursing, anesthesia, pharmacy, and the hospital purchasing department. During a 30-month period, 684 attempted central venous catheter insertions were identified, including 126 surgically placed central venous catheters, 264 peripherally inserted central catheters by the nursing service, and 294 radiologically inserted peripheral ports. Overall complications were rare but tended to be more severe in the surgical group. Relative cost differences between the groups were significant. Charges for peripherally inserted central catheters were $401 per procedure, compared with $3870 for radiologically placed peripheral ports and $3532 to $4296 for surgically placed catheters. Traditional surgically placed central catheters are increasingly being replaced by peripherally inserted central venous access devices. Significant cost savings and fewer severe complications can be realized by preferential use of peripherally inserted central catheters when clinically indicated. Cost savings may not be as significant when comparing radiologically placed versus surgically placed catheters. However, significant cost savings and fewer severe complications are associated with peripheral central venous access versus the surgical or radiologic approach.

A model to estimate cost-savings in diabetic foot ulcer prevention efforts.

PubMed

Barshes, Neal R; Saedi, Samira; Wrobel, James; Kougias, Panos; Kundakcioglu, O Erhun; Armstrong, David G

2017-04-01

Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential. Published by Elsevier Inc.

Dedicated Orthogeriatric Service Saves the HSE a Million Euro.

PubMed

Shanahan, E; Henderson, C; Butler, A; Lenehan, B; Sheehy, T; Costelloe, A; Carew, S; Peters, C; O'Connor, M; Lyons, D; Ryan, J

2016-04-11

Hip fracture is common in older adults and is associated with high morbidity, mortality and significant health care costs. A pilot orthogeriatrics service was established in an acute hospital. We aimed to establish the cost effectiveness of this service. Length of hospital stay, discharge destination and rehabilitation requirements were analysed for a one year period and compared to patients who received usual care prior to the service. We calculated the costs incurred and savings produced by the orthogeriatric service. Median length of stay was reduced by 3 days (p < 0.001) saving €266,976. There was a 19% reduction in rehabilitation requirements saving €192,600. Median rehabilitation length of stay was reduced by 6.5 days saving €171,093. Reductions in long term care requirements led to savings of €10,934 per week. Costs to establish such a service amount to €171,564. The introduction of this service led to improved patient outcomes in a cost effective manner.

Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization

DTIC Science & Technology

2014-05-01

1 Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization David N. Ford...2014 4. TITLE AND SUBTITLE Potential Cost Savings with 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization 5a...Manufacturing ( 3D printing ) 2 Research Context Problem: Learning curve savings forecasted in SHIPMAIN maintenance initiative have not materialized

Water Conservation Measures

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

Ian Metzger, Jesse Dean

2010-12-31

This software requires inputs of simple water fixture inventory information and calculates the water/energy and cost benefits of various retrofit opportunities. This tool includes water conservation measures for: Low-flow Toilets, Low-flow Urinals, Low-flow Faucets, and Low-flow Showheads. This tool calculates water savings, energy savings, demand reduction, cost savings, and building life cycle costs including: simple payback, discounted payback, net-present value, and savings to investment ratio. In addition this tool also displays the environmental benefits of a project.

Cost savings through implementation of an integrated home-based record: a case study in Vietnam.

PubMed

Aiga, Hirotsugu; Pham Huy, Tuan Kiet; Nguyen, Vinh Duc

2018-03-01

In Vietnam, there are three major home-based records (HBRs) for maternal and child health (MCH) that have been already nationally scaled up, i.e., Maternal and Child Health Handbook (MCH Handbook), Child Vaccination Handbook, and Child Growth Monitoring Chart. The MCH Handbook covers all the essential recording items that are included in the other two. This overlapping of recording items between the HBRs is likely to result in inefficient use of both financial and human resources. This study is aimed at estimating the magnitude of cost savings that are expected to be realized through implementing exclusively the MCH Handbook by terminating the other two. Secondary data collection and analyses on HBR production and distribution costs and health workers' opportunity costs. Through multiplying the unit costs by their respective quantity multipliers, recurrent costs of operations of three HBRs were estimated. Moreover, magnitude of cost savings likely to be realized was estimated, by calculating recurrent costs overlapping between the three HBRs. It was estimated that implementing exclusively the MCH Handbook would lead to cost savings of United States dollar 3.01 million per annum. The amount estimated is minimum cost savings because only recurrent cost elements (HBR production and distribution costs and health workers' opportunity costs) were incorporated into the estimation. Further indirect cost savings could be expected through reductions in health expenditures, as the use of the MCH Handbook would contribute to prevention of maternal and child illnesses by increasing antenatal care visits and breastfeeding practices. To avoid wasting financial and human resources, the MCH Handbook should be exclusively implemented by abolishing the other two HBRs. This study is globally an initial attempt to estimate cost savings to be realized through avoiding overlapping operations between multiple HBRs for MCH. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Optimizing the financial impact of transitioning to transconjunctival vitrectomy and microincisional phacoemulsification].

PubMed

Cornut, P-L; Soldermann, Y; Robin, C; Barranco, R; Kerhoas, A; Burillon, C

2013-12-01

To report the financial impact of using modern lens and vitreoretinal surgical techniques. Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Reported Energy and Cost Savings from the DOE ESPC Program: FY 2015

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

Slattery, Bob S.

2017-01-01

The objective of this work was to determine the realization rate of energy and cost savings from the Department of Energy’s Energy Savings Performance Contract (ESPC) program based on information reported by the energy services companies (ESCOs) that are carrying out ESPC projects at federal sites. Information was extracted from 151 Measurement and Verification (M&V) reports to determine reported, estimated, and guaranteed cost savings and reported and estimated energy savings for the previous contract year. Because the quality of the reports varied, it was not possible to determine all of these parameters for each project.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

PubMed

Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

2018-05-01

On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p < 0.001). Cost savings were confirmed by reducing the number of days used for cost comparison by three days for those with hospice stays of at least four days ($4,318 using 2009-2010 rates, $3,138 for 2016 rates: p < 0.001). Cost savings were greater for males ($3,393) versus females ($1,051) and greatest in cancer ($6,706) followed by debility and failure to thrive ($5,636) and congestive heart failure ($1,309); dementia patients had higher costs (+$1,880) (p < 0.001). When adding 3 days to the comparison period, hospice increased costs to Medicare. Medicare savings could continue with the 2016 payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

Evaluating Thin Client Computers for Use by the Polish Army

DTIC Science & Technology

2006-06-01

43 Figure 15. Annual Electricity Cost and Savings for 5 to 100 Users (source: Thin Client Computing...50 percent in hard costs in the first year of thin client network deployment.20 However, the greatest savings come from the reduction in soft costs ...resources from both the classrooms and home. The thin client solution increased the reliability of the IT infrastructure and resulted in cost savings

Technique to verify the accuracy of a definitive cast before the fabrication of a fixed dental prosthesis.

PubMed

Farah, Ra'fat I; Alshabi, Abdullah M

2016-09-01

This report describes a straightforward technique for verifying the accuracy of a definitive cast by using a maximal intercuspation record fabricated from polyvinyl siloxane occlusal registration material. This precise verification method detects inaccurate casts before the dental prosthesis is fabricated, thus saving chairside and laboratory time while reducing the number of costly prosthesis remakes. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Iowa Energy and Cost Savings for New Single- and Multifamily Homes: 2012 IECC as Compared to the 2009 IECC

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-06-15

The 2012 International Energy Conservation Code (IECC) yields positive benefits for Iowa homeowners. Moving to the 2012 IECC from the 2009 IECC is cost effective over a 30-year life cycle. On average, Iowa homeowners will save $7,573 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 1 year for the 2012 IECC. Average annual energy savings are $454 for the 2012 IECC.

Texas Energy and Cost Savings for New Single- and Multifamily Homes: 2012 IECC as Compared to the 2009 IECC

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-06-15

The 2012 International Energy Conservation Code (IECC) yields positive benefits for Texas homeowners. Moving to the 2012 IECC from the 2009 IECC is cost effective over a 30-year life cycle. On average, Texas homeowners will save $3,456 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 2 years for the 2012 IECC. Average annual energy savings are $259 for the 2012 IECC.

The Potential of Combined Heat and Power Generation, Wind Power Generation and Load Management Techniques for Cost Reduction in Small Electricity Supply Systems.

NASA Astrophysics Data System (ADS)

Bass, Jeremy Hugh

Available from UMI in association with The British Library. Requires signed TDF. An evaluation is made of the potential fuel and financial savings possible when a small, autonomous diesel system sized to meet the demands of an individual, domestic consumer is adapted to include: (1) combined heat and power (CHP) generation, (2) wind turbine generation, (3) direct load control. The potential of these three areas is investigated by means of time-step simulation modelling on a microcomputer. Models are used to evaluate performance and a Net Present Value analysis used to assess costs. A cost/benefit analysis then enables those areas, or combination of areas, that facilitate and greatest savings to be identified. The modelling work is supported by experience gained from the following: (1) field study of the Lundy Island wind/diesel system, (2) laboratory testing of a small diesel generator set, (3) study of a diesel based CHP unit, (4) study of a diesel based direct load control system, (5) statistical analysis of data obtained from the long-term monitoring of a large number of individual household's electricity consumption. Rather than consider the consumer's electrical demand in isolation, a more flexible approach is adopted, with consumer demand being regarded as the sum of primarily two components: a small, electricity demand for essential services and a large, reschedulable demand for heating/cooling. The results of the study indicate that: (1) operating a diesel set in a CHP mode is the best strategy for both financial and fuel savings. A simple retrofit enables overall conversion efficiencies to be increased from 25% to 60%, or greater, at little cost. (2) wind turbine generation in association with direct load control is a most effective combination. (3) a combination of both the above areas enables greatest overall financial savings, in favourable winds resulting in unit energy costs around 20% of those of diesel only operation.

Setting analyst: A practical harvest planning technique

Treesearch

Olivier R.M. Halleux; W. Dale Greene

2001-01-01

Setting Analyst is an ArcView extension that facilitates practical harvest planning for ground-based systems. By modeling the travel patterns of ground-based machines, it compares different harvesting settings based on projected average skidding distance, logging costs, and site disturbance levels. Setting Analyst uses information commonly available to consulting...

Comparative costs of family planning services and hospital-based maternity care in Turkey.

PubMed

Cakir, H V; Fabricant, S J; Kircalioğlu, F N

1996-01-01

The costs of running a recently established family planning program in the Turkish social security system were measured and compared with the costs of providing the medical services and nonmedical benefits for pregnant women. The undiscounted cost savings from averting pregnancy were estimated to exceed the program's recurrent costs by 17.6 to 1. Cost savings represent only 1 percent of all of the system's medical expenditures, but the family planning program is in an early stage, and potential savings could influence management decisionmaking regarding investments in specialized maternity hospitals.

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects.

PubMed

Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

2017-09-27

To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings. © Mwencha et al.

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects

PubMed Central

Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

2017-01-01

ABSTRACT Background: To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. Methods: We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. Results: The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Conclusion: Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades—while not inexpensive—contributed to greater system efficiency and modest savings. PMID:28877933

Michigan Energy and Cost Savings for New Single- and Multifamily Homes: 2012 IECC as Compared to the Michigan Uniform Energy Code

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-07-03

The 2012 International Energy Conservation Code (IECC) yields positive benefits for Michigan homeowners. Moving to the 2012 IECC from the Michigan Uniform Energy Code is cost-effective over a 30-year life cycle. On average, Michigan homeowners will save $10,081 with the 2012 IECC. Each year, the reduction to energy bills will significantly exceed increased mortgage costs. After accounting for up-front costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 1 year for the 2012 IECC. Average annual energy savings are $604 for the 2012 IECC.

Ohio Energy and Cost Savings for New Single- and Multifamily Homes: 2012 IECC as Compared to the 2009 IECC

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-07-03

The 2012 International Energy Conservation Code (IECC) yields positive benefits for Ohio homeowners. Moving to the 2012 IECC from the 2009 IECC is cost-effective over a 30-year life cycle. On average, Ohio homeowners will save $5,151 with the 2012 IECC. Each year, the reduction to energy bills will significantly exceed increased mortgage costs. After accounting for up-front costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 1 year for the 2012 IECC. Average annual energy savings are $330 for the 2012 IECC.

The impact of changing dental needs on cost savings from fluoridation.

PubMed

Campain, A C; Mariño, R J; Wright, F A C; Harrison, D; Bailey, D L; Morgan, M V

2010-03-01

Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. Community water fluoridation remains a cost-effective preventive measure in Australia.

Telephone-based disease management: why it does not save money.

PubMed

Motheral, Brenda R

2011-01-01

To understand why the current telephone-based model of disease management (DM) does not provide cost savings and how DM can be retooled based on the best available evidence to deliver better value. Literature review. The published peer-reviewed evaluations of DM and transitional care models from 1990 to 2010 were reviewed. Also examined was the cost-effectiveness literature on the treatment of chronic conditions that are commonly included in DM programs, including heart failure, diabetes mellitus, coronary artery disease, and asthma. First, transitional care models, which have historically been confused with commercial DM programs, can provide credible savings over a short period, rendering them low-hanging fruit for plan sponsors who desire real savings. Second, cost-effectiveness research has shown that the individual activities that constitute contemporary DM programs are not cost saving except for heart failure. Targeting of specific patients and activity combinations based on risk, actionability, treatment and program effectiveness, and costs will be necessary to deliver a cost-saving DM program, combined with an outreach model that brings vendors closer to the patient and physician. Barriers to this evidence-driven approach include resources required, marketability, and business model disruption. After a decade of market experimentation with limited success, new thinking is called for in the design of DM programs. A program design that is based on a cost-effectiveness approach, combined with greater program efficacy, will allow for the development of DM programs that are cost saving.

Retrospective Assessment of Cost Savings From Prevention

PubMed Central

Grosse, Scott D.; Berry, Robert J.; Tilford, J. Mick; Kucik, James E.; Waitzman, Norman J.

2016-01-01

Introduction Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997–1998. Methods Estimates of annual numbers of live-born spina bifida cases in 1995–1996 relative to 1999–2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. Results The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. Conclusions The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. PMID:26790341

Reducing Operating Costs and Energy Consumption at Water Utilities

EPA Pesticide Factsheets

Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

Standardization and program effect analysis (Study 2.4). Volume 2: Equipment commonality analysis. [cost savings of using flight-proven components in designing spacecraft

NASA Technical Reports Server (NTRS)

Shiokari, T.

1975-01-01

The feasibility and cost savings of using flight-proven components in designing spacecraft were investigated. The components analyzed were (1) large space telescope, (2) stratospheric aerosol and gas equipment, (3) mapping mission, (4) solar maximum mission, and (5) Tiros-N. It is concluded that flight-proven hardware can be used with not-too-extensive modification, and significant savings can be realized. The cost savings for each component are presented.

Education and empowerment of the nursing assistant: validating their important role in skin care and pressure ulcer prevention, and demonstrating productivity enhancement and cost savings.

PubMed

Howe, Lynn

2008-06-01

This article details an educational program designed to utilize nonlicensed personnel (certified nursing assistants [CNAs] and nursing assistants [NAs]) in the prevention of pressure ulcers and improved skin care in a 250-bed acute care facility in a suburban setting. The article is divided into 2 parts: A and B. Part A addresses the educational program, which was part of a major initiative for improving patient outcomes that included a review and standardization of skin care products and protocols. Part B addresses productivity enhancement and cost savings experienced because of changing bathing and incontinence care products and procedures. The educational program included instruction on time-saving methods for increasing productivity in bathing and incontinence care, and effectively promoted the importance of proper skin care and pressure ulcer prevention techniques. Methods incorporated into the educational training targeted different reading and comprehension levels, ranging from the use of PowerPoint slides, hands-on return demonstration, and group discussion related to pressure ulcer staging and wound treatment. These educational methods provided the participants with significant reinforcement of each day's learning objectives. Productivity enhancement and cost savings are addressed in part B, as well as the results of a time-motion study. Because of the program, CNAs/NAs were empowered in their integral caregiver roles. This program was part of a larger, major process improvement initiative, but the rate of acquired pressure ulcers declined from 2.17% in 2002 to 1.71% in 2003. This educational program was considered a contributor to the improved patient outcomes.

Technology requirements for communication satellites in the 1980's

NASA Technical Reports Server (NTRS)

Burtt, J. E.; Moe, C. R.; Elms, R. V.; Delateur, L. A.; Sedlacek, W. C.; Younger, G. G.

1973-01-01

The key technology requirements are defined for meeting the forecasted demands for communication satellite services in the 1985 to 1995 time frame. Evaluation is made of needs for services and technical and functional requirements for providing services. The future growth capabilities of the terrestrial telephone network, cable television, and satellite networks are forecasted. The impact of spacecraft technology and booster performance and costs upon communication satellite costs are analyzed. Systems analysis techniques are used to determine functional requirements and the sensitivities of technology improvements for reducing the costs of meeting requirements. Recommended development plans and funding levels are presented, as well as the possible cost saving for communications satellites in the post 1985 era.

Financial impact of disease-related malnutrition at the San Pedro de Alcántara hospital. Estimated cost savings associated to a specialized nutritional survey.

PubMed

Morán López, Jesús Manuel; Enciso Izquierdo, Fidel Jesús; Luengo Pérez, Luis Miguel; Beneítez Moralejo, Belén; Piedra León, María; de Luis, Daniel A; Amado Señaris, José Antonio

2017-10-01

DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy. Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM). Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Accounting for the relationship between per diem cost and LOS when estimating hospitalization costs.

PubMed

Ishak, K Jack; Stolar, Marilyn; Hu, Ming-yi; Alvarez, Piedad; Wang, Yamei; Getsios, Denis; Williams, Gregory C

2012-12-01

Hospitalization costs in clinical trials are typically derived by multiplying the length of stay (LOS) by an average per-diem (PD) cost from external sources. This assumes that PD costs are independent of LOS. Resource utilization in early days of the stay is usually more intense, however, and thus, the PD cost for a short hospitalization may be higher than for longer stays. The shape of this relationship is unlikely to be linear, as PD costs would be expected to gradually plateau. This paper describes how to model the relationship between PD cost and LOS using flexible statistical modelling techniques. An example based on a clinical study of clevidipine for the treatment of peri-operative hypertension during hospitalizations for cardiac surgery is used to illustrate how inferences about cost-savings associated with good blood pressure (BP) control during the stay can be affected by the approach used to derive hospitalization costs.Data on the cost and LOS of hospitalizations for coronary artery bypass grafting (CABG) from the Massachusetts Acute Hospital Case Mix Database (the MA Case Mix Database) were analyzed to link LOS to PD cost, factoring in complications that may have occurred during the hospitalization or post-discharge. The shape of the relationship between LOS and PD costs in the MA Case Mix was explored graphically in a regression framework. A series of statistical models including those based on simple logarithmic transformation of LOS to more flexible models using LOcally wEighted Scatterplot Smoothing (LOESS) techniques were considered. A final model was selected, using simplicity and parsimony as guiding principles in addition traditional fit statistics (like Akaike's Information Criterion, or AIC). This mapping was applied in ECLIPSE to predict an LOS-specific PD cost, and then a total cost of hospitalization. These were then compared for patients who had good vs. poor peri-operative blood-pressure control. The MA Case Mix dataset included data from over 10,000 patients. Visual inspection of PD vs. LOS revealed a non-linear relationship. A logarithmic model and a series of LOESS and piecewise-linear models with varying connection points were tested. The logarithmic model was ultimately favoured for its fit and simplicity. Using this mapping in the ECLIPSE trials, we found that good peri-operative BP control was associated with a cost savings of $5,366 when costs were derived using the mapping, compared with savings of $7,666 obtained using the traditional approach of calculating the cost. PD costs vary systematically with LOS, with short stays being associated with high PD costs that drop gradually and level off. The shape of the relationship may differ in other settings. It is important to assess this and model the observed pattern, as this may have an impact on conclusions based on derived hospitalization costs.

Accounting for the relationship between per diem cost and LOS when estimating hospitalization costs

PubMed Central

2012-01-01

Background Hospitalization costs in clinical trials are typically derived by multiplying the length of stay (LOS) by an average per-diem (PD) cost from external sources. This assumes that PD costs are independent of LOS. Resource utilization in early days of the stay is usually more intense, however, and thus, the PD cost for a short hospitalization may be higher than for longer stays. The shape of this relationship is unlikely to be linear, as PD costs would be expected to gradually plateau. This paper describes how to model the relationship between PD cost and LOS using flexible statistical modelling techniques. Methods An example based on a clinical study of clevidipine for the treatment of peri-operative hypertension during hospitalizations for cardiac surgery is used to illustrate how inferences about cost-savings associated with good blood pressure (BP) control during the stay can be affected by the approach used to derive hospitalization costs. Data on the cost and LOS of hospitalizations for coronary artery bypass grafting (CABG) from the Massachusetts Acute Hospital Case Mix Database (the MA Case Mix Database) were analyzed to link LOS to PD cost, factoring in complications that may have occurred during the hospitalization or post-discharge. The shape of the relationship between LOS and PD costs in the MA Case Mix was explored graphically in a regression framework. A series of statistical models including those based on simple logarithmic transformation of LOS to more flexible models using LOcally wEighted Scatterplot Smoothing (LOESS) techniques were considered. A final model was selected, using simplicity and parsimony as guiding principles in addition traditional fit statistics (like Akaike’s Information Criterion, or AIC). This mapping was applied in ECLIPSE to predict an LOS-specific PD cost, and then a total cost of hospitalization. These were then compared for patients who had good vs. poor peri-operative blood-pressure control. Results The MA Case Mix dataset included data from over 10,000 patients. Visual inspection of PD vs. LOS revealed a non-linear relationship. A logarithmic model and a series of LOESS and piecewise-linear models with varying connection points were tested. The logarithmic model was ultimately favoured for its fit and simplicity. Using this mapping in the ECLIPSE trials, we found that good peri-operative BP control was associated with a cost savings of $5,366 when costs were derived using the mapping, compared with savings of $7,666 obtained using the traditional approach of calculating the cost. Conclusions PD costs vary systematically with LOS, with short stays being associated with high PD costs that drop gradually and level off. The shape of the relationship may differ in other settings. It is important to assess this and model the observed pattern, as this may have an impact on conclusions based on derived hospitalization costs. PMID:23198908

Accuracy of automated measurement and verification (M&V) techniques for energy savings in commercial buildings

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

Granderson, Jessica; Touzani, Samir; Custodio, Claudine

Trustworthy savings calculations are critical to convincing investors in energy efficiency projects of the benefit and cost-effectiveness of such investments and their ability to replace or defer supply-side capital investments. However, today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of efficiency projects. They also require time-consuming manual data acquisition and often do not deliver results until years after the program period has ended. The rising availability of “smart” meters, combined with new analytical approaches to quantifying savings, has opened the door to conducting M&V more quickly and at lower cost,more » with comparable or improved accuracy. These meter- and software-based approaches, increasingly referred to as “M&V 2.0”, are the subject of surging industry interest, particularly in the context of utility energy efficiency programs. Program administrators, evaluators, and regulators are asking how M&V 2.0 compares with more traditional methods, how proprietary software can be transparently performance tested, how these techniques can be integrated into the next generation of whole-building focused efficiency programs. This paper expands recent analyses of public-domain whole-building M&V methods, focusing on more novel M&V2.0 modeling approaches that are used in commercial technologies, as well as approaches that are documented in the literature, and/or developed by the academic building research community. We present a testing procedure and metrics to assess the performance of whole-building M&V methods. We then illustrate the test procedure by evaluating the accuracy of ten baseline energy use models, against measured data from a large dataset of 537 buildings. The results of this study show that the already available advanced interval data baseline models hold great promise for scaling the adoption of building measured savings calculations using Advanced Metering Infrastructure (AMI) data. Median coefficient of variation of the root mean squared error (CV(RMSE)) was less than 25% for every model tested when twelve months of training data were used. With even six months of training data, median CV(RMSE) for daily energy total was under 25% for all models tested. Finally, these findings can be used to build confidence in model robustness, and the readiness of these approaches for industry uptake and adoption« less

Accuracy of automated measurement and verification (M&V) techniques for energy savings in commercial buildings

DOE PAGES

Granderson, Jessica; Touzani, Samir; Custodio, Claudine; ...

2016-04-16

Trustworthy savings calculations are critical to convincing investors in energy efficiency projects of the benefit and cost-effectiveness of such investments and their ability to replace or defer supply-side capital investments. However, today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of efficiency projects. They also require time-consuming manual data acquisition and often do not deliver results until years after the program period has ended. The rising availability of “smart” meters, combined with new analytical approaches to quantifying savings, has opened the door to conducting M&V more quickly and at lower cost,more » with comparable or improved accuracy. These meter- and software-based approaches, increasingly referred to as “M&V 2.0”, are the subject of surging industry interest, particularly in the context of utility energy efficiency programs. Program administrators, evaluators, and regulators are asking how M&V 2.0 compares with more traditional methods, how proprietary software can be transparently performance tested, how these techniques can be integrated into the next generation of whole-building focused efficiency programs. This paper expands recent analyses of public-domain whole-building M&V methods, focusing on more novel M&V2.0 modeling approaches that are used in commercial technologies, as well as approaches that are documented in the literature, and/or developed by the academic building research community. We present a testing procedure and metrics to assess the performance of whole-building M&V methods. We then illustrate the test procedure by evaluating the accuracy of ten baseline energy use models, against measured data from a large dataset of 537 buildings. The results of this study show that the already available advanced interval data baseline models hold great promise for scaling the adoption of building measured savings calculations using Advanced Metering Infrastructure (AMI) data. Median coefficient of variation of the root mean squared error (CV(RMSE)) was less than 25% for every model tested when twelve months of training data were used. With even six months of training data, median CV(RMSE) for daily energy total was under 25% for all models tested. Finally, these findings can be used to build confidence in model robustness, and the readiness of these approaches for industry uptake and adoption« less

Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

PubMed

Henson, Gay; Ghonim, Elham; Swiatlo, Andrea; King, Shelia; Moore, Kimberly S; King, S Travis; Sullivan, Donna

2014-01-01

A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

Low cost drip irrigation: Impact on sugarcane yield, water and energy saving in semiarid tropical agro ecosystem in India.

PubMed

Surendran, U; Jayakumar, M; Marimuthu, S

2016-12-15

Low cost drip irrigation (LCDI) has been a recent introduction to India and it may be an inexpensive means of expanding irrigation into uncultivated areas, thereby increasing land productivity. This paper is structured into two phases. The first phase, presents an assessment of different irrigation methods (LCDI, conventional drip irrigation (CDI) with single row and paired row, siphon and flood irrigation) on sugarcane production. The results showed that cane yield and water productivity was significantly increased in both plant and ratoon crop of sugarcane owing to the methods of irrigation. Among the methods, LCDI recorded 118.6tha -1 of cane yield and it was on par with the single row CDI, which recorded the highest mean yield of 120.4tha -1 and both are found to be significantly superior to the rest of the treatments. The lowest yield was recorded in the treatment of flood irrigation (94.40tha -1 ). Benefit Cost Ratio analysis confirmed that LCDI performed better compared to other irrigation methods. The second phase deals with the farmer participatory research demonstrations at multi location on evaluation of LCDI with flood irrigation. LCDI out performed flood irrigation under all the locations in terms of sugarcane yield, soil moisture content, postharvest soil fertility, reduction in nutrient transport to surface and ground water, water and energy saving. These results suggest that LCDI is a feasible option to increase the sugarcane production in water scarcity areas of semiarid agro ecosystems, and have long-term sustained economic benefits than flood irrigation in terms of water productivity, energy saving and environmental sustainability. Copyright © 2016 Elsevier B.V. All rights reserved.

Evaluation of the Ethiopian Millennium Rural Initiative: Impact on Mortality and Cost-Effectiveness

PubMed Central

Curry, Leslie A.; Byam, Patrick; Linnander, Erika; Andersson, Kyeen M.; Abebe, Yigeremu; Zerihun, Abraham; Thompson, Jennifer W.; Bradley, Elizabeth H.

2013-01-01

Main Objective Few studies have examined the long-term, impact of large-scale interventions to strengthen primary care services for women and children in rural, low-income settings. We evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI), an 18-month systems-based intervention to improve the performance of 30 primary health care units in rural areas of Ethiopia. Methods We assessed the impact of EMRI on maternal and child survival using The Lives Saved Tool (LiST), Demography (DemProj) and AIDS Impact Model (AIM) tools in Spectrum software, inputting monthly data on 6 indicators 1) antenatal coverage (ANC), 2) skilled birth attendance coverage (SBA), 3) post-natal coverage (PNC), 4) HIV testing during ANC, 5) measles vaccination coverage, and 6) pentavalent 3 vaccination coverages. We calculated a cost-benefit ratio of the EMRI program including lives saved during implementation and lives saved during implementation and 5 year follow-up. Results A total of 134 lives (all children) were estimated to have been saved due to the EMRI interventions during the 18-month intervention in 30 health centers and their catchment areas, with an estimated additional 852 lives (820 children and 2 adults) saved during the 5-year post-EMRI period. For the 18-month intervention period, EMRI cost $37,313 per life saved ($42,366 per life if evaluation costs are included). Calculated over the 18-month intervention plus 5 years post-intervention, EMRI cost $5,875 per life saved ($6,671 per life if evaluation costs are included). The cost effectiveness of EMRI improves substantially if the performance achieved during the 18 months of the EMRI intervention is sustained for 5 years. Scaling up EMRI to operate for 5 years across the 4 major regions of Ethiopia could save as many as 34,908 lives. Significance A systems-based approach to improving primary care in low-income settings can have transformational impact on lives saved and be cost-effective. PMID:24260307

Alabama Energy and Cost Savings for New Single- and Multifamily Homes: 2009 and 2012 IECC as Compared to the 2006 IECC

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-06-15

The 2009 and 2012 International Energy Conservation Codes (IECC) yield positive benefits for Alabama homeowners. Moving to either the 2009 or 2012 IECC from the 2006 IECC is cost effective over a 30-year life cycle. On average, Alabama homeowners will save $2,117 over 30 years under the 2009 IECC, with savings still higher at $6,182 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 2 years for both the 2009 and 2012 IECC. Average annual energy savings aremore » $168 for the 2009 IECC and $462 for the 2012 IECC.« less

Minimum savings requirements in shared savings provider payment.

PubMed

Pope, Gregory C; Kautter, John

2012-11-01

Payer (insurer) sharing of savings is a way of motivating providers of medical services to reduce cost growth. A Medicare shared savings program is established for accountable care organizations in the 2010 Patient Protection and Affordable Care Act. However, savings created by providers cannot be distinguished from the normal (random) variation in medical claims costs, setting up a classic principal-agent problem. To lessen the likelihood of paying undeserved bonuses, payers may pay bonuses only if observed savings exceed minimum levels. We study the trade-off between two types of errors in setting minimum savings requirements: paying bonuses when providers do not create savings and not paying bonuses when providers create savings. Copyright © 2011 John Wiley & Sons, Ltd.

Looking at IT through a New Lens: Achieving Cost Savings in a Fiscally Challenging Time

ERIC Educational Resources Information Center

Claffey, George F., Jr.

2009-01-01

Information technology (IT) departments must cut costs and justify expenditures in the face of shrinking budgets. To promote greater cost savings, it is important to look at IT through a new "lens." This article discusses four broad categories that can be evaluated to determine if IT resource alignment is appropriate and if savings can…

Screening HIV-Infected Patients with Low CD4 Counts for Cryptococcal Antigenemia prior to Initiation of Antiretroviral Therapy: Cost Effectiveness of Alternative Screening Strategies in South Africa.

PubMed

Larson, Bruce A; Rockers, Peter C; Bonawitz, Rachael; Sriruttan, Charlotte; Glencross, Deborah K; Cassim, Naseem; Coetzee, Lindi M; Greene, Gregory S; Chiller, Tom M; Vallabhaneni, Snigdha; Long, Lawrence; van Rensburg, Craig; Govender, Nelesh P

2016-01-01

In 2015 South Africa established a national cryptococcal antigenemia (CrAg) screening policy targeted at HIV-infected patients with CD4+ T-lymphocyte (CD4) counts <100 cells/ μl who are not yet on antiretroviral treatment (ART). Two screening strategies are included in national guidelines: reflex screening, where a CrAg test is performed on remnant blood samples from CD4 testing; and provider-initiated screening, where providers order a CrAg test after a patient returns for CD4 test results. The objective of this study was to compare costs and effectiveness of these two screening strategies. We developed a decision analytic model to compare reflex and provider-initiated screening in terms of programmatic and health outcomes (number screened, number identified for preemptive treatment, lives saved, and discounted years of life saved) and screening and treatment costs (2015 USD). We estimated a base case with prevalence and other parameters based on data collected during CrAg screening pilot projects integrated into routine HIV care in Gauteng, Free State, and Western Cape Provinces. We conducted sensitivity analyses to explore how results change with underlying parameter assumptions. In the base case, for each 100,000 CD4 tests, the reflex strategy compared to the provider-initiated strategy has higher screening costs ($37,536 higher) but lower treatment costs ($55,165 lower), so overall costs of screening and treatment are $17,629 less with the reflex strategy. The reflex strategy saves more lives (30 lives, 647 additional years of life saved). Sensitivity analyses suggest that reflex screening dominates provider-initiated screening (lower total costs and more lives saved) or saves additional lives for small additional costs (< $125 per life year) across a wide range of conditions (CrAg prevalence, patient and provider behavior, patient survival without treatment, and effectiveness of preemptive fluconazole treatment). In countries with substantial numbers of people with untreated, advanced HIV disease such as South Africa, CrAg screening before initiation of ART has the potential to reduce cryptococcal meningitis and save lives. Reflex screening compared to provider-initiated screening saves more lives and is likely to be cost saving or have low additional costs per additional year of life saved.

Screening HIV-Infected Patients with Low CD4 Counts for Cryptococcal Antigenemia prior to Initiation of Antiretroviral Therapy: Cost Effectiveness of Alternative Screening Strategies in South Africa

PubMed Central

Rockers, Peter C.; Bonawitz, Rachael; Sriruttan, Charlotte; Glencross, Deborah K.; Cassim, Naseem; Coetzee, Lindi M.; Greene, Gregory S.; Chiller, Tom M.; Vallabhaneni, Snigdha; Long, Lawrence; van Rensburg, Craig; Govender, Nelesh P.

2016-01-01

Background In 2015 South Africa established a national cryptococcal antigenemia (CrAg) screening policy targeted at HIV-infected patients with CD4+ T-lymphocyte (CD4) counts <100 cells/ μl who are not yet on antiretroviral treatment (ART). Two screening strategies are included in national guidelines: reflex screening, where a CrAg test is performed on remnant blood samples from CD4 testing; and provider-initiated screening, where providers order a CrAg test after a patient returns for CD4 test results. The objective of this study was to compare costs and effectiveness of these two screening strategies. Methods We developed a decision analytic model to compare reflex and provider-initiated screening in terms of programmatic and health outcomes (number screened, number identified for preemptive treatment, lives saved, and discounted years of life saved) and screening and treatment costs (2015 USD). We estimated a base case with prevalence and other parameters based on data collected during CrAg screening pilot projects integrated into routine HIV care in Gauteng, Free State, and Western Cape Provinces. We conducted sensitivity analyses to explore how results change with underlying parameter assumptions. Results In the base case, for each 100,000 CD4 tests, the reflex strategy compared to the provider-initiated strategy has higher screening costs ($37,536 higher) but lower treatment costs ($55,165 lower), so overall costs of screening and treatment are $17,629 less with the reflex strategy. The reflex strategy saves more lives (30 lives, 647 additional years of life saved). Sensitivity analyses suggest that reflex screening dominates provider-initiated screening (lower total costs and more lives saved) or saves additional lives for small additional costs (< $125 per life year) across a wide range of conditions (CrAg prevalence, patient and provider behavior, patient survival without treatment, and effectiveness of preemptive fluconazole treatment). Conclusions In countries with substantial numbers of people with untreated, advanced HIV disease such as South Africa, CrAg screening before initiation of ART has the potential to reduce cryptococcal meningitis and save lives. Reflex screening compared to provider-initiated screening saves more lives and is likely to be cost saving or have low additional costs per additional year of life saved. PMID:27390864

City-scale analysis of water-related energy identifies more cost-effective solutions.

PubMed

Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

2017-02-01

Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This would create opportunities where the same capital investment could achieve far greater energy savings and greenhouse gas emissions abatement. Copyright © 2016 Elsevier Ltd. All rights reserved.

A generic model for evaluating payor net cost savings from a disease management program.

PubMed

McKay, Niccie L

2006-01-01

Private and public payors increasingly are turning to disease management programs as a means of improving the quality of care provided and controlling expenditures for individuals with specific medical conditions. This article presents a generic model that can be adapted to evaluate payor net cost savings from a variety of types of disease management programs, with net cost savings taking into account both changes in expenditures resulting from the program and the costs of setting up and operating the program. The model specifies the required data, describes the data collection process, and shows how to calculate the net cost savings in a spreadsheet format. An accompanying hypothetical example illustrates how to use the model.

Material costs of anterior cruciate ligament reconstruction with hamstring tendons by two different techniques.

PubMed

Cournapeau, J; Klouche, S; Hardy, P

2013-04-01

In France, approximately 36,000 anterior cruciate ligament (ACL) reconstruction surgical procedures are performed every year. Technical progress, in particular arthroscopy, has made surgery more precise, but more expensive. In a context of healthcare cost containment, the increase in the cost of technology must be compared to the improved outcome for the patients. The main aim of this study was to determine all material costs related to ACL reconstruction using hamstring tendons. This study also compared the material costs between the two arthroscopic techniques: standard or "all-inside". A retrospective study of material costs was performed in 2011. With the standard technique, the tibial tunnel was drilled from outside to inside, while with the all-inside technique two tunnels were drilled from inside to outside. All of the material used from the first swab to the final bandage was reported. It was classified into three categories: reusable arthroscopy material, disposable arthroscopic material, and disposable surgical supplies. The costs were those of our supplier in 2011 (Arthrex™) and based on Public Hospitals of Paris (AP-HP) public contract tariffs. Standard ligament reconstruction was less expensive than the all-inside technique: 791.59€ versus 931.06€ excluding taxes (hors taxes [HT]), respectively. The largest percentage of expenses was allocated to disposable material use (81 and 84%). Possible avenues of savings are limited: all the material used was necessary. To control costs, correct use and good maintenance of instruments are the most important elements. Level IV. Economic and decision analyses, retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: an analysis for Austria.

PubMed

Gruber, R; Walter, E; Helbich, T H

2010-06-01

To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Overall cost savings for US-guided LCBB over OSB were euro 977 (euro 2,337/euro 3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were euro 1,542 (euro 2,600/euro 4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be euro 18.5 million. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S.

PubMed

Grosse, Scott D; Berry, Robert J; Mick Tilford, J; Kucik, James E; Waitzman, Norman J

2016-05-01

Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997-1998. Estimates of annual numbers of live-born spina bifida cases in 1995-1996 relative to 1999-2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. Published by Elsevier Inc.

A green salt-leaching technique to produce sericin/PVA/glycerin scaffolds with distinguished characteristics for wound-dressing applications.

PubMed

Aramwit, Pornanong; Ratanavaraporn, Juthamas; Ekgasit, Sanong; Tongsakul, Duangta; Bang, Nipaporn

2015-05-01

Sericin/PVA/glycerin scaffolds could be fabricated using the freeze-drying technique; they showed good physical and biological properties and can be applied as wound dressings. However, freeze-drying is an energy- and time-consuming process with a high associated cost. In this study, an alternative, solvent-free, energy- and time-saving, low-cost salt-leaching technique is introduced as a green technology to produce sericin/PVA/glycerin scaffolds. We found that sericin/PVA/glycerin scaffolds were successfully fabricated without any crosslinking using a salt-leaching technique. The salt-leached sericin/PVA/glycerin scaffolds had a porous structure with pore interconnectivity. The sericin in the salt-leached scaffolds had a crystallinity that was as high as that of the freeze-dried scaffolds. Compared to the freeze-dried scaffolds with the same composition, the salt-leached sericin/PVA/glycerin scaffolds has larger pores, a lower Young's modulus, and faster rates of biodegradation and sericin release. When cultured with L929 mouse fibroblast cells, a higher number of cells were found in the salt-leached scaffolds. Furthermore, the salt-leached scaffolds were less adhesive to the wound, which would reduce pain upon removal. Therefore, salt-leached sericin/PVA/glycerin scaffolds with distinguished characteristics were introduced as another choice of wound dressing, and their production process was simpler, more energy efficient, and saved time and money compared to the freeze-dried scaffolds. © 2014 Wiley Periodicals, Inc.

Partnership working between the Fire Service and NHS: delivering a cost-saving service to improve the safety of high-risk people.

PubMed

Craig, Joyce A; Creegan, Shelagh; Tait, Martin; Dolan, Donna

2015-04-14

The Scottish Fire and Rescue Service and NHS Tayside piloted partnership working. A Community Fire Safety Link Worker provided Risk Assessments to adults, identified by community health teams, at high risk of fires, with the aim of reducing fires. An existing evaluation shows the Service developed a culture of 'high trust' between partners and had high client satisfaction. This paper reports on an economic evaluation of the costs and benefits of the Link Worker role. An economic evaluation of the costs and benefits of the Link Worker role was undertaken. Changes in the Risk Assessment score following delivery of the Service were used to estimate the potential fires avoided. These were valued using a national cost of a fire. The estimated cost of delivering the Service was deducted from these savings. The pilot was estimated to save 4.4 fires, equivalent to £286 per client. The estimated cost of delivering the Service was £55 per client, giving net savings of £231 per client. The pilot was cost-saving under all scenarios, with results sensitive to the probability of a fire. We believe this is the first evaluation of Fire Safety Risk Assessments. Partnership working, delivering joint Risk Assessments in the homes of people at high risk of fire, is modelled to be cost saving. Uncertainties in data and small sample are key limitations. Further research is required into the ex ante risk of fire by risk category. Despite these limitations, potential savings identified in this study supports greater adoption of this partnership initiative.

Regional cost and experience, not size or hospital inclusion, helps predict ACO success.

PubMed

Schulz, John; DeCamp, Matthew; Berkowitz, Scott A

2017-06-01

The Medicare Shared Savings Program (MSSP) continues to expand and now includes 434 accountable care organizations (ACOs) serving more than 7 million beneficiaries. During 2014, 86 of these ACOs earned over $300 million in shared savings payments by promoting higher-quality patient care at a lower cost.Whether organizational characteristics, regional cost of care, or experience in the MSSP are associated with the ability to achieve shared savings remains uncertain.Using financial results from 2013 and 2014, we examined all 339 MSSP ACOs with a 2012, 2013, or 2014 start-date. We used a cross-sectional analysis to examine all ACOs and used a multivariate logistic model to predict probability of achieving shared savings.Experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs: ACOs in high cost regions were more likely to earn savings. In the multivariate model, the number of ACO beneficiaries, inclusion of a hospital or involvement of an academic medical center, was not associated with likelihood of earning shared savings, after accounting for regional baseline cost variation.These results suggest ACOs are learning and improving from their experience. Additionally, the results highlight regional differences in ACO success and the strong association with variation in regional per capita costs, which can inform CMS policy to help promote ACO success nationwide.

Preliminary engineering analysis for clothes washers

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

Biermayer, Peter J.

1996-10-01

The Engineering Analysis provides information on efficiencies, manufacturer costs, and other characteristics of the appliance class being analyzed. For clothes washers, there are two classes: standard and compact. Since data were not available to analyze the compact class, only clothes washers were analyzed in this report. For this analysis, individual design options were combined and ordered in a manner that resulted in the lowest cumulative cost/savings ratio. The cost/savings ratio is the increase in manufacturer cost for a design option divided by the reduction in operating costs due to fuel and water savings.

Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

PubMed

Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul

2018-01-01

The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Life-cycle costing. 435.8 Section 435.8 Energy DEPARTMENT...-cycle costing. Each Federal agency shall determine life-cycle cost-effectiveness by using the procedures..., including lower life-cycle costs, positive net savings, savings-to-investment ratio that is estimated to be...

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Life-cycle costing. 435.8 Section 435.8 Energy DEPARTMENT...-cycle costing. Each Federal agency shall determine life-cycle cost-effectiveness by using the procedures..., including lower life-cycle costs, positive net savings, savings-to-investment ratio that is estimated to be...

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Life-cycle costing. 435.8 Section 435.8 Energy DEPARTMENT...-cycle costing. Each Federal agency shall determine life-cycle cost-effectiveness by using the procedures..., including lower life-cycle costs, positive net savings, savings-to-investment ratio that is estimated to be...

The integration of manual and automatic image analysis techniques with supporting ground data in a multistage sampling framework for timber resource inventories: Three examples

NASA Technical Reports Server (NTRS)

Gialdini, M.; Titus, S. J.; Nichols, J. D.; Thomas, R.

1975-01-01

An approach to information acquisition is discussed in the context of meeting user-specified needs in a cost-effective, timely manner through the use of remote sensing data, ground data, and multistage sampling techniques. The roles of both LANDSAT imagery and Skylab photography are discussed as first stages of three separate multistage timber inventory systems and results are given for each system. Emphasis is placed on accuracy and meeting user needs.

Impact of stereotactic 11-g vacuum-assisted breast biopsy on cost of diagnosis in Austria.

PubMed

Gruber, R; Walter, E; Helbich, T H

2011-01-01

To determine the frequency with which stereotactic 11-g vacuum-assisted breast biopsy (11-g SVAB) obviates an open surgical biopsy (OSB), to compare the costs of these two biopsy methods, and to estimate the potential cost savings attributable to 11-g SVAB in the diagnosis of suspicious breast lesions in patients in Austria. We retrospectively reviewed 318 consecutive breast lesions of BI-RADS categories IV and V (microcalcifications n=166; masses n=152) on which 11-g SVAB and OSB were performed. Cost savings were calculated using nationally allowed flat rates and patient charges. Costs were measured from a hospital and a socioeconomic perspective. Common clinical scenarios and sensitivity analyses assessed the extent of achievable cost savings. 11-g SVAB obviated the need for an OSB in 93 (29%) of 318 women. Overall cost savings per 11-g SVAB over OSB were € 242 per case from a hospital perspective, and € 422 per case from a socioeconomic perspective. The use of 11-g SVAB decreased the cost of diagnosis by 7% from a hospital perspective, and by 10% from a socioeconomic perspective. In Austria, annual national savings of over 5 million Euro could be realized with the use of 11-g SVAB for the diagnosis of suspicious breast lesions. Although savings per case are modest, the national health care system realizes significant cost reduction as women benefit from a faster and less invasive approach to diagnosis. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Autonomous Aerobraking Development Software: Phase 2 Summary

NASA Technical Reports Server (NTRS)

Cianciolo, Alicia D.; Maddock, Robert W.; Prince, Jill L.; Bowes, Angela; Powell, Richard W.; White, Joseph P.; Tolson, Robert; O'Shaughnessy, Daniel; Carrelli, David

2013-01-01

NASA has used aerobraking at Mars and Venus to reduce the fuel required to deliver a spacecraft into a desired orbit compared to an all-propulsive solution. Although aerobraking reduces the propellant, it does so at the expense of mission duration, large staff, and DSN coverage. These factors make aerobraking a significant cost element in the mission design. By moving on-board the current ground-based tasks of ephemeris determination, atmospheric density estimation, and maneuver sizing and execution, a flight project would realize significant cost savings. The NASA Engineering and Safety Center (NESC) sponsored Phase 1 and 2 of the Autonomous Aerobraking Development Software (AADS) study, which demonstrated the initial feasibility of moving these current ground-based functions to the spacecraft. This paper highlights key state-of-the-art advancements made in the Phase 2 effort to verify that the AADS algorithms are accurate, robust and ready to be considered for application on future missions that utilize aerobraking. The advancements discussed herein include both model updates and simulation and benchmark testing. Rigorous testing using observed flight atmospheres, operational environments and statistical analysis characterized the AADS operability in a perturbed environment.

Ultrasonic flowmeters offer oil line leak-detection potential

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

Hettrich, U.

1995-04-01

Ultrasonic flowmeters (USFM) installed on Transalpine Pipeline Co.`s (TAL) crude-oil system have proven to be a cost-effective flow measurement technique and beneficial in batch identification and leak detection. Through close examination, TAL has determined that clamp-on USFMs offer cost-saving advantages in installation, maintenance and operation. USFMs do not disturb pig passage. The technique also provides sound velocity capabilities, which can be used for liquid identification and batch tracking. The instruments have a repeatability of better than 0.25% and achieve an accuracy of better than 1%, depending on the flow profiles predictability. Using USFMs with multiple beams probably will improve accuracymore » further and it should be possible to find leaks even smaller than 1% of flow.« less

New protocol for construction of eyeglasses-supported provisional nasal prosthesis using CAD/CAM techniques.

PubMed

Ciocca, Leonardo; Fantini, Massimiliano; De Crescenzio, Francesca; Persiani, Franco; Scotti, Roberto

2010-01-01

A new protocol for making an immediate provisional eyeglasses-supported nasal prosthesis is presented that uses laser scanning, computer-aided design/computer-aided manufacturing procedures, and rapid prototyping techniques, reducing time and costs while increasing the quality of the final product. With this protocol, the eyeglasses were digitized, and the relative position of the nasal prosthesis was planned and evaluated in a virtual environment without any try-in appointment. This innovative method saves time, reduces costs, and restores the patient's aesthetic appearance after a disfiguration caused by ablation of the nasal pyramid better than conventional restoration methods. Moreover, the digital model of the designed nasal epithesis can be used to develop a definitive prosthesis anchored to osseointegrated craniofacial implants.

Preventive eye care in people with diabetes is cost-saving to the federal government. Implications for health-care reform.

PubMed

Javitt, J C; Aiello, L P; Chiang, Y; Ferris, F L; Canner, J K; Greenfield, S

1994-08-01

Diabetic retinopathy, which leads to macular edema and retinal neovascularization, is the leading cause of blindness among working-age Americans. Previous research has demonstrated significant cost savings associated with detection of eye disease in Americans with type I diabetes. However, detection and treatment of eye disease among those with type II diabetes was previously thought not to be cost-saving. Our purpose was to estimate the current and potential federal savings resulting from the screening and treatment of retinopathy in patients with type II diabetes, based on recently available data concerning efficacy of treating both macular edema and neovascularization along with new data on federal budgetary costs of blindness. We used computer modeling, incorporating data from population-based epidemiological studies and multicenter clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings. Screening and treatment for eye disease in patients with type II diabetes generates annual savings of $247.9 million to the federal budget and 53,986 person-years of sight, even at current suboptimal (60%) levels of care. If all patients with type II diabetes receive recommended care, the predicted net savings (discounted at 5%) exceeds $472.1 million and 94,304 person-years of sight. Nearly all savings are associated with detection and treatment of diabetic macular edema. Enrolling each additional person with type II diabetes into currently recommended ophthalmological care results in an average net savings of $975/person, even if all costs of care are borne by the federal government. Our analysis indicates that prevention programs aimed at improving eye care for patients with diabetes not only reduce needless vision loss but also will provide a financial return on the investment of public funds.

Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs.

PubMed

Newman-Casey, Paula Anne; Woodward, Maria A; Niziol, Leslie M; Lee, Paul P; De Lott, Lindsey B

2018-03-01

To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. Retrospective cross-sectional study. Eye care providers prescribing medications through Medicare Part D in 2013. Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). Total cost of brand and generic medications prescribed by eye care providers. Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P < 0.001; 79% vs. 56% by total cost, P < 0.001). The total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). Eye care providers prescribe more brand medications by volume than any other provider group. Efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions. Policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

From Science to Finance-A Tool for Deriving Economic Implications from the Results of Dietary Supplement Clinical Studies.

PubMed

Shanahan, Christopher J; de Lorimier, Robert

2016-01-01

This article examines evidence showing that the use of key dietary supplements can reduce overall disease treatment-related hospital utilization costs associated with coronary heart disease (CHD) in the United States among those at a high risk of experiencing a costly, disease-related event. Results show that the potential avoided hospital utilization costs related to the use of omega-3 supplements at preventive intake levels among the target population can be as much as $2.06 billion on average per year from 2013 to 2020. The potential net savings in avoided CHD-related hospital utilization costs after accounting for the cost of omega-3 dietary supplements at preventive daily intake levels would be more than $3.88 billion in cumulative health care cost savings from 2013 to 2020. Furthermore, the use of folic acid, B6, and B12 among the target population at preventive intake levels could yield avoided CHD-related hospital utilization costs savings of an average savings of $1.52 billion per year from 2013 to 2020. The potential net savings in avoided CHD-related health care costs after accounting for the cost of folic acid, B6, and B12 utilization at preventive daily intake levels would be more than $5.23 billion in cumulative health care cost net savings during the same period. Thus, targeted dietary supplement regimens are recommended as a means to help control rising societal health care costs, and as a means for high-risk individuals to minimize the chance of having to deal with potentially costly events and to invest in increased quality of life.

Intelligent unmanned vehicle systems suitable for individual or cooperative missions

NASA Astrophysics Data System (ADS)

Anderson, Matthew O.; McKay, Mark D.; Wadsworth, Derek C.

2007-04-01

The Department of Energy's Idaho National Laboratory (INL) has been researching autonomous unmanned vehicle systems for over fifteen years. Areas of research have included unmanned ground and aerial vehicles used for hazardous and remote operations as well as teamed together for advanced payloads and mission execution. Areas of application include aerial particulate sampling, cooperative remote radiological sampling, and persistent surveillance including real-time mosaic and geo-referenced imagery in addition to high-resolution still imagery. Both fixed-wing and rotary airframes are used possessing capabilities spanning remote control to fully autonomous operation. Patented INL-developed auto steering technology is taken advantage of to provide autonomous parallel path swathing with either manned or unmanned ground vehicles. Aerial look-ahead imagery is utilized to provide a common operating picture for the ground and air vehicles during cooperative missions. This paper will discuss the various robotic vehicles, including sensor integration, used to achieve these missions and anticipated cost and labor savings.

Minnesota Energy and Cost Savings for New Single- and Multifamily Homes: 2009 and 2012 IECC as Compared to the Minnesota Residential Energy Code

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-04-01

The 2009 and 2012 International Energy Conservation Codes (IECC) yield positive benefits for Minnesota homeowners. Moving to either the 2009 or 2012 IECC from the current Minnesota Residential Energy Code is cost effective over a 30-year life cycle. On average, Minnesota homeowners will save $1,277 over 30 years under the 2009 IECC, with savings still higher at $9,873 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceed cumulative cash outlays) in 3 years for the 2009 IECC and 1 year for themore » 2012 IECC. Average annual energy savings are $122 for the 2009 IECC and $669 for the 2012 IECC.« less

Arizona Energy and Cost Savings for New Single- and Multifamily Homes: 2009 and 2012 IECC as Compared to the 2006 IECC

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-04-01

The 2009 and 2012 International Energy Conservation Codes (IECC) yield positive benefits for Arizona homeowners. Moving to either the 2009 or 2012 IECC from the 2006 IECC is cost-effective over a 30-year life cycle. On average, Arizona homeowners will save $3,245 over 30 years under the 2009 IECC, with savings still higher at $6,550 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 1 year for the 2009 and 2 years with the 2012 IECC. Average annual energymore » savings are $231 for the 2009 IECC and $486 for the 2012 IECC.« less

Wisconsin Energy and Cost Savings for New Single- and Multifamily Homes: 2009 and 2012 IECC as Compared to the Wisconsin Uniform Dwelling Code

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

Lucas, Robert G.; Taylor, Zachary T.; Mendon, Vrushali V.

2012-04-01

The 2009 and 2012 International Energy Conservation Codes (IECC) yield positive benefits for Wisconsin homeowners. Moving to either the 2009 or 2012 IECC from the current Wisconsin state code is cost effective over a 30-year life cycle. On average, Wisconsin homeowners will save $2,484 over 30 years under the 2009 IECC, with savings still higher at $10,733 with the 2012 IECC. After accounting for upfront costs and additional costs financed in the mortgage, homeowners should see net positive cash flows (i.e., cumulative savings exceeding cumulative cash outlays) in 1 year for both the 2009 and 2012 IECC. Average annual energymore » savings are $149 for the 2009 IECC and $672 for the 2012 IECC.« less

Innovations in cost management.

PubMed

Daly, Rich

2014-03-01

To better understand true costs and use this knowledge to drive savings, health systems are: finding ways to combine clinical and financial data to identify clinical care savings, including equipment not just care variation when researching clinical cost drivers, benchmarking to identify both relatively high-cost areas and lower-cost approaches, including nonclinical support areas when looking for systemwide cost drivers.

Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative

PubMed Central

Everett, Beverly; McGinnis, Matthew; Beresky, Amy; Cane, Rudolph C.; Cooper, Tasha; Davda, Rajesh K.; Farmer, Donna; John, Stella M.; Sollars, Denise L.; Rausch, John F.

2017-01-01

Purpose of Study: Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5. Primary Practice Settings: A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012. Methodology and Sample: Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences. Results: As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs. Implications for Case Management Practice: The observed 12% increased rate of creation of AV fistulas and $199 (6%) decrease in PMPM cost between the intervention and control groups corresponded to a savings of more than $18 million in 2015 U.S. dollars (USD). On the basis of observation of substantial improvements in outcomes and cost savings, health plan administrators could better serve those at highest risk of progression by implementing focused case management. Our findings support the value of care coordination between nephrologists, providers, and health plan case managers in improving outcomes and reducing total medical costs among beneficiaries at risk for CKD progression from Stage 4 to Stage 5. PMID:28902768

Economic Evaluation of Telemedicine for Patients in ICUs.

PubMed

Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P

2016-02-01

Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on break-even analyses. Our analyses suggest that telemedicine in the ICU is cost-effective in most cases and cost saving in some cases. The thresholds of cost and effectiveness, estimated by break-even analyses, help hospitals determine the impact of telemedicine in the ICU and potential cost saving.

National and State Cost Savings Associated With Prohibiting Smoking in Subsidized and Public Housing in the United States

PubMed Central

Peck, Richard M.; Babb, Stephen D.

2014-01-01

Introduction Despite progress in implementing smoke-free laws in indoor public places and workplaces, millions of Americans remain exposed to secondhand smoke at home. The nation’s 80 million multiunit housing residents, including the nearly 7 million who live in subsidized or public housing, are especially susceptible to secondhand smoke infiltration between units. Methods We calculated national and state costs that could have been averted in 2012 if smoking were prohibited in all US subsidized housing, including public housing: 1) secondhand smoke-related direct health care, 2) renovation of smoking-permitted units; and 3) smoking-attributable fires. Annual cost savings were calculated by using residency estimates from the Department of Housing and Urban Development and cost data reported elsewhere. Data were adjusted for inflation and variations in state costs. National and state estimates (excluding Alaska and the District of Columbia) were calculated by cost type. Results Prohibiting smoking in subsidized housing would yield annual cost savings of $496.82 million (range, $258.96–$843.50 million), including $310.48 million ($154.14–$552.34 million) in secondhand smoke-related health care, $133.77 million ($75.24–$209.01 million) in renovation expenses, and $52.57 million ($29.57–$82.15 million) in smoking-attributable fire losses. By state, cost savings ranged from $0.58 million ($0.31–$0.94 million) in Wyoming to $124.68 million ($63.45–$216.71 million) in New York. Prohibiting smoking in public housing alone would yield cost savings of $152.91 million ($79.81–$259.28 million); by state, total cost savings ranged from $0.13 million ($0.07–$0.22 million) in Wyoming to $57.77 million ($29.41–$100.36 million) in New York. Conclusion Prohibiting smoking in all US subsidized housing, including public housing, would protect health and could generate substantial societal cost savings. PMID:25275808

National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States.

PubMed

King, Brian A; Peck, Richard M; Babb, Stephen D

2014-10-02

Despite progress in implementing smoke-free laws in indoor public places and workplaces, millions of Americans remain exposed to secondhand smoke at home. The nation's 80 million multiunit housing residents, including the nearly 7 million who live in subsidized or public housing, are especially susceptible to secondhand smoke infiltration between units. We calculated national and state costs that could have been averted in 2012 if smoking were prohibited in all US subsidized housing, including public housing: 1) secondhand smoke-related direct health care, 2) renovation of smoking-permitted units; and 3) smoking-attributable fires. Annual cost savings were calculated by using residency estimates from the Department of Housing and Urban Development and cost data reported elsewhere. Data were adjusted for inflation and variations in state costs. National and state estimates (excluding Alaska and the District of Columbia) were calculated by cost type. Prohibiting smoking in subsidized housing would yield annual cost savings of $496.82 million (range, $258.96-$843.50 million), including $310.48 million ($154.14-$552.34 million) in secondhand smoke-related health care, $133.77 million ($75.24-$209.01 million) in renovation expenses, and $52.57 million ($29.57-$82.15 million) in smoking-attributable fire losses. By state, cost savings ranged from $0.58 million ($0.31-$0.94 million) in Wyoming to $124.68 million ($63.45-$216.71 million) in New York. Prohibiting smoking in public housing alone would yield cost savings of $152.91 million ($79.81-$259.28 million); by state, total cost savings ranged from $0.13 million ($0.07-$0.22 million) in Wyoming to $57.77 million ($29.41-$100.36 million) in New York. Prohibiting smoking in all US subsidized housing, including public housing, would protect health and could generate substantial societal cost savings.

A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy.

PubMed

Menzin, Joseph; Lines, Lisa M; Weiner, Daniel E; Neumann, Peter J; Nichols, Christine; Rodriguez, Lauren; Agodoa, Irene; Mayne, Tracy

2011-10-01

Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money. For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1-4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories. A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 1-4 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively). There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.

The High Cost of Saving Energy Dollars.

ERIC Educational Resources Information Center

Rose, Patricia

1985-01-01

In alternative financing a private company provides the capital and expertise for improving school energy efficiency. Savings are split between the school system and the company. Options for municipal leasing, cost sharing, and shared savings are explained along with financial, procedural, and legal considerations. (MLF)

Do hospital mergers reduce costs?

PubMed

Schmitt, Matt

2017-03-01

Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD): MaineCare (Medicaid) Cost Savings

PubMed Central

Towey, Michael P.

2012-01-01

This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice. The study suggests that without access to speech therapy telepractice for patients with VCD, the medical costs to MaineCare will be ongoing and significant. PMID:25945195

Shortwave Radiation

NASA Technical Reports Server (NTRS)

Klassen, Steve; Bugbee, Bruce

2005-01-01

Accurate shortwave radiation data is critical to evapotranspiration (ET) models used for developing irrigation schedules to optimize crop production while saving water, minimizing fertilizer, herbicide, and pesticide applications, reducing soil erosion, and protecting surface and ground water quality. Low cost silicon cell pyranometers have proven to be sufficiently accurate and robust for widespread use in agricultural applications under unobstructed daylight conditions. More expensive thermopile pyranometers are required for use as calibration standards and measurements under light with unique spectral properties (electric lights, under vegetation, in greenhouses and growth chambers). Routine cleaning, leveling, and annual calibration checks will help to ensure the integrity of long-term data.

Cogeneration Technology Alternatives Study (CTAS). Volume 2: Analytical approach

NASA Technical Reports Server (NTRS)

Gerlaugh, H. E.; Hall, E. W.; Brown, D. H.; Priestley, R. R.; Knightly, W. F.

1980-01-01

The use of various advanced energy conversion systems were compared with each other and with current technology systems for their savings in fuel energy, costs, and emissions in individual plants and on a national level. The ground rules established by NASA and assumptions made by the General Electric Company in performing this cogeneration technology alternatives study are presented. The analytical methodology employed is described in detail and is illustrated with numerical examples together with a description of the computer program used in calculating over 7000 energy conversion system-industrial process applications. For Vol. 1, see 80N24797.

Air transportation energy consumption - Yesterday, today, and tomorrow

NASA Technical Reports Server (NTRS)

Mascy, A. C.; Williams, L. J.

1975-01-01

The energy consumption by aviation is reviewed and projections of its growth are discussed. Forecasts of domestic passenger demand are presented, and the effect of restricted fuel supply and increased fuel prices is considered. The most promising sources for aircraft fuels, their availability and cost, and possible alternative fuels are reviewed. The energy consumption by various air and surface transportation modes is identified and compared on typical portal-to-portal trips. A measure of the indirect energy consumed by ground and air modes is defined. Historical trends in aircraft energy intensities are presented and the potential fuel savings with new technologies are discussed.

Linking and Combining Distributed Operations Facilities using NASA's "GMSEC" Systems Architectures

NASA Technical Reports Server (NTRS)

Smith, Danford; Grubb, Thomas; Esper, Jaime

2008-01-01

NASA's Goddard Mission Services Evolution Center (GMSEC) ground system architecture has been in development since late 2001, has successfully supported eight orbiting satellites and is being applied to many of NASA's future missions. GMSEC can be considered an event-driven service-oriented architecture built around a publish/subscribe message bus middleware. This paper briefly discusses the GMSEC technical approaches which have led to significant cost savings and risk reduction for NASA missions operated at the Goddard Space Flight Center (GSFC). The paper then focuses on the development and operational impacts of extending the architecture across multiple mission operations facilities.

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan.

PubMed

Ou, Huang-Tz; Chen, Yen-Ting; Liu, Ya-Ming; Wu, Jin-Shang

2016-06-01

To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. We utilized Taiwan's National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan's population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin-pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin-rosiglitazone. When CVD is considered an important clinical outcome, Metformin-pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

David Grant Medical Center energy use baseline and integrated resource assessment

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

Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

1993-04-01

The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program`s (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROsmore » that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O&M) savings.« less

David Grant Medical Center energy use baseline and integrated resource assessment

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

Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

1993-04-01

The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program's (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROsmore » that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O M) savings.« less

Multiple Drug Cost Containment Policies in Michigan’s Medicaid Program Saved Money Overall, Although Some Increased Costs

PubMed Central

Kibicho, Jennifer; Pinkerton, Steven D.

2014-01-01

Michigan’s Medicaid program implemented four policies (preferred lists, joint and multi-state purchasing arrangements, and maximum allowable cost) in 2002–2004 for its dual-eligible Medicaid and Medicare beneficiaries, taking antihypertensives and antihyperlipidemics prescriptions. We used interrupted time series analysis to evaluate the impact of each individual policy while holding the effect of all other policies constant. Preferred lists increased preferred and generic market share, and reduced daily cost. In contrast, maximum allowable cost increased daily cost, and is the only policy that did not generate cost savings. The joint and multi-state arrangements did not impact daily cost. Despite policy tradeoffs, the cumulative effect was a 10% decrease in daily cost and an annualized cost savings of $46,195. PMID:22492899

The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

PubMed

Obiero, Walter; Young, Marisa R; Bailey, Robert C

2013-01-01

Male circumcision (MC) reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC) method. The PrePex male circumcision (PMC) method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method. Data were obtained from the Nyanza Reproductive Health Society (NRHS), an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars. Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively. The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

The costs and service implications of substituting intermediate care for acute hospital care.

PubMed

Mayhew, Leslie; Lawrence, David

2006-05-01

Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis.

PubMed

Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne

2018-01-02

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.

Geothermal as a heat sink application for raising air conditioning efficency

NASA Astrophysics Data System (ADS)

Ibrahim, Hesham Safwat Osman Mohamed

2016-04-01

Objective: Geothermal applications in heating, ventilation, air-conditioning is a US technology for more than 30 years old ,which saves more than 30% average energy cost than the traditional air-conditioning systems systems. Applying this technology in Middle East and African countries would be very feasible specially in Egypt specially as it suffers Electric crisis --The temperature of the condensers and the heat rejecting equipment is much higher than the Egyptian land at different depth which is a great advantages, and must be measured, recorded, and studied accurately -The Far goal of the proposal is to construct from soil analysis a temperature gradient map for Egypt and , African countries on different depth till 100 m which is still unclear nowadays and must be measured and recorded in databases through researches - The main model of the research is to study the heat transfer gradient through the ground earth borehole,grout,high density polyethylene pipes , and water inlet temperature which affect the electric efficiency of the ground source heat pump air conditioning unit Impact on the Region: Such research result will contribute widely in Energy saving sector specially the air conditioning sector in Egypt and the African countries which consumes more than 30% of the electric consumption of the total consumption . and encouraging Green systems such Geothermal to be applied

Saving Energy. Managing School Facilities, Guide 3.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England). Architects and Building Branch.

This guide offers information on how schools can implement an energy saving action plan to reduce their energy costs. Various low-cost energy-saving measures are recommended covering heating levels and heating systems, electricity demand reduction and lighting, ventilation, hot water usage, and swimming pool energy management. Additional…

Changing of the Bulbs.

ERIC Educational Resources Information Center

Baba, Keith

1995-01-01

Explains how a school's use of compact fluorescents can reduce operating costs and maintain performance. Indicates that energy cost savings can repay the initial costs of buying incandescent bulbs in as short as 12 months with continuing savings thereafter. Tips for avoiding costly mistakes in lighting retrofits are highlighted. (GR)

Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

PubMed Central

Rostovtseva, Daria P.; Brindis, Claire D.; Biggs, M. Antonia; Hulett, Denis; Darney, Philip D.

2009-01-01

Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. PMID:18703437

Cost comparison and economic implications of commonly used originator and generic chemotherapy drugs in India.

PubMed

Lopes, G de L

2013-09-01

Cancer treatments have improved outcomes but access to medications is an issue around the world and especially so in low- and middle-income countries, such as India. Generic substitution may lead to significant cost savings. The author aimed to compare the cost and estimate potential cost savings per cycle, per patient, and for the country as a whole with generic substitution of frequently used chemotherapy drugs in the treatment of common cancers in India. Generic paclitaxel (Taxol), docetaxel (Taxotere), gemcitabine, oxaliplatin and irinotecan cost from 8.9% to 36% of their equivalent branded originator drug, resulting in cost savings of ~ Indian Rupees (INR) 11,000 to >INR 90,000 (USD 200-1600, Euro 160-1300) per cycle; and ~INR 50,000 to >INR 240,000 (USD 900-4300, Euro 700-3400) per patient. Overall, potential yearly savings for health systems in India were nearly INR 47 billion (~USD 843 million, Euro 670 million). In conclusion, generic substitution for frequently used chemotherapy drugs in the treatment of common cancers has an enormous potential to generate significant cost savings and increase access to cancer treatments in India and other low- and middle-income countries.

Costs and savings associated with implementation of a police crisis intervention team.

PubMed

El-Mallakh, Peggy L; Kiran, Kranti; El-Mallakh, Rif S

2014-06-01

Police crisis intervention teams (CIT) have demonstrated their effectiveness in reducing injury to law enforcement personnel and citizens and the criminalization of mental illness; however, their financial effect has not been fully investigated. The objective of the study was to determine the total costs or total savings associated with implementing a CIT program in a medium-size city. The costs and savings associated with the implementation of a CIT program were analyzed in a medium-size city, Louisville, Kentucky, 9 years after the program's initiation. Costs associated with officer training, increased emergency psychiatry visits, and hospital admissions resulting from CIT activity were compared with the savings associated with diverted hospitalizations and reduced legal bookings. Based on an average of 2400 CIT calls annually, the overall costs associated with CIT per year were $2,430,128 ($146,079 for officer training, $1,768,536 for hospitalizations of patients brought in by CIT officers, $508,690 for emergency psychiatry evaluations, and $6823 for arrests). The annual savings of the CIT were $3,455,025 ($1,148,400 in deferred hospitalizations, $2,296,800 in reduced inpatient referrals from jail, and $9825 in avoided bookings and jail time). The balance is $1,024,897 in annual cost savings. The net financial effect of a CIT program is of modest benefit; however, much of this analysis was based on estimates and average length of stay. Furthermore, the costs and savings associated with officer or citizen injuries were not included because there was inadequate information about their prevalence and costs. Finally, this analysis does not take into account the nonmonetary gains of a CIT program.

Cost-consequence analysis of multimodal interventions with environmental components for pediatric asthma in the state of Maryland.

PubMed

Jassal, Mandeep S; Diette, Gregory B; Dowdy, David W

2013-08-01

Applied environmental strategies for asthma control are often expensive, but may save longer-term healthcare costs. Whether these savings outweigh additional costs of implementing these strategies is uncertain. We conducted a systematic review to estimate the expenditures and savings of environmental interventions for asthma in the state of Maryland. Direct costs included hospitalizations, emergency room, and clinic visits. Indirect expenditures included costs of lost work productivity and travel incurred during the usage of healthcare services. We used decision analysis, assuming a hypothetical cohort of the approximated 49,290 pediatric individuals in Maryland with persistent asthma, to compare costs and benefits of environmental asthma interventions against the standard of care (no intervention) from the societal perspective. Three interventions among nine articles met the inclusion criteria for the systematic review: 1) environmental education using medical professionals; 2) education using non-medical personnel; and 3) multi-component strategy involving education with non-medical personnel, allergen-impermeable covers, and pest management. All interventions were found to be cost-saving relative to the standard of care. Home environmental education using non-medical professionals yielded the highest net savings of $14.1 million (95% simulation interval (SI): $-.283 million, $19.4 million), while the multi-component intervention resulted in the lowest net savings of $8.1 million (95% SI: $-4.9 million, $15.9 million). All strategies were most sensitive to the baseline number of hospitalizations in those not receiving targeted interventions for asthma. Limited environmental reduction strategies for asthma are likely to be cost-saving to the healthcare system in Maryland and should be considered for broader scale-up in other economically similar settings.

ICU early physical rehabilitation programs: financial modeling of cost savings.

PubMed

Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

2013-03-01

To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

PubMed

Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P

2017-04-01

The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins?

PubMed

Grover, Steven A; Ho, Vivian; Lavoie, Frédéric; Coupal, Louis; Zowall, Hanna; Pilote, Louise

2003-02-10

The losses in productivity due to cardiovascular disease (CVD) are substantial but rarely considered in health economic analyses. We compared the cost-effectiveness of lipid level modification in the primary prevention of CVD with and without these indirect costs. We used the Cardiovascular Life Expectancy Model to estimate the long-term benefits and cost-effectiveness of lipid level modification with atorvastatin calcium, including 28% and 38% reductions in total cholesterol and low-density lipoprotein cholesterol levels, respectively, and a 5.5% increase in high-density lipoprotein cholesterol level. The direct costs included all medical care costs associated with CVD. The indirect costs represented the loss of employment income and the decreased value of housekeeping services after different manifestations of CVD. All costs were expressed in 2000 Canadian dollars. When only direct medical care costs were considered, the incremental cost-effectiveness ratios for lifelong therapy with atorvastatin calcium, 10 mg/d, were generally positive, ranging from a few thousand to nearly $20 000 per year of life saved. When the societal point of view was adopted and indirect costs were included, the total costs were generally negative, representing substantial cost savings (up to $50 000) and increased life expectancy for most groups of individuals. Lipid therapy with statins can reduce CVD morbidity and mortality as demonstrated in a number of clinical trials. Adding the indirect CVD costs associated with productivity losses at work and home can result in forecasted cost savings to society as a whole such that lipid therapy could potentially save lives and money.

Cost-benefit estimates of an elderly exercise program on Kaua'i.

PubMed

Sugihara, Naomi; Watanabe, Marisa; Tomioka, Michiyo; Braun, Kathryn L; Pang, Lorrin

2011-06-01

The elderly consume a disproportionate amount of health care resources, and the recent trend in obesity will only escalate costs. EnhanceFitness® (EF) is an exercise program designed to increase the strength, flexibility, and balance of older adults. A comprehensive controlled study in Washington state of an elderly population has shown that participants who attend at least one EF class per week reduce healthcare costs by 20% per year. The present study reports the costs and potential benefits of replicating EF on Kaua'i. For Kaua'i the annual cost of an EF pilot program for 132 clients would be $204,735. Attendance records of the Kaua'i program showed that 96 (73%) of those enrolled attended at least weekly. Based on national reports of healthcare costs for the elderly, averting 20% of the costs for these 96 elderly would save $344,256 per year. The expected investment to return ratio, I-R ratio, for EF on Kaua'i is about 1-1.8. On economic grounds, a case can be made to support and expand these types of programs. In these times of budget cuts, cost-benefit analysis provides a common economic "language" to prioritize among different programs.

Demand reduction analysis for Aberdeen Proving Grounds, Aberdeen, Maryland. Final report

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

NONE

1996-06-01

The objectives of the project are to research, identify, evaluate, and define energy saving projects that meet the Army`s criteria and lead to energy savings at the Aberdeen Proving Grounds, Aberdeen campus, with respect to electrical demand reduction. Details of the authorization and objectives of this report, which delineates our contractual arrangement with the government, may be found in Section 8.11.

Use of resources and costs associated with the treatment of Dupuytren’s contracture at an orthopedics and traumatology surgery department in Denia (Spain): collagenase clostridium hystolyticum versus subtotal fasciectomy

PubMed Central

2013-01-01

Background Our purpose was to analyze and compare the use of direct health resources and costs generated in the treatment of Dupuytren's contracture using two different techniques: subtotal fasciectomy and infiltration with Collagenase Clostridium Histolyticum (CCH) in regular clinical practice at the Orthopedic and Traumatology Surgery (OTS) Department at the Hospital de Denia (Spain). Methods Observational, retrospective study based on data from the computerized clinical histories of two groups of patients- those treated surgically using a one or two digit subtotal fasciectomy technique (FSC) and those treated with CCH infiltration, monitored in regular clinical practice from February, 2009 to May, 2012. Demographic (age, sex), clinical (number of digits affected and which ones) and use of resources (hospitalizations, medical visits, tests and drugs) data were collected. Resource use and associated costs, according to the hospital’s accounting department, were compared based on the type of treatment from Spain’s National Health Service. Results 91 patients (48 (52.8%) in the FSC group) were identified. The average age and number of digits affected was 65.9 (9.2) years and 1.33 (0.48) digits affected in the FSC group, and 65.1 (9.7) years and 1.16 (0.4) digits in the CCH group. Overall, the costs of treating Dupuytren's disease with subtotal FSC amount to €1,814 for major ambulatory surgery and €1,961 with hospital stay including admission, surgical intervention (€904), examinations, dressings and physiotherapy. As to collagenase infiltration, costs amount to €952 (including minor surgery admission, vial with product, office examination and dressings). Finally, comparing total costs for treatments, a savings of €388 is estimated in favor of CCH treatment in the best-case scenario (patient under MAS system with no need for physiotherapy) and €1,008 in the worst-case scenario (patient admitted to hospital needing subsequent physiotherapy), implying a savings of 29% and 51%, respectively. Conclusions This study demonstrates that treating patients with DC by injection with CCH at the OTS department of the Hospital de Denia generates a total savings of 29% and 51% (€388 and €1008) compared with fasciectomy at the time of treatment. Long term evolution of CCH treatment is uncertain and the recurrence rate unknown. PMID:24125161

Computed Tomography For Internal Inspection Of Castings

NASA Technical Reports Server (NTRS)

Hanna, Timothy L.

1995-01-01

Computed tomography used to detect internal flaws in metal castings before machining and otherwise processing them into finished parts. Saves time and money otherwise wasted on machining and other processing of castings eventually rejected because of internal defects. Knowledge of internal defects gained by use of computed tomography also provides guidance for changes in foundry techniques, procedures, and equipment to minimize defects and reduce costs.

Modern developments for ground-based monitoring of fire behavior and effects

Treesearch

Colin C. Hardy; Robert Kremens; Matthew B. Dickinson

2010-01-01

Advances in electronic technology over the last several decades have been staggering. The cost of electronics continues to decrease while system performance increases seemingly without limit. We have applied modern techniques in sensors, electronics and instrumentation to create a suite of ground based diagnostics that can be used in laboratory (~ 1 m2), field scale...

Reflector Technology Development and System Design for Concentrating Solar Power Technologies

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

Adam Schaut

2011-12-30

Alcoa began this program in March of 2008 with the goal of developing and validating an advanced CSP trough design to lower the levelized cost of energy (LCOE) as compared to existing glass based, space-frame trough technology. In addition to showing a pathway to a significant LCOE reduction, Alcoa also desired to create US jobs to support the emerging CSP industry. Alcoa's objective during Phase I: Concept Feasibility was to provide the DOE with a design approach that demonstrates significant overall system cost savings without sacrificing performance. Phase I consisted of two major tasks; reflector surface development and system conceptmore » development. Two specific reflective surface technologies were investigated, silver metallized lamination, and thin film deposition both applied on an aluminum substrate. Alcoa prepared samples; performed test validation internally; and provided samples to the NREL for full-spectrum reflectivity measurements. The final objective was to report reflectivity at t = 0 and the latest durability results as of the completion of Phase 1. The target criteria for reflectance and durability were as follows: (1) initial (t = 0), hemispherical reflectance >93%, (2) initial spectral reflectance >90% for 25-mrad reading and >87% for 7-mrad reading, and (3) predicted 20 year durability of less than 5% optical performance drop. While the results of the reflective development activities were promising, Alcoa was unable to down-select on a reflective technology that met the target criteria. Given the progress and potential of both silver film and thin film technologies, Alcoa continued reflector surface development activities in Phase II. The Phase I concept development activities began with acquiring baseline CSP system information from both CSP Services and the DOE. This information was used as the basis to develop conceptual designs through ideation sessions. The concepts were evaluated based on estimated cost and high-level structural performance. The target criteria for the concept development was to achieve a solar field cost savings of 25%-50% thereby meeting or exceeding the DOE solar field cost savings target of $350/m2. After evaluating various structural design approaches, Alcoa down-selected to a monocoque, dubbed Wing Box, design that utilizes the reflective surface as a structural, load carrying member. The cost and performance potential of the Wing Box concept was developed via initial finite element analysis (FEA) and cost modeling. The structural members were sized through material utilization modeling when subjected to representative loading conditions including wind loading. Cost modeling was utilized to refine potential manufacturing techniques that could be employed to manufacture the structural members. Alcoa concluded that an aluminum intensive collector design can achieve significant cost savings without sacrificing performance. Based on the cost saving potential of this Concept Feasibility study, Alcoa recommended further validation of this CSP approach through the execution of Phase II: Design and Prototype Development. Alcoa Phase II objective was to provide the DOE with a validated CSP trough design that demonstrates significant overall system cost savings without sacrificing performance. Phase II consisted of three major tasks; Detail System Design, Prototype Build, and System Validation. Additionally, the reflector surface development that began in Phase I was continued in Phase II. After further development work, Alcoa was unable to develop a reflective technology that demonstrated significant performance or cost benefits compared to commercially available CSP reflective products. After considering other commercially available reflective surfaces, Alcoa selected Alano's MIRO-SUN product for use on the full scale prototype. Although MIRO-SUN has a lower specular reflectivity compared to other options, its durability in terms of handling, cleaning, and long-term reflectivity was deemed the most important attribute to successfully validate Alcoa's advanced trough architecture. To validate the performance of the Wing Box trough, a 6 meter aperture by 14 meter long prototype trough was built. For ease of shipping to and assembly at NREL's test facility, the prototype was fabricated in two half modules and joined along the centerline to create the Wing Box trough. The trough components were designed to achieve high precision of the reflective surface while leveraging high volume manufacturing and assembly techniques.« less

Aircraft wing structural design optimization based on automated finite element modelling and ground structure approach

NASA Astrophysics Data System (ADS)

Yang, Weizhu; Yue, Zhufeng; Li, Lei; Wang, Peiyan

2016-01-01

An optimization procedure combining an automated finite element modelling (AFEM) technique with a ground structure approach (GSA) is proposed for structural layout and sizing design of aircraft wings. The AFEM technique, based on CATIA VBA scripting and PCL programming, is used to generate models automatically considering the arrangement of inner systems. GSA is used for local structural topology optimization. The design procedure is applied to a high-aspect-ratio wing. The arrangement of the integral fuel tank, landing gear and control surfaces is considered. For the landing gear region, a non-conventional initial structural layout is adopted. The positions of components, the number of ribs and local topology in the wing box and landing gear region are optimized to obtain a minimum structural weight. Constraints include tank volume, strength, buckling and aeroelastic parameters. The results show that the combined approach leads to a greater weight saving, i.e. 26.5%, compared with three additional optimizations based on individual design approaches.

Consortium Purchases: Case Study for a Cost-Benefit Analysis.

ERIC Educational Resources Information Center

Scigliano, Marisa

2002-01-01

Discusses library cooperation and academic library consortia and presents a case study of a Canadian consortia that conducted a cost-benefit analysis for purchasing an electronic resource. Reports on member library subscription costs, external economic factors, value of patron time saved, costs and benefits for patrons, and net savings. (LRW)

Cost Evaluation of Panretinal Photocoagulation versus Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy

PubMed Central

Lin, James; Chang, Jonathan S; Smiddy, William E

2016-01-01

Purpose To evaluate costs of panretinal photocoagulation (PRP) vs. intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR). Design A Markov-style model of cost-effectiveness and cost utility. Participants There were no participants. Methods Based on results from Diabetic Retinopathy Clinical Research (DRCR) Network Protocol S, we performed a Markov-style analysis to generate the total 2-year costs for each treatment arm. The cost per line-year saved and cost utility were calculated based on the estimated life years remaining. Both treatment arms were assumed to result in 9 lines of vision saved in 20% of patients. Medicare reimbursement data were acquired to determine costs, which were then separately calculated for practice settings of a hospital-based facility as the highest end of the cost range and a nonfacility in the same geographic area as the lowest end. Cost parameters for a prototypical patient's life expectancy also were modeled and calculated. Main Outcome Measures Inputed cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY). Results When PRP was the primary treatment, the 2-year cost in the facility setting was $13 053, with cost per line saved $7252, cost per line-year $240, and cost per QALY $7988. In the nonfacility setting costs were approximately 21% lower. When IVR was the primary treatment, the 2-year cost in the facility setting was $30 328, cost per line saved was $16 849, cost per line-year $575, and cost per QALY $19 150. In the nonfacility setting costs were approximately 15% lower. Extrapolation to lifetime therapy yielded the cost per QALY with PRP treatment of $14 219 to $24 005 and with IVR of $138 852 to $164 360. Cost utility for PRP would be 85% lower than IVR in the facility setting and 90% lower than IVR in the nonfacility setting. Conclusions PRP compared with IVR as primary treatment for PDR is less expensive over 2 years, but both fall well below the accepted cost per QALY upper limit. However, over an average lifetime, the cost differential between PRP and IVR increases, and IVR therapy may exceed the typical accepted limit of cost per QALY. PMID:27425822

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.

The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives.

PubMed

Black, Amanda Y; Guilbert, Edith; Hassan, Fareen; Chatziheofilou, Ismini; Lowin, Julia; Jeddi, Mark; Filonenko, Anna; Trussell, James

2015-12-01

Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs). A cost model was constructed to estimate the annual number and direct costs of UP in women aged 18 to 44 years. Adherence-associated UP rates were estimated using perfect- and typical-use contraceptive failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC usage. One-way sensitivity analyses were conducted to assess the impact of key variables on scenarios of increased LARC use. There are more than 180 700 UPs annually in Canada. The associated direct cost was over $320 million. Fifty-eight percent (58%) of UPs occurred in women aged 20 to 29 years at an annual cost of $175 million; 82% of this cost ($143 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $34 million in all three switching scenarios; the largest savings ($35 million) occurred when 10% of oral contraceptive users switched to LARCs. The minimum duration of LARC usage required before cost savings was realized was 12 months. The cost of UPs in Canada is significant and much of it can be attributed to imperfect contraceptive adherence. Increased LARC uptake may reduce contraceptive non-adherence, thereby reducing rates of UP and generating significant cost savings, particularly in women aged 20 to 29.

Cost savings threshold analysis of a capacity-building program for HIV prevention organizations.

PubMed

Dauner, Kim Nichols; Oglesby, Willie H; Richter, Donna L; LaRose, Christopher M; Holtgrave, David R

2008-06-01

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

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

Chatterton, Mike

The Recovery Act: Districtwide Geothermal Heating Conversion project performed by the Blaine County School District was part of a larger effort by the District to reduce operating costs, address deferred maintenance items, and to improve the learning environment of the students. This project evaluated three options for the ground source which were Open-Loop Extraction/Re-injection wells, Closed-Loop Vertical Boreholes, and Closed-Loop Horizontal Slinky approaches. In the end the Closed-Loop Horizontal Slinky approach had the lowest total cost of ownership but the majority of the sites associated with this project did not have enough available ground area to install the system somore » the second lowest option was used (Open-Loop). In addition to the ground source, this project looked at ways to retrofit existing HVAC systems with new high efficiency systems. The end result was the installation of distributed waterto- air heat pumps with water-to-water heat pumps installed to act as boilers/chillers for areas with a high ventilation demand such as they gymnasiums. A number of options were evaluated and the lowest total cost of ownership approach was implemented in the majority of the facilities. The facilities where the lowest total cost of ownership approaches was not selected were done to maintain consistency of the systems from facility to facility. This project had a number of other benefits to the Blaine County public. The project utilizes guaranteed energy savings to justify the levy funds expended. The project also developed an educational dashboard that can be used in the classrooms and to educate the community on the project and its performance. In addition, the majority of the installation work was performed by contractors local to Blaine County which acted as an economic stimulus to the area during a period of recession.« less

Cost-Effective Telemetry and Command Ground Systems Automation Strategy for the Soil Moisture Active Passive (SMAP) Mission

NASA Technical Reports Server (NTRS)

Choi, Josh; Sanders, Antonio

2012-01-01

Soil Moisture Active Passive (SMAP) is an Earth-orbiting, remote-sensing NASA mission slated for launch in 2014. The ground data system (GDS) being developed for SMAP is composed of many heterogeneous subsystems, ranging from those that support planning and sequencing to those used for real-time operations, and even further to those that enable science data exchange. A full end-to-end automation of the GDS may result in cost savings during mission operations, but it would require a significant upfront investment to develop such a comprehensive automation. As demonstrated by the Jason-1 and Wide-field Infrared Survey Explorer (WISE) missions, a measure of "lights-out" automation for routine, orbital pass, ground operations can still reduce mission costs through smaller staffing of operators and limiting their working hours. The challenge, then, for the SMAP GDS engineering team, is to formulate an automated operations strategy--and corresponding system architecture -- to minimize operator intervention during routine operations, while balancing the development costs associated with the scope and complexity of automation. This paper discusses the automated operations approach being developed for the SMAP GDS. The focus is on automating the activities involved in routine passes, which limits the scope to real-time operations. A key subsystem of the SMAP GDS -- NASA's AMMOS Mission Data Processing and Control System (AMPCS) -- provides a set of capabilities that enable such automation. Also discussed are the lights-out pass automations of the Jason-1 and WISE missions and how they informed the automation strategy for SMAP. The paper aims to provide insights into what is necessary in automating the GDS operations for Earth satellite missions.

Cost-Effective Telemetry and Command Ground Systems Automation Strategy for the Soil Moisture Active Passive (SMAP) Mission

NASA Technical Reports Server (NTRS)

Choi, Joshua S.; Sanders, Antonio L.

2012-01-01

Soil Moisture Active Passive (SMAP) is an Earth-orbiting, remote-sensing NASA mission slated for launch in 2014.[double dagger] The ground data system (GDS) being developed for SMAP is composed of many heterogeneous subsystems, ranging from those that support planning and sequencing to those used for real-time operations, and even further to those that enable science data exchange. A full end-to-end automation of the GDS may result in cost savings during mission operations, but it would require a significant upfront investment to develop such comprehensive automation. As demonstrated by the Jason-1 and Wide-field Infrared Survey Explorer (WISE) missions, a measure of "lights-out" automation for routine, orbital pass ground operations can still reduce mission cost through smaller staffing of operators and limited work hours. The challenge, then, for the SMAP GDS engineering team is to formulate an automated operations strategy--and corresponding system architecture--to minimize operator intervention during operations, while balancing the development cost associated with the scope and complexity of automation. This paper discusses the automated operations approach being developed for the SMAP GDS. The focus is on automating the activities involved in routine passes, which limits the scope to real-time operations. A key subsystem of the SMAP GDS--NASA's AMMOS Mission Data Processing and Control System (AMPCS)--provides a set of capabilities that enable such automation. Also discussed are the lights-out pass automations of the Jason-1 and WISE missions and how they informed the automation strategy for SMAP. The paper aims to provide insights into what is necessary in automating the GDS operations for Earth satellite missions.

Optimising dewatering costs on a south african gold mine

NASA Astrophysics Data System (ADS)

Connelly, R. J.; Ward, A. D.

1987-06-01

Many South African Gold Mines are geologically in proximity to the Transvaal Dolomites. This geological unit, is karstic in many areas and is very extensive. Very large volumes of ground water can be found in the dolomites, and have given rise to major dewatering problems on the mines. Hitherto, the general philosophy on the mines has been to acept these large inflows into the mine, and then to pump out from underground at a suitably convenient level. The dolomites constitute a ground water control area which means that Goverment permission is required to do anything with ground water within the dolomite. When the first major inflows occurred, the mines started dewatering the dolomites, and in many areas induced sinkholes, with significant loss of life and buildings. The nett result is that mines have to pump large quantities of water out of the mine but recharge into the dolomite to maintain water levesl. During the past 2 years a number of investigations have been carried out to reduce the very high costs of dewatering. On one mine the cost of removing 130×103 m3/day is about 1×106 Rand/month. The hydrogeologic model for the dolomites is now reasonably well understood. It shows that surface wells to a depth of up to 150 m can withdraw significant quantities of water and reduce the amount that has to be pumped from considerable depth with significant saving in puming costs. Such a system has a number of additional advantages such as removing some of the large volume of water from the underground working environment and providing a system that can be used for controlled surface dewatering should it be required.

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.

Estimation of cost savings between 2011 and 2014 attributed to infliximab biosimilar in the South Korean healthcare market: real-world evidence using a nationwide database.

PubMed

Kim, Jiyoun; Ha, Dongmun; Song, Inmyung; Park, Haesun; Lee, Sang-Won; Lee, Eui-Kyung; Shin, Ju-Young

2018-06-01

The introduction of biosimilars is expected to reduce the cost of biologic drugs, but the actual cost savings have not yet been quantified in Korea. The aim of this study was to estimate the annual cost savings attributed to the introduction of infliximab biosimilar. We conducted a retrospective analysis using data from the Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) between 2011 and 2014. The study subjects were patients who were treated with infliximab, adalimumab or etanercept. We compared the drug costs before and after the introduction of infliximab biosimilar in December 2012 (2011-2012 and 2013-2014) to estimate the annual drug cost savings attributed to this and the number of patients who could additionally benefit from the biosimilar in 2013 and 2014. A total of 10 986 prescriptions were identified: 2620 for infliximab. The cost savings were estimated at $262 270 for 133 patients in 2013 and $395 220 for 174 patients in 2014. Among the patients who underwent a 1-year maintenance course of infliximab therapy, the annual expenditure on infliximab was lower in 2014 than in 2011. If the cost savings were used to treat additional patients, 13.3%-38.6% more patients per year could be treated by indication. The introduction of infliximab biosimilar reduced direct medical costs for both patients and the payer, which could then be used to increase patient access to biologic medicines. The entry of infliximab biosimilar could result in further reductions in healthcare costs. © 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Review of the Fuel Saving, Life Cycle GHG Emission, and Ownership Cost Impacts of Lightweighting Vehicles with Different Powertrains.

PubMed

Luk, Jason M; Kim, Hyung Chul; De Kleine, Robert; Wallington, Timothy J; MacLean, Heather L

2017-08-01

The literature analyzing the fuel saving, life cycle greenhouse gas (GHG) emission, and ownership cost impacts of lightweighting vehicles with different powertrains is reviewed. Vehicles with lower powertrain efficiencies have higher fuel consumption. Thus, fuel savings from lightweighting internal combustion engine vehicles can be higher than those of hybrid electric and battery electric vehicles. However, the impact of fuel savings on life cycle costs and GHG emissions depends on fuel prices, fuel carbon intensities and fuel storage requirements. Battery electric vehicle fuel savings enable reduction of battery size without sacrificing driving range. This reduces the battery production cost and mass, the latter results in further fuel savings. The carbon intensity of electricity varies widely and is a major source of uncertainty when evaluating the benefits of fuel savings. Hybrid electric vehicles use gasoline more efficiently than internal combustion engine vehicles and do not require large plug-in batteries. Therefore, the benefits of lightweighting depend on the vehicle powertrain. We discuss the value proposition of the use of lightweight materials and alternative powertrains. Future assessments of the benefits of vehicle lightweighting should capture the unique characteristics of emerging vehicle powertrains.

[Measures to reduce lighting-related energy use and costs at hospital nursing stations].

PubMed

Su, Chiu-Ching; Chen, Chen-Hui; Chen, Shu-Hwa; Ping, Tsui-Chu

2011-06-01

Hospitals have long been expected to deliver medical services in an environment that is comfortable and bright. This expectation keeps hospital energy demand stubbornly high and energy costs spiraling due to escalating utility fees. Hospitals must identify appropriate strategies to control electricity usage in order to control operating costs effectively. This paper proposes several electricity saving measures that both support government policies aimed at reducing global warming and help reduce energy consumption at the authors' hospital. The authors held educational seminars, established a website teaching energy saving methods, maximized facility and equipment use effectiveness (e.g., adjusting lamp placements, power switch and computer saving modes), posted signs promoting electricity saving, and established a regularized energy saving review mechanism. After implementation, average nursing staff energy saving knowledge had risen from 71.8% to 100% and total nursing station electricity costs fell from NT$16,456 to NT$10,208 per month, representing an effective monthly savings of 37.9% (NT$6,248). This project demonstrated the ability of a program designed to slightly modify nursing staff behavior to achieve effective and meaningful results in reducing overall electricity use.

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

PubMed

Faul, Mark; Wald, Marlena M; Rutland-Brown, Wesley; Sullivent, Ernest E; Sattin, Richard W

2007-12-01

A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs ($262 million), annual rehabilitation costs ($43 million) and lifetime societal costs ($3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be $61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

The relationships between OHS prevention costs, safety performance, employee satisfaction and accident costs.

PubMed

Bayram, Metin; Ünğan, Mustafa C; Ardıç, Kadir

2017-06-01

Little is known about the costs of safety. A literature review conducted for this study indicates there is a lack of survey-based research dealing with the effects of occupational health and safety (OHS) prevention costs. To close this gap in the literature, this study investigates the interwoven relationships between OHS prevention costs, employee satisfaction, OHS performance and accident costs. Data were collected from 159 OHS management system 18001-certified firms operating in Turkey and analyzed through structural equation modeling. The findings indicate that OHS prevention costs have a significant positive effect on safety performance, employee satisfaction and accident costs savings; employee satisfaction has a significant positive effect on accident costs savings; and occupational safety performance has a significant positive effect on employee satisfaction and accident costs savings. Also, the results indicate that safety performance and employee satisfaction leverage the relationship between prevention costs and accident costs.

COST Action TU1208 - Working Group 3 - Electromagnetic modelling, inversion, imaging and data-processing techniques for Ground Penetrating Radar

NASA Astrophysics Data System (ADS)

Pajewski, Lara; Giannopoulos, Antonios; Sesnic, Silvestar; Randazzo, Andrea; Lambot, Sébastien; Benedetto, Francesco; Economou, Nikos

2017-04-01

This work aims at presenting the main results achieved by Working Group (WG) 3 "Electromagnetic methods for near-field scattering problems by buried structures; data processing techniques" of the COST (European COoperation in Science and Technology) Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar" (www.GPRadar.eu, www.cost.eu). The main objective of the Action, started in April 2013 and ending in October 2017, is to exchange and increase scientific-technical knowledge and experience of Ground Penetrating Radar (GPR) techniques in civil engineering, whilst promoting in Europe the effective use of this safe non-destructive technique. The Action involves more than 150 Institutions from 28 COST Countries, a Cooperating State, 6 Near Neighbour Countries and 6 International Partner Countries. Among the most interesting achievements of WG3, we wish to mention the following ones: (i) A new open-source version of the finite-difference time-domain simulator gprMax was developed and released. The new gprMax is written in Python and includes many advanced features such as anisotropic and dispersive-material modelling, building of realistic heterogeneous objects with rough surfaces, built-in libraries of antenna models, optimisation of parameters based on Taguchi's method - and more. (ii) A new freeware CAD was developed and released, for the construction of two-dimensional gprMax models. This tool also includes scripts easing the execution of gprMax on multi-core machines or network of computers and scripts for a basic plotting of gprMax results. (iii) A series of interesting freeware codes were developed will be released by the end of the Action, implementing differential and integral forward-scattering methods, for the solution of simple electromagnetic problems by buried objects. (iv) An open database of synthetic and experimental GPR radargrams was created, in cooperation with WG2. The idea behind this initiative is to give researchers the opportunity of testing and validating, against reliable data, their electromagnetic-modelling, inversion, imaging and processing algorithms. One of the most interesting dataset comes from the IFSTTAR Geophysical Test Site, in Nantes (France): this is an open-air laboratory including a large and deep area, filled with various materials arranged in horizontal compacted slices, separated by vertical interfaces and water-tighted in surface; several objects as pipes, polystyrene hollows, boulders and masonry are embedded in the field. Data were collected by using nine different GPR systems and at different frequencies ranging from 200 MHz to 1 GHz. Moreover, some sections of this test site were modelled by using gprMax and the commercial software CST Microwave Studio. Hence, both experimental and synthetic data are available. Further interesting datasets were collected on roads, bridges, concrete cells, columns - and more. (v) WG3 contributed to the TU1208 Education Pack, an open educational package conceived to teach GPR in University courses. (vi) WG3 was very active in offering training activities. The following courses were successfully organised: Training School (TS) "Microwave Imaging and Diagnostics" (in cooperation with the European School of Antennas; 1st edition: Madonna di Campiglio, Italy, March 2014, 2nd edition: Taormina, Italy, October 2016); TS "Numerical modelling of Ground Penetrating Radar using gprMax" (Thessaloniki, Greece, November 2015); TS "Electromagnetic Modelling Techniques for Ground Penetrating Radar" (Split, Croatia, November 2016). Moreover, WG3 organized a workshop on "Electromagnetic modelling with the Finite-Difference Time-Domain technique" (Nantes, France, February 2014) and a workshop on "Electromagnetic modelling and inversion techniques for GPR" (Davos, Switzerland, April 2016) within the 2016 European Conference on Antennas and Propagation (EuCAP). Acknowledgement: The Authors are deeply grateful to COST (European COoperation in Science and Technology, www.cost.eu), for funding and supporting the COST Action TU1208 "Civil engineering applications of Ground Penetrating Radar" (www.GPRadar.eu).

Cost-effectiveness analysis of the use of high-flow oxygen through nasal cannula in intensive care units in NHS England.

PubMed

Eaton Turner, Emily; Jenks, Michelle

2018-06-01

To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective. Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted. When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this. For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.

Cost effectiveness of recycling: A systems model

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

Tonjes, David J., E-mail: david.tonjes@stonybrook.edu; Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000; Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044

Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have alsomore » found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.« less

Hepatitis C Cure Is Associated with Decreased Healthcare Costs in Cirrhotics in Retrospective Veterans Affairs Cohort.

PubMed

Maier, Marissa M; Zhou, Xiao-Hua; Chapko, Michael; Leipertz, Steven L; Wang, Xuan; Beste, Lauren A

2018-06-01

Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined. To measure downstream healthcare costs in a national population of HCV-infected patients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences. This is a retrospective cohort study (2004-2014) of hepatitis C-infected patients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment. For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosis patients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient. Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.

Lower HVAC Costs | Efficient Windows Collaborative

Science.gov Websites

system. Smaller HVAC systems cost less and as such can offset some of the cost of the efficient windows dehumidification. First cost savings - Smaller HVAC units cost less. If, for example, down-sizing the HVAC system by half a ton saves $275, the cost premium of energy-efficient windows does not present as big an up

Implementing Endobronchial Ultrasound-Guided (EBUS) for Staging and Diagnosis of Lung Cancer: A Cost Analysis

PubMed Central

Slavova-Azmanova, Neli S.; Phillips, Martin; Trevenen, Michelle L.; Li, Ian W.; Johnson, Claire E.

2018-01-01

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) are gaining popularity for diagnosis and staging of lung cancer compared to CT-guided transthoracic needle aspiration (CT-TTNA), blind fiber-optic bronchoscopy, and mediastinoscopy. This paper aimed to examine predictors of higher costs for diagnosing and staging lung cancer, and to assess the effect of EBUS techniques on hospital cost. Material/Methods Hospital costs for diagnosis and staging of new primary lung cancer patients presenting in 2007–2008 and 2010–2011 were reviewed retrospectively. Multiple linear regression was used to determine relationships with hospital cost. Results We reviewed 560 lung cancer patient records; 100 EBUS procedures were performed on 90 patients. Higher hospital costs were associated with: EBUS-TBNA performed (p<0.0001); increasing inpatient length of stay (p<0.0001); increasing number of other surgical/diagnostic procedures (p<0.0001); whether the date of management decision fell within an inpatient visit (p<0.0001); and if the patient did not have a CT-TTNA, then costs increased as the number of imaging events increased (interaction p<0.0001). Cohort was not significantly related to cost. Location of the procedure (outside vs. inside theater) was a predictor of lower one-day EBUS costs (p<0.0001). Cost modelling revealed potential cost saving of $1506 per EBUS patient if all EBUS procedures were performed outside rather than in the theater ($66,259 per annum). Conclusions EBUS-TBNA only was an independent predictor of higher cost for diagnosis and staging of lung cancer. Performing EBUS outside compared to in the theater may lower costs for one-day procedures; potential future savings are considerable if more EBUS procedures could be performed outside the operating theater. PMID:29377878

Invisible costs, visible savings.

PubMed

Lefever, G

1999-08-01

By identifying hidden inventory costs, nurse managers can save money for the organization. Some measures include tracking and standardizing supplies, accurately evaluating patients' needs, and making informed purchasing decisions.

Cost Avoidance vs. Utility Bill Accounting - Explaining theDiscrepancy Between Guaranteed Savings in ESPC Projects and UtilityBills

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

Kumar, S.; Sartor, D.

2005-08-15

Federal agencies often ask if Energy Savings PerformanceContracts (ESPCs) result in the energy and cost savings projected duringthe project development phase. After investing in ESPCs, federal agenciesexpect a reduction in the total energy use and energy cost at the agencylevel. Such questions about the program are common when implementing anESPC project. But is this a fair or accurate perception? Moreimportantly, should the federal agencies evaluate the success or failureof ESPCs by comparing the utility costs before and after projectimplementation?In fact, ESPC contracts employ measurement andverification (M&V) protocols to measure and ensure kilowatt-hour orBTU savings at the project level. In mostmore » cases, the translation toenergy cost savings is not based on actual utility rate structure, but acontracted utility rate that takes the existing utility rate at the timethe contract is signed with a clause to escalate the utility rate by afixed percentage for the duration of the contract. Reporting mechanisms,which advertise these savings in dollars, may imply an impact to budgetsat a much higher level depending on actual utility rate structure. FEMPhas prepared the following analysis to explain why the utility billreduction may not materialize, demonstrate its larger implication onagency s energy reduction goals, and advocate setting the rightexpectations at the outset to preempt the often asked question why I amnot seeing the savings in my utility bill?« less

ATS-6 - Television Relay Using Small Terminals Experiment

NASA Technical Reports Server (NTRS)

Miller, J. E.

1975-01-01

The Television Relay Using Small Terminals (TRUST) Experiment was designed to advance and promote the technology of broadcasting satellites. A constant envelope television FM signal was transmitted at C band to the ATS-6 earth coverage horn and retransmitted at 860 MHz through the 9-m antenna to a low-cost direct-readout ground station. The experiment demonstrated that high-quality television and audio can be received by low-cost direct-receive ground stations. Predetection bandwidths significantly less than predicted by Carson's rule can be utilized with minimal degradation of either monochrome or color pictures. Two separate techniques of dual audio channel transmission have been demonstrated to be suitable for low-cost applications.

Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial

PubMed Central

Lattimer, Val; Sassi, Franco; George, Steve; Moore, Michael; Turnbull, Joanne; Mullee, Mark; Smith, Helen

2000-01-01

Objective To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. Design Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. Setting General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. Subjects All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). Main outcome measures Costs and savings to the NHS during the trial year. Results The cost of providing nurse telephone consultation was £81 237 per annum. This, however, determined a £94 422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to £123 824 per annum. Savings of only £3728 would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of £16 928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call. Conclusions Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis. PMID:10764368

32 CFR Appendix to Part 162 - Reporting Procedures

Code of Federal Regulations, 2014 CFR

2014-07-01

... generated. e. Projected Life-Cycle Savings. For each PIF project provide the estimated amount of savings the project is projected to earn over the project's economic life. f. Projected Life-Cycle Cost Avoidance. For... Projected Life-Cycle Savings. e. Total Projected Life-Cycle Cost Avoidance. 3. CSI. Each DoD Component that...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

Cost-Savings Analysis of the Better Beginnings, Better Futures Community-Based Project for Young Children and Their Families: A 10-Year Follow-up.

PubMed

Peters, Ray DeV; Petrunka, Kelly; Khan, Shahriar; Howell-Moneta, Angela; Nelson, Geoffrey; Pancer, S Mark; Loomis, Colleen

2016-02-01

This study examined the long-term cost-savings of the Better Beginnings, Better Futures (BBBF) initiative, a community-based early intervention project for young children living in socioeconomically disadvantaged neighborhoods during their transition to primary school. A quasi-experimental, longitudinal two-group design was used to compare costs and outcomes for children and families in three BBBF project neighborhoods (n = 401) and two comparison neighborhoods (n = 225). A cost-savings analysis was conducted using all project costs for providing up to 4 years of BBBF programs when children were in junior kindergarten (JK) (4 years old) to grade 2 (8 years old). Data on 19 government service cost measures were collected from the longitudinal research sample from the time the youth were in JK through to grade 12 (18 years old), 10 years after ending project participation. The average family incremental net savings to government of providing the BBBF project was $6331 in 2014 Canadian dollars. When the BBBF monetary return to government as a ratio of savings to costs was calculated, for every dollar invested by the government, a return of $2.50 per family was saved. Findings from this study have important implications for government investments in early interventions focused on a successful transition to primary school as well as parenting programs and community development initiatives in support of children's development.

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis

PubMed Central

Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne

2018-01-01

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million–$1.6 billion for CVD and AUD$18.2 million–$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia. PMID:29301298

Energy saving effects of wireless sensor networks: a case study of convenience stores in Taiwan.

PubMed

Chen, Chih-Sheng; Lee, Da-Sheng

2011-01-01

Wireless sensor network (WSN) technology has been successfully applied to energy saving applications in many places, and plays a significant role in achieving power conservation. However, previous studies do not discuss WSN costs and cost-recovery. The application of WSNs is currently limited to research and laboratory experiments, and not mass industrial production, largely because business owners are unfamiliar with the possible favorable return and cost-recovery on WSN investments. Therefore, this paper focuses on the cost-recovery of WSNs and how to reduce air conditioning energy consumption in convenience stores. The WSN used in this study provides feedback to the gateway and adopts the predicted mean vote (PMV) and computational fluid dynamics (CFD) methods to allow customers to shop in a comfortable yet energy-saving environment. Four convenience stores in Taipei have used the proposed WSN since 2008. In 2008, the experiment was initially designed to optimize air-conditioning for energy saving, but additions to the set-up continued beyond 2008, adding the thermal comfort and crowds peak, off-peak features in 2009 to achieve human-friendly energy savings. Comparison with 2007 data, under the same comfort conditions, shows that the power savings increased by 40% (2008) and 53% (2009), respectively. The cost of the WSN equipment was 500 US dollars. Experimental results, including three years of analysis and calculations, show that the marginal energy conservation benefit of the four convenience stores achieved energy savings of up to 53%, recovering all costs in approximately 5 months. The convenience store group participating in this study was satisfied with the efficiency of energy conservation because of the short cost-recovery period.

Energy Saving Effects of Wireless Sensor Networks: A Case Study of Convenience Stores in Taiwan

PubMed Central

Chen, Chih-Sheng; Lee, Da-Sheng

2011-01-01

Wireless sensor network (WSN) technology has been successfully applied to energy saving applications in many places, and plays a significant role in achieving power conservation. However, previous studies do not discuss WSN costs and cost-recovery. The application of WSNs is currently limited to research and laboratory experiments, and not mass industrial production, largely because business owners are unfamiliar with the possible favorable return and cost-recovery on WSN investments. Therefore, this paper focuses on the cost-recovery of WSNs and how to reduce air conditioning energy consumption in convenience stores. The WSN used in this study provides feedback to the gateway and adopts the predicted mean vote (PMV) and computational fluid dynamics (CFD) methods to allow customers to shop in a comfortable yet energy-saving environment. Four convenience stores in Taipei have used the proposed WSN since 2008. In 2008, the experiment was initially designed to optimize air-conditioning for energy saving, but additions to the set-up continued beyond 2008, adding the thermal comfort and crowds peak, off-peak features in 2009 to achieve human-friendly energy savings. Comparison with 2007 data, under the same comfort conditions, shows that the power savings increased by 40% (2008) and 53% (2009), respectively. The cost of the WSN equipment was 500 US dollars. Experimental results, including three years of analysis and calculations, show that the marginal energy conservation benefit of the four convenience stores achieved energy savings of up to 53%, recovering all costs in approximately 5 months. The convenience store group participating in this study was satisfied with the efficiency of energy conservation because of the short cost-recovery period. PMID:22319396

Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

PubMed

Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

2013-01-01

Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

COST Action TU1208 - Working Group 4 - Combined use of GPR and other NDT methods & GPR applications in geosciences

NASA Astrophysics Data System (ADS)

Pajewski, Lara; Solla, Mercedes; Fontul, Simona

2017-04-01

This work aims at presenting the main results achieved by Working Group (WG) 4 "Different applications of GPR and other NDT technologies in civil engineering" of the COST (European COoperation in Science and Technology) Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar" (www.GPRadar.eu, www.cost.eu). The main objective of the Action TU1208, started in April 2013 and ending in October 2017, is to exchange and increase scientific-technical knowledge and experience of Ground Penetrating Radar (GPR) techniques in civil engineering, whilst promoting in Europe the effective use of this safe non-destructive technique. The Action involves more than 150 Institutions from 28 COST Countries, a Cooperating State, 6 Near Neighbour Countries and 6 International Partner Countries. WG4 deals with the use of GPR outside from the civil engineering area, namely in archaeological prospecting and cultural heritage diagnostics, agriculture and management of water resources, investigation of polluted industrial sites, non-destructive testing of living tree trunks, planetary exploration, demining, localization of people buried under avalanches and debris, and more. Furthermore, this WG studies the integration of GPR with other Non-Destructive Testing (NDT) methods. The most relevant achievements stemming from WG4 will be presented during the 2017 EGU GA. These are: (i) The collection of thorough information on the state-of-the-art, ongoing studies, problems and future research needs on the topics of interest for this WG; (ii) The performance of a plethora of interesting case studies in important sites all over Europe, including well-known historical places such as Stonehenge (United Kingdom), Carnuntum (Austria), the Wawel Cathedral (Cracow, Poland), the Tholos Tomb of Acharnon (Athens, Greece), the Łazienki Royal Palace (Warsaw, Poland), and more; (iii) WG4 contributed to the TU1208 Education Pack, an open educational package conceived to teach GPR in University courses. Additionally, WG4 was very active in offering training activities. In cooperation with the other WGs, the following courses were successfully organised: Training School (TS) "Civil engineering applications of Ground Penetrating Radar" (Pisa, Italy, September 2014), TS "Applications of Ground Penetrating Radar in urban areas: the sensitive case of historical cities" (Cracow, Poland, May 2015), TS "Applications of GPR to civil engineering and archaeology" (Valletta, Malta, January 2016), and TS "Non-destructive testing techniques for civil engineering" (Barcelona, Spain, March 2016). Finally, WG4 contributed to the organization of a series of national events devoted to fostering the interaction of Action Members with stakeholders, new potential GPR end-users, and interested citizens. During such events, participants could discover what is Ground Penetrating Radar (GPR) and how this technique can be effectively used in civil engineering works as well as in different fields ("TU1208 GPR Road Show"). Acknowledgement: The Authors are deeply grateful to COST (European Cooperation in Science and Technology, www.cost.eu), for funding and supporting the COST Action TU1208 "Civil engineering applications of Ground Penetrating Radar" (www.GPRadar.eu).

Financial Impact of Cancer Drug Wastage and Potential Cost Savings From Mitigation Strategies.

PubMed

Leung, Caitlyn Y W; Cheung, Matthew C; Charbonneau, Lauren F; Prica, Anca; Ng, Pamela; Chan, Kelvin K W

2017-07-01

Cancer drug wastage occurs when a parenteral drug within a fixed vial is not administered fully to a patient. This study investigated the extent of drug wastage, the financial impact on the hospital budget, and the cost savings associated with current mitigation strategies. We conducted a cross-sectional study in three University of Toronto-affiliated hospitals of various sizes. We recorded the actual amount of drug wasted over a 2-week period while using current mitigation strategies. Single-dose vial cancer drugs with the highest wastage potentials were identified (14 drugs). To calculate the hypothetical drug wastage with no mitigation strategies, we determined how many vials of drugs would be needed to fill a single prescription. The total drug costs over the 2 weeks ranged from $50,257 to $716,983 in the three institutions. With existing mitigation strategies, the actual drug wastage over the 2 weeks ranged from $928 to $5,472, which was approximately 1% to 2% of the total drug costs. In the hypothetical model with no mitigation strategies implemented, the projected drug cost wastage would have been $11,232 to $149,131, which accounted for 16% to 18% of the total drug costs. As a result, the potential annual savings while using current mitigation strategies range from 15% to 17%. The financial impact of drug wastage is substantial. Mitigation strategies lead to substantial cost savings, with the opportunity to reinvest those savings. More research is needed to determine the appropriate methods to minimize risk to patients while using the cost-saving mitigation strategies.

Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction.

PubMed

Rwagitinywa, Joseph; Sommet, Agnès; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

2018-03-01

Simulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life. ARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings. Between 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124-388) to 385 (229-670). The median cost increased from €3751/1000 inhabitants/year (1109-4681) to €9158 (3269-10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France. Overall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself. Copyright © 2018 Elsevier B.V. All rights reserved.

Offering lung cancer screening to high-risk medicare beneficiaries saves lives and is cost-effective: an actuarial analysis.

PubMed

Pyenson, Bruce S; Henschke, Claudia I; Yankelevitz, David F; Yip, Rowena; Dec, Ellynne

2014-08-01

By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening. To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer. Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures. Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life-year saved. If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014. LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring.

Offering Lung Cancer Screening to High-Risk Medicare Beneficiaries Saves Lives and Is Cost-Effective: An Actuarial Analysis

PubMed Central

Pyenson, Bruce S.; Henschke, Claudia I.; Yankelevitz, David F.; Yip, Rowena; Dec, Ellynne

2014-01-01

Background By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening. Objective To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer. Methods Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures. Results Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life-year saved. Conclusion If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014. LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring. PMID:25237423

Building a Better Learning Environment.

ERIC Educational Resources Information Center

Dentch, Matthew

2000-01-01

Explains how an environmentally friendly (Green Building) educational facility can be cost effective and enhance student performance. The concepts behind a Green Building, the areas where cost savings are possible, and some examples of realized cost savings are highlighted. Green Building funding issues are discussed. (GR)

[Influenza vaccination in the elderly population in Mexico: economic considerations].

PubMed

Gutiérrez, Juan Pablo; Bertozzi, Stefano M

2005-01-01

To estimate costs and health outcomes that could be attained by an influenza vaccination program in adults 65 years of age and older in Mexico. Between June and October 2004, a model was constructed to estimate the number of life years lost due to influenza and the fraction that could be prevented by vaccination among adults 65 years of age and older. The model also allowed the estimation of the net cost of a vaccination program, including both the cost of delivering the vaccine and savings from prevented infections and their treatment costs. Using two scenarios of vaccine effectiveness, between 7 454 and 11 169 life years could saved by the vaccine if given to all adults 65 years and older in Mexico, with a net cost per life year saved between 13 301 and 21 037 Mexican pesos (about dollar 1 210 and dollar 1 910 US dollars). Influenza vaccination among the elderly in Mexico would result in savings per life year saved well below the Mexican gross domestic product (GDP) per capita, suggesting, even without examining alternative uses for these resources, that this is a cost effective intervention in Mexico and probably also in other middle-income developing countries.

Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

DOE PAGES

Cui, Borui; Gao, Dian-ce; Xiao, Fu; ...

2016-12-23

This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. Inmore » the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.« less

Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

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

Cui, Borui; Gao, Dian-ce; Xiao, Fu

This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. Inmore » the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.« less

Transaction costs and sequential bargaining in transferable discharge permit markets.

PubMed

Netusil, N R; Braden, J B

2001-03-01

Market-type mechanisms have been introduced and are being explored for various environmental programs. Several existing programs, however, have not attained the cost savings that were initially projected. Modeling that acknowledges the role of transactions costs and the discrete, bilateral, and sequential manner in which trades are executed should provide a more realistic basis for calculating potential cost savings. This paper presents empirical evidence on potential cost savings by examining a market for the abatement of sediment from farmland. Empirical results based on a market simulation model find no statistically significant change in mean abatement costs under several transaction cost levels when contracts are randomly executed. An alternative method of contract execution, gain-ranked, yields similar results. At the highest transaction cost level studied, trading reduces the total cost of compliance relative to a uniform standard that reflects current regulations.

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

PubMed

Miller, T R; Levy, D T

2000-06-01

The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

Material saving by means of CWR technology using optimization techniques

NASA Astrophysics Data System (ADS)

Pérez, Iñaki; Ambrosio, Cristina

2017-10-01

Material saving is currently a must for the forging companies, as material costs sum up to 50% for parts made of steel and up to 90% in other materials like titanium. For long products, cross wedge rolling (CWR) technology can be used to obtain forging preforms with a suitable distribution of the material along its own axis. However, defining the correct preform dimensions is not an easy task and it could need an intensive trial-and-error campaign. To speed up the preform definition, it is necessary to apply optimization techniques on Finite Element Models (FEM) able to reproduce the material behaviour when being rolled. Meta-models Assisted Evolution Strategies (MAES), that combine evolutionary algorithms with Kriging meta-models, are implemented in FORGE® software and they allow reducing optimization computation costs in a relevant way. The paper shows the application of these optimization techniques to the definition of the right preform for a shaft from a vehicle of the agricultural sector. First, the current forging process, based on obtaining the forging preform by means of an open die forging operation, is showed. Then, the CWR preform optimization is developed by using the above mentioned optimization techniques. The objective is to reduce, as much as possible, the initial billet weight, so that a calculation of flash weight reduction due to the use of the proposed preform is stated. Finally, a simulation of CWR process for the defined preform is carried out to check that most common failures (necking, spirals,..) in CWR do not appear in this case.

Economic impact of angioplasty salvage techniques, with an emphasis on coronary stents: a method incorporating costs, revenues, clinical effectiveness and payer mix.

PubMed

Vaitkus, P T; Witmer, W T; Brandenburg, R G; Wells, S K; Zehnacker, J B

1997-10-01

We sought to broaden assessment of the economic impact of percutaneous transluminal coronary angioplasty (PTCA) revascularization salvage strategies by taking into account costs, revenues, the off-setting effects of prevented clinical complications and the effects of payer mix. Previous economic analyses of PTCA have focused on the direct costs of treatment but have not accounted either for associated revenues or for the ability of costly salvage techniques such as coronary stenting to reduce even costlier complications. Procedural costs, revenues and contribution margins (i.e., "profit") were measured for 765 consecutive PTCA cases to assess the economic impact of salvage techniques (prolonged heparin administration, thrombolysis, intracoronary stenting or use of perfusion balloon catheters) and clinical complications (myocardial infarction, coronary artery bypass graft surgery [CABG] or acute vessel closure with repeat PTCA). To assess the economic impact of various salvage techniques for failed PTCA, we used actual 1995 financial data as well as models of various mixes of fee-for-service, diagnosis-related group (DRG) and capitated payers. Under fee-for-service arrangements, most salvage techniques were profitable for the hospital. Stents were profitable at almost any level of clinical effectiveness. Under DRG-based systems, most salvage techniques such as stenting produced a financial loss to the hospital because one complication (CABG) remained profitable. Under capitated arrangements, stenting and other salvage modalities were profitable only if they were clinically effective in preventing complications in > 50% of cases in which they were used. The economic impact of PTCA salvage techniques depends on their clinical effectiveness, costs and revenues. In reimbursement systems dominated by DRG payers, salvage techniques are not rewarded, whereas complications are. Under capitated systems, the level of clinical effectiveness needed to achieve cost savings is probably not achievable in current practice. Further studies are needed to define equitable reimbursement schedules that will promote clinically effective practice.

Alcoa World Alumina: Plant-Wide Assessment at Arkansas Operations Reveals More than$900,000 in Potential Annual Savings

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

Not Available

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of$925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at$271,200. The average payback period for all five projects would be approximately 8 months.

Alcoa World Alumina: Plant Wide Assessment at Arkansas Operation Reveals More than $900,000 in Potential Annual Savings

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

None

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of $925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at $271,200. The average payback period for all five projects would be approximately 8 months.

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

PubMed

Prada, Sergio I

2017-12-01

The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of methodology transparency, which is important, because lack of transparency hinders states from learning from each other. Ultimately, the federal government needs to evaluate and improve its DUR program.

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

Costs and financial feasibility of malaria elimination

PubMed Central

Sabot, Oliver; Cohen, Justin M; Hsiang, Michelle S; Kahn, James G; Basu, Suprotik; Tang, Linhua; Zheng, Bin; Gao, Qi; Zou, Linda; Tatarsky, Allison; Aboobakar, Shahina; Usas, Jennifer; Barrett, Scott; Cohen, Jessica L; Jamison, Dean T; Feachem, Richard GA

2010-01-01

Summary The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework—potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed. PMID:21035839

The Impact of an Electronic Expensive Test Notification.

PubMed

Riley, Jacquelyn D; Stanley, Glenn; Wyllie, Robert; Kottke-Marchant, Kandice; Procop, Gary W

2018-04-25

The impact of clinical decision support tools (CDSTs) that display test cost information has been variable. We retrospectively analyzed the 3-year impact of a passive CDST that notified providers when the test order cost was $1,000 or more. We determined the most common expensive tests ordered, the frequency with which providers abandoned the order after notification, and the costs saved through this intervention. The average monthly abandonment rate was 12.5% (2014), 12.9% (2015), and 14.3% (2016). The cost savings from tests not performed for this 3-year period was $696,007. Molecular hematopathology assays were the most frequently ordered tests, with variable abandonment rates. Although this CDST was passive (ie, could be overridden at the point of order entry) and was associated with a relatively low abandonment rate, it achieved a considerable cost savings each year since each abandoned test saved the institution $1,000 or more.

Vaccination versus treatment of influenza in working adults: a cost-effectiveness analysis.

PubMed

Rothberg, Michael B; Rose, David N

2005-01-01

To determine the cost-effectiveness of influenza vaccination, antiviral therapy, or no intervention for healthy working adults, accounting for annual variation in vaccine efficacy. We conducted a cost-effectiveness analysis based on published clinical trials of influenza vaccine and antiviral drugs, incorporating 10 years of surveillance data from the World Health Organization. We modeled influenza vaccination, treatment of influenza-like illness with antiviral drugs, or both, as compared with no intervention, targeting healthy working adults under age 50 years in the general community or workplace. Outcomes included costs, illness days, and quality-adjusted days gained. In the base case analysis, the majority of costs incurred for all strategies were related to lost productivity from influenza illness. The least expensive strategy varied from year to year. For the 10-year period, antiviral therapy without vaccination was associated with the lowest overall costs (234 US dollars per person per year). Annual vaccination cost was 239 US dollars per person, and was associated with 0.0409 quality-adjusted days saved, for a marginal cost-effectiveness ratio of 113 US dollars per quality-adjusted day gained or 41,000 US dollars per quality-adjusted life-year saved compared with antiviral therapy. No intervention was the most expensive and least effective option. In sensitivity analyses, lower vaccination costs, higher annual probabilities of influenza, and higher numbers of workdays lost to influenza made vaccination more cost-effective than treatment. If vaccination cost was less than 16 US dollars or time lost from work exceeded 2.4 days per episode of influenza, then vaccination was cost saving compared with all other strategies. Influenza vaccination for healthy working adults is reasonable economically, and under certain circumstances is cost saving. Antiviral therapy is consistently cost saving.

The Cost-Benefit Balance of Statins in Hawai'i: A Moving Target.

PubMed

Lum, Corey J; Nakagawa, Kazuma; Shohet, Ralph V; Seto, Todd B; Taira, Deborah A

2017-04-01

Statins are lipid-lowering medications used for primary and secondary prevention of atherosclerotic disease and represent a substantial portion of drug costs in the United States. A better understanding of prescribing patterns and drug costs should lead to more rational utilization and help constrain health care expenditures in the United States. The 2013 Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for the State of Hawai'i was analyzed. The number of prescriptions for statins, total annual cost, and daily cost were calculated by prescriber specialty and drug. Potential savings from substituting the highest-cost statin with lower-cost statins were calculated. Over 421,000 prescriptions for statins were provided to Medicare Part D beneficiaries in Hawai'i in 2013, which cost $17.6M. The three most commonly prescribed statins were simvastatin (33.4%), atorvastatin (33.4%), and lovastatin (13.9%). Although rosuvastatin comprised 5.4% of the total statin prescriptions, it represented 30.1% of the total cost of statins due to a higher daily cost ($5.53/day) compared to simvastatin ($0.25/day) and atorvastatin ($1.10/day). Cardiologists and general practitioners prescribed the highest percentage of rosuvastatin (8% each). Hypothetical substitution of rosuvastatin would have resulted in substantial annual cost savings (Simvastatin would have saved $1.3M for 25% substitution and $5.1M for 100% substitution, while atorvastatin would have saved $1.1M for 25% substitution and $4.3M for 100% substitution). Among Medicare Part D beneficiaries in Hawai'i, prescribing variation for statins between specialties were observed. Substitution of higher-cost with lower-cost statins may lead to substantial cost savings.

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.

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

Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception

PubMed Central

Henry, Nathaniel; Schlueter, Max; Lowin, Julia; Lekander, Ingrid; Filonenko, Anna; Trussell, James; Skjeldestad, Finn Egil

2015-01-01

Objectives The objective of this study was to quantify the cost burden of unintended pregnancies (UPs) in Norway, and to estimate the proportion of costs due to imperfect contraceptive adherence. Potential cost savings that could arise from increased uptake of long-acting reversible contraception (LARC) were also investigated. Methods An economic model was constructed to estimate the total number of UPs and associated costs in women aged 15–24 years. Adherence-related UP was estimated using ‘perfect use’ and ‘typical use’ contraceptive failure rates. Potential savings from increased use of LARC were projected by comparing current costs to projected costs following a 5% increase in LARC uptake. Results Total costs from UP in women aged 15–24 years were estimated to be 164 million Norwegian Kroner (NOK), of which 81.7% were projected to be due to imperfect contraceptive adherence. A 5% increase in LARC uptake was estimated to generate cost savings of NOK 7.2 million in this group. Conclusions The cost of UP in Norway is substantial, with a large proportion of this cost arising from imperfect contraceptive adherence. Increased LARC uptake may reduce the UP incidence and generate cost savings for both the health care payer and contraceptive user. PMID:25537792

Analytical optimization of demand management strategies across all urban water use sectors

NASA Astrophysics Data System (ADS)

Friedman, Kenneth; Heaney, James P.; Morales, Miguel; Palenchar, John

2014-07-01

An effective urban water demand management program can greatly influence both peak and average demand and therefore long-term water supply and infrastructure planning. Although a theoretical framework for evaluating residential indoor demand management has been well established, little has been done to evaluate other water use sectors such as residential irrigation in a compatible manner for integrating these results into an overall solution. This paper presents a systematic procedure to evaluate the optimal blend of single family residential irrigation demand management strategies to achieve a specified goal based on performance functions derived from parcel level tax assessor's data linked to customer level monthly water billing data. This framework is then generalized to apply to any urban water sector, as exponential functions can be fit to all resulting cumulative water savings functions. Two alternative formulations are presented: maximize net benefits, or minimize total costs subject to satisfying a target water savings. Explicit analytical solutions are presented for both formulations based on appropriate exponential best fits of performance functions. A direct result of this solution is the dual variable which represents the marginal cost of water saved at a specified target water savings goal. A case study of 16,303 single family irrigators in Gainesville Regional Utilities utilizing high quality tax assessor and monthly billing data along with parcel level GIS data provide an illustrative example of these techniques. Spatial clustering of targeted homes can be easily performed in GIS to identify priority demand management areas.

Building energy information systems: Synthesis of costs, savings, and best-practice uses

DOE PAGES

Granderson, Jessica; Lin, Guanjing

2016-02-19

Building energy information systems (EIS) are a powerful customer-facing monitoring and analytical technology that can enable up to 20% site energy savings for buildings. Few technologies are as heavily marketed, but in spite of their potential, EIS remain an under-adopted emerging technology. One reason is the lack of information on purchase costs and associated energy savings. While insightful, the growing body of individual case studies has not provided industry the information needed to establish the business case for investment. Vastly different energy and economic metrics prevent generalizable conclusions. This paper addresses three common questions concerning EIS use: what are themore » costs, what have users saved, and which best practices drive deeper savings? We present a large-scale assessment of the value proposition for EIS use based on data from over two-dozen organizations. Participants achieved year-over-year median site and portfolio savings of 17% and 8%, respectively; they reported that this performance would not have been possible without the EIS. The median five-year cost of EIS software ownership (up-front and ongoing costs) was calculated to be $1,800 per monitoring point (kilowatt meter points were most common), with a median portfolio-wide implementation size of approximately 200 points. In this paper, we present an analysis of the relationship between key implementation factors and achieved energy reductions. Extent of efficiency projects, building energy performance prior to EIS installation, depth of metering, and duration of EIS were strongly correlated with greater savings. As a result, we also identify the best practices use of EIS associated with greater energy savings.« less

Building energy information systems: Synthesis of costs, savings, and best-practice uses

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

Granderson, Jessica; Lin, Guanjing

Building energy information systems (EIS) are a powerful customer-facing monitoring and analytical technology that can enable up to 20% site energy savings for buildings. Few technologies are as heavily marketed, but in spite of their potential, EIS remain an under-adopted emerging technology. One reason is the lack of information on purchase costs and associated energy savings. While insightful, the growing body of individual case studies has not provided industry the information needed to establish the business case for investment. Vastly different energy and economic metrics prevent generalizable conclusions. This paper addresses three common questions concerning EIS use: what are themore » costs, what have users saved, and which best practices drive deeper savings? We present a large-scale assessment of the value proposition for EIS use based on data from over two-dozen organizations. Participants achieved year-over-year median site and portfolio savings of 17% and 8%, respectively; they reported that this performance would not have been possible without the EIS. The median five-year cost of EIS software ownership (up-front and ongoing costs) was calculated to be $1,800 per monitoring point (kilowatt meter points were most common), with a median portfolio-wide implementation size of approximately 200 points. In this paper, we present an analysis of the relationship between key implementation factors and achieved energy reductions. Extent of efficiency projects, building energy performance prior to EIS installation, depth of metering, and duration of EIS were strongly correlated with greater savings. As a result, we also identify the best practices use of EIS associated with greater energy savings.« less

Convergence Analysis of the Graph Allen-Cahn Scheme

DTIC Science & Technology

2016-02-01

CONVERGENCE ANALYSIS OF THE GRAPH ALLEN-CAHN SCHEME ∗ XIYANG LUO† AND ANDREA L. BERTOZZI† Abstract. Graph partitioning problems have a wide range of...optimization, convergence and monotonicity are shown for a class of schemes under a graph-independent timestep restriction. We also analyze the effects of...spectral truncation, a common technique used to save computational cost. Convergence of the scheme with spectral truncation is also proved under a

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

A cost-benefit analysis of a deposit-refund program for beverage containers in Israel.

PubMed

Lavee, Doron

2010-02-01

The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program--storage, collection, and treatment costs of empty containers, and all potential benefits--savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearly economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.

A Business Case for Tele-Intensive Care Units

PubMed Central

Coustasse, Alberto; Deslich, Stacie; Bailey, Deanna; Hairston, Alesia; Paul, David

2014-01-01

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. Conclusions: Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU. PMID:25662529

Effects of tunnel and station size on the costs and service of subway transit systems

NASA Technical Reports Server (NTRS)

Dayman, B., Jr.

1979-01-01

The feasibility of less spacious, less costly underground rail mass transit system designs is studied. The major cost saving expected from alternative tunnel designs results from using precast concrete segment liners in place of steel. The saying expected for a two-foot decrease in the diameter of twin, single track tunnels is about two million dollars per route mile from 13 million dollars for precast concrete segment liners (a saving of about 16%). The cost per route-mile of a double track tunnel appears to be 15 to 25% higher than for the twin, single track tunnels. The effective cost saving expected from stations with four-car train capability instead of the usual eight-car trains is nearly 25% or seven million dollars per route mile. The saving in station costs can be obtained while improving service to the user (lower transit time and less waiting for trains) up to a capacity of 36,000 riders per hour in each direction.

Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

PubMed

Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

2015-04-01

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. Project HOPE—The People-to-People Health Foundation, Inc.

GB-InSAR monitoring and observational method for landslide emergency management: the Montaguto earthflow (AV, Italy)

NASA Astrophysics Data System (ADS)

Ferrigno, Federica; Gigli, Giovanni; Fanti, Riccardo; Intrieri, Emanuele; Casagli, Nicola

2017-06-01

On 10 March 2010, because of the heavy rainfall in the preceding days, the Montaguto landslide (Southern Italy) reactivated, affecting both state road 90 Delle Puglie and the Rome-Bari railway. A similar event occurred on May 2005 and on September 2009. As a result, the National Civil Protection Department (DPC) started an accurate monitoring and analysis program. A monitoring project using the GB-InSAR (ground-based interferometric synthetic aperture radar) system was emplaced to investigate the landslide kinematics, plan urgent safety measures for risk mitigation and design long-term stabilization work.Here, we present the GB-InSAR monitoring system results and its applications in the observational method (OM) approach. GB-InSAR is an established instrument for long-term campaigns aimed at early warning and monitoring during construction works. Our paper further develops these aspects in that it highlights how the OM based on the GB-InSAR technique can produce savings in terms of cost and time in engineering projects without compromising safety. This study focuses on the key role played by the monitoring activities during the design and planning activities, with special reference to the emergency phase.

Studies on the corrosion resistance of reinforced steel in concrete with ground granulated blast-furnace slag--An overview.

PubMed

Song, Ha-Won; Saraswathy, Velu

2006-11-16

The partial replacement of clinker, the main constituent of ordinary Portland cement by pozzolanic or latent hydraulic industrial by-products such as ground granulated blast furnace slag (GGBFS), effectively lowers the cost of cement by saving energy in the production process. It also reduces CO2 emissions from the cement plant and offers a low priced solution to the environmental problem of depositing industrial wastes. The utilization of GGBFS as partial replacement of Portland cement takes advantage of economic, technical and environmental benefits of this material. Recently offshore, coastal and marine concrete structures were constructed using GGBFS concrete because high volume of GGBFS can contribute to the reduction of chloride ingress. In this paper, the influence of using GGBFS in reinforced concrete structures from the durability aspects such as chloride ingress and corrosion resistance, long term durability, microstructure and porosity of GGBFS concrete has been reviewed and discussed.

Can home care services achieve cost savings in long-term care for older people?

PubMed

Greene, V L; Ondrich, J; Laditka, S

1998-07-01

To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis

PubMed Central

John-Baptiste, A.; Sowerby, L.J.; Chin, C.J.; Martin, J.; Rotenberg, B.W.

2016-01-01

Background: When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). Methods: We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. Results: The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Interpretation: Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems. PMID:27975045

Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis.

PubMed

John-Baptiste, A; Sowerby, L J; Chin, C J; Martin, J; Rotenberg, B W

2016-01-01

When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.

Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes.

PubMed

Wheeler, Matthew T; Heidenreich, Paul A; Froelicher, Victor F; Hlatky, Mark A; Ashley, Euan A

2010-03-02

Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness. To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening. Decision-analysis, cost-effectiveness model. Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. Competitive athletes in high school and college aged 14 to 22 years. Lifetime. Societal. Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. Incremental health care cost per life-year gained. Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000). Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. Stanford Cardiovascular Institute and the Breetwor Foundation.

A cost-consequences analysis of a primary care librarian question and answering service.

PubMed

McGowan, Jessie; Hogg, William; Zhong, Jianwei; Zhao, Xue

2012-01-01

Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

Estimating plant biomass in early-successional subtropical vegetation using a visual obstruction technique

Treesearch

Genie M. Fleming; Joseph M. Wunderle; David N. Ewert; Joseph O' Brien

2014-01-01

Aim: Non-destructive methods for quantifying above-ground plant biomass are important tools in many ecological studies and management endeavours, but estimation methods can be labour intensive and particularly difficult in structurally diverse vegetation types. We aimed to develop a low-cost, but reasonably accurate, estimation technique within early-successional...

Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.

PubMed

Lucas, Douglas E; Simpson, G Alex; Philbin, Terrence M

2015-02-01

The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs. Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary. Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P < .05). Time to radiographic healing was not significantly different (P = .87). The screw fixation group required more follow-up visits over a longer period of time (P < .05). Implant cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included. This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost. Therapeutic, Level III, Retrospective Comparative Study. © 2014 The Author(s).

The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers.

PubMed

Carls, Ginger S; Gibson, Teresa B; Driver, Vickie R; Wrobel, James S; Garoufalis, Matthew G; Defrancis, Roy R; Wang, Shaohung; Bagalman, J Erin; Christina, James R

2011-01-01

We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer. We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations. Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans. These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes.

How low can you go? The impact of reduced benefits and increased cost sharing.

PubMed

Lee, Jason S; Tollen, Laura

2002-01-01

Amid escalating health care costs and a managed care backlash, employers are considering traditional cost control methods from the pre-managed care era. We use an actuarial model to estimate the premium-reducing effects of two such methods: increasing employee cost sharing and reducing benefits. Starting from a baseline plan with rich benefits and low cost sharing, estimated premium savings as a result of eliminating five specific benefits were about 22 percent. The same level of savings was also achieved by increasing cost sharing from a 15 dollars copayment with no deductible to 20 percent coinsurance and a 250 dollars deductible. Further increases in cost sharing produced estimated savings of up to 50 percent. We discuss possible market- and individual-level effects of the proliferation of plans with high cost sharing and low benefits.

Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery.

PubMed

Chern, Alexander; Hunter, Jacob B; Bennett, Marc L

2017-01-01

To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. Retrospective case series. One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.

Oilwell Power Controller (OPC)

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

Not Available

1993-08-01

The Oil Well Power Controller (OPC) prototype units is nearing completion. This device is an oilwell beam pump controller and data logger. Applications for this device have been for an electrical power saving device, pump off control, parafffin detection, demand power load control, chemical treatment data, dynamometer and pump efficiency data. Preliminary results appear vary promising. A total of ten OPC rod pump controllers were assembled and installed on oilwells in several areas of Central and Western United States. Data was analyzed on these wells and forwarded to the participating oil companies. Cost savings on each individual oil well participatingmore » in the OPC testing vary considerably, savings on some situations have been outstanding. In situations where the pump efficiency was determined to be low, the cost savings have been considerable. Cost savings due to preventive maintenance are also present, but are difficult to pin point an exact dollar amount at the present time. A break out of actual cost data obtained on some of the oilwells controlled and monitored with the oilwell power controller.« less

The economic and operational value of using drones to transport vaccines.

PubMed

Haidari, Leila A; Brown, Shawn T; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L; Lee, Bruce Y

2016-07-25

Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40L) than the currently assumed UAV payload of 1.5L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. Copyright © 2016. Published by Elsevier Ltd.

The economic and operational value of using drones to transport vaccines

PubMed Central

Haidari, Leila A.; Brown, Shawn T.; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L.; Lee, Bruce Y.

2017-01-01

Background Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Methods Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Results Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40 L) than the currently assumed UAV payload of 1.5 L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Conclusion Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. PMID:27340098

Regional Variation in Residential Heat Pump Water Heater Performance in the U.S.

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

Maguire, Jeff; Burch, Jay; Merrigan, Tim

2014-01-01

Residential heat pump water heaters (HPWHs) have recently re-emerged on the U.S. market, and they have the potential to provide homeowners significant cost and energy savings. However, actual in use performance of a HPWH will vary significantly with climate, installation location, HVAC equipment, and hot water use. To determine the actual energy consumption of a HPWH in different U.S. regions, annual simulations of both 50 and 80 gallon HPWHs as well as a standard electric water heater were performed for over 900 locations across the United States. The simulations included a benchmark home to take into account interactions between themore » space conditioning equipment and the HPWH and a realistic hot water draw profile. It was found that the HPWH will always save some source energy when compared to a standard electric resistance water heater, although savings varies widely with location. In addition to looking at source energy savings, the breakeven cost (the net installed cost a HPWH would have to have to be a cost neutral replacement for a standard water heater) was also examined. The highest breakeven costs were seen in cases with high energy savings, such as the southeastern U.S., or high energy costs, such as New England and California. While the breakeven cost is higher for 80 gallon units than 50 gallon units, the higher net installed costs of an 80 gallon unit lead to the 50 gallon HPWHs being more likely to be cost effective.« less

Studies on Punching Shear Resistance of Two Way Slab Specimens with Partial Replacement of Cement by GGBS with Different Edge Conditions

NASA Astrophysics Data System (ADS)

Nemani, Ravi Dakshina Murthy; Rao, M. V. S.; Grandhe, Veera Venkata Satya Naranyana

2016-09-01

The present work is an effort to quantify the punching shear load resistance effect on two way simply supported slab specimens with replacement of cement by Ground Granulated Blast Furnace Slag (GGBS) with different edge conditions at various replacement levels and evaluate its efficiency. GGBS replacement has emerged as a major alternative to conventional concrete and has rapidly drawn the concrete industry attention due to its cement savings, cost savings, environmental and socio-economic benefits. The two way slab specimens were subjected to punching shear load by in house fabricated apparatus. The slab specimens were cast using M30 grade concrete with HYSD bars. The cement was partially replaced with GGBS at different percentages i.e., 0 to 30 % at regular intervals of 10 %. The test results indicate that the two way slab specimens with partial replacement of cement by GGBS exhibit high resistance against punching shear when compared with conventional concretes slab specimens.

Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic? : [participant presentation].

DOT National Transportation Integrated Search

2012-08-01

This webinar is for TxDOT project 0-6677: Costs Associated with Conversion of Surfaced to Un-surfaced Roads. The topic is Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic?.

Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic? : [instructor presentation].

DOT National Transportation Integrated Search

2012-08-01

This webinar is for TxDOT project 0-6677: Costs Associated with Conversion of Surfaced to Un-surfaced Roads. The topic is Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic?.

Time- and cost-saving apparatus for analytical sample filtration

Treesearch

William R. Kenealy; Joseph C. Destree

2005-01-01

Simple and cost-effective protocols were developed for removing particulates from samples prior to analysis by high performance liquid chromatography and gas chromatography. A filter and vial holder were developed for use with a 96-well filtration plate. The device saves preparation time and costs.

Backup, Archive, Recovery

ERIC Educational Resources Information Center

Pearring, John

2012-01-01

The education sector remains abuzz with cost-cutting expectations despite pressures to increase services. Automation of costly manual tasks could save funds for many of these institutions, specifically in data protection. The IT departments of schools and universities can take advantage of a proven cost-savings opportunity in data protection that…

Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.

PubMed

Horwitz, Jill R; Kelly, Brenna D; DiNardo, John E

2013-03-01

The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.

E-procurement and automatic identification: enhancing supply chain management in the healthcare industry.

PubMed

Smith, Alan D; Flanegin, Frank R

2004-01-01

The concepts of automated e-procurement, or electronic B2B (business-to-business) trade, are grounded in the strategic leveraging of both tangible/intangible assets for successful implementation and execution of electronic trade, resulting in significant financial benefits for firms. Some of the major reasons for this growth include significant process savings from automation, compliance, and purchasing advantage; and reduced costs that organisations can experience by conducting transactions electronically. Although these are the basic benefits associated with generic e-commerce strategies, a majority of these B2B transactions have focused on the purchase of indirect materials (especially office products and travel services). In fact, more than 93% of medical supplies on hospital shelves appear to have universal product numbers on them--at least while still in their boxes and there is a great potential for huge savings in e-procurement in the healthcare field. However, other types of supply chain-related purchases, including maintenance, repair, and operating and replacement parts, and direct material purchases, are becoming more important operational management considerations. In addition, several other key considerations are: existing procurement strategy, the vendor, technology, suppliers, and total costs of ownership. Companies need to analyse their current procurement strategy before developing an e-procurement plan.

State deregulation and Medicare costs for acute cardiac care.

PubMed

Ho, Vivian; Ku-Goto, Meei-Hsiang

2013-04-01

Past literature suggests that Certificate of Need (CON) regulations for cardiac care were ineffective in improving quality, but less is known about the effect of CON on patient costs. We analyzed Medicare data for 1991-2002 to test whether states that dropped CON experienced changes in costs or reimbursements for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. We found that states that dropped CON experienced lower costs per patient for CABG but not for percutaneous coronary intervention. Average Medicare reimbursement was lower for both procedures in states that dropped CON. The cost savings from removing CON regulations slightly exceed the total fixed costs of new CABG facilities that entered after deregulation. Assuming continued cost savings past 2002, the savings from deregulating CABG surgery outweigh the fixed costs of new entry. Thus, CON regulations for CABG may not be justified in terms of either improving quality or controlling cost growth.

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

PubMed Central

Mishra, Vinod; Lewandowska, Milena; Andersen, Jack Gunnar; Andersen, Marit Helen; Lindberg, Harald; Døhlen, Gaute; Fosse, Erik

2017-01-01

Abstract OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device. PMID:28007875

Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

PubMed Central

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

2017-01-01

Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D) and incidence of cardiovascular disease (CVD) following a low glycemic index (GI) or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1) estimate the proportions of individuals who are likely to consume pulses; (2) evaluate the reductions in established risk factors for T2D and CVD; (3) assess the percent reduction in incidences or complications of the diseases of interest; and (4) calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9) to Can$62.4 (95% CI $26–$98.8) and Can$31.6 (95% CI $11.1–$52) to Can$315.5 (95% CI $110.6–$520.4) million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term. PMID:28737688

Economics of an adolescent meningococcal conjugate vaccination catch-up campaign in the United States.

PubMed

Ortega-Sanchez, Ismael R; Meltzer, Martin I; Shepard, Colin; Zell, Elizabeth; Messonnier, Mark L; Bilukha, Oleg; Zhang, Xinzhi; Stephens, David S; Messonnier, Nancy E

2008-01-01

In June 2005, the Advisory Committee on Immunization Practices recommended the newly licensed quadrivalent meningococcal conjugate vaccine for routine use among all US children aged 11 years. A 1-time catch-up vaccination campaign for children and adolescents aged 11-17 years, followed by routine annual immunization of each child aged 11 years, could generate immediate herd immunity benefits. The objective of our study was to analyze the cost-effectiveness of a catch-up vaccination campaign with quadrivalent meningococcal conjugate vaccine for children and adolescents aged 11-17 years. We built a probabilistic model of disease burden and economic impacts for a 10-year period with and without a program of adolescent catch-up meningococcal vaccination, followed by 9 years of routine immunization of children aged 11 years. We used US age- and serogroup-specific surveillance data on incidence and mortality. Assumptions related to the impact of herd immunity were drawn from experience with routine meningococcal vaccination in the United Kingdom. We estimated costs per case, deaths prevented, life-years saved, and quality-adjusted life-years saved. With herd immunity, the catch-up and routine vaccination program for adolescents would prevent 8251 cases of meningococcal disease in a 10-year period (a 48% decrease). Excluding program costs, this catch-up and routine vaccination program would save US$551 million in direct costs and $920 million in indirect costs, including costs associated with permanent disability and premature death. At $83 per vaccinee, the catch-up vaccination would cost society approximately $223,000 per case averted, approximately $2.6 million per death prevented, approximately $127,000 per life-year saved, and approximately $88,000 per quality-adjusted life-year saved. Targeting counties with a high incidence of disease decreased the cost per life-year saved by two-thirds. Although costly, catch-up and routine vaccination of adolescents can have a substantial impact on meningococcal disease burden. Because of herd immunity, catch-up and routine vaccination cost per life-year saved could be up to one-third less than that previously assessed for routine vaccination of children aged 11 years.

Cost-Savings Analysis of Renal Scintigraphy, Stratified by Renal Function Thresholds: Mercaptoacetyltriglycine Versus Diethylene Triamine Penta-Acetic Acid.

PubMed

Parikh, Kushal R; Davenport, Matthew S; Viglianti, Benjamin L; Hubers, David; Brown, Richard K J

2016-07-01

To determine the financial implications of switching technetium (Tc)-99m mercaptoacetyltriglycine (MAG-3) to Tc-99m diethylene triamine penta-acetic acid (DTPA) at certain renal function thresholds before renal scintigraphy. Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant, retrospective, cohort study. Consecutive adult subjects (27 inpatients; 124 outpatients) who underwent MAG-3 renal scintigraphy, in the period from July 1, 2012 to June 30, 2013, were stratified retrospectively by hypothetical serum creatinine and estimated glomerular filtration rate (eGFR) thresholds, based on pre-procedure renal function. Thresholds were used to estimate the financial effects of using MAG-3 when renal function was at or worse than a given cutoff value, and DTPA otherwise. Cost analysis was performed with consideration of raw material and preparation costs, with radiotracer costs estimated by both vendor list pricing and proprietary institutional pricing. The primary outcome was a comparison of each hypothetical threshold to the clinical reality in which all subjects received MAG-3, and the results were supported by univariate sensitivity analysis. Annual cost savings by serum creatinine threshold were as follows (threshold given in mg/dL): $17,319 if ≥1.0; $33,015 if ≥1.5; and $35,180 if ≥2.0. Annual cost savings by eGFR threshold were as follows (threshold given in mL/min/1.73 m(2)): $21,649 if ≤60; $28,414 if ≤45; and $32,744 if ≤30. Cost-savings inflection points were approximately 1.25 mg/dL (serum creatinine) and 60 mL/min/1.73m(2) (eGFR). Secondary analysis by proprietary institutional pricing revealed similar trends, and cost savings of similar magnitude. Sensitivity analysis confirmed cost savings at all tested thresholds. Reserving MAG-3 utilization for patients who have impaired renal function can impart substantial annual cost savings to a radiology department. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.

PubMed

Tuttle, C R; Dewey, K G

1996-09-01

To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California. Cost-savings analysis. Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal. Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%. Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from $3,442 to $4,944 (4% discount) to $4,475 to $6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between $459 and $659 (4% discount) and $597 and $808 (0% discount) per family. Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.

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.

Alumina Calcination in the Fluid-Flash Calciner

NASA Astrophysics Data System (ADS)

Fish, William M.

In the mid 40's, Alcoa turned to fluidized solids techniques as a means of improving the efficiency of the alumina calcining process. This paper traces calciner development from the first pilot operation in 1946 through the first plant fluid-bed unit in 1952, the early "fluid-flash" calciner designs in 1960, the first 300 ton/day fluid-flash calciner at Alcoa's Bauxite, Arkansas plant in 1963, the 600 ton/day calciners installed in Suriname and Australia in 1965 and 1966, up to the 1500 ton/day Mark III calciners now operating in Jamaica, Australia and the United States. These Mark III fluid-flash calciners have provided a 30 to 40 percent fuel saving in addition to major savings in capital investment and maintenance costs.

Technology Solutions Case Study: Excavationless: Exterior-Side Foundation Insulation for Existing Homes

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

None

Building science research supports installing exterior (soil side) foundation insulation as the optimal method to enhance the hygrothermal performance of new homes. With exterior foundation insulation, water management strategies are maximized while insulating the basement space and ensuring a more even temperature at the foundation wall. This project describes an innovative, minimally invasive foundation insulation upgrade technique on an existing home that uses hydrovac excavation technology combined with a liquid insulating foam. Cost savings over the traditional excavation process ranged from 23% to 50%. The excavationless process could result in even greater savings since replacement of building structures, exterior features,more » utility meters, and landscaping would be minimal or non-existent in an excavationless process.« less

Potential Savings From Increasing Adherence to Inhaled Corticosteroid Therapy in Medicaid-Enrolled Children

PubMed Central

Rust, George; Zhang, Shun; McRoy, Luceta; Pisu, Maria

2016-01-01

Background Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx). Objectives We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children. Study Design We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007. Methods Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%. Results Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence. Conclusions If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma. PMID:25880622

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.

PubMed

Seidman, Gabriel; Atun, Rifat

2017-04-13

Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

Wound closure with Karydakis flap is decreasing the perioperative costs after pilonidal sinus excision as compared to lay-open approach.

PubMed

Borel, F; Gaudin, C; Duchalais, E; Lehur, P-A; Meurette, G

2017-12-01

To assess the impact of a simple flap closing procedure by Karydakis flap (KF) after pilonidal sinus excision on the costs and healing time as compared to routine lay-open technique. Out of 44 consecutive patients operated on for pilonidal excision (November 2013-March 2015), 17 had a Karydakis flap and 27 a lay-open procedure. For each patient, the length of stay, the operating time (OT), the time needed for complete healing and postoperative care resources were recorded. The global costs included OT, nursing care quantity, and modalities until complete scar healing. One reoperation in the lay-open group was necessary during the follow-up (8±5months). No recurrence occurred. Postoperative morbidity was similar in both groups. Results showed that KF global cost was inferior as compared to lay-open technique (941±178€ vs. 1601±399€; P=0.0001), KF healed faster (32±17 vs. 59±22days; P=0.0001), whereas OT was longer in KF group (16±7 vs. 25±4min; P=0.001). KF allows a faster healing time and a 41% lower cost than lay-open technique. Preferential use of KF rather than lay-open procedure could allow a significant health cost saving. Copyright © 2017. Published by Elsevier Masson SAS.

The Finnish experience to save asthma costs by improving care in 1987-2013.

PubMed

Haahtela, Tari; Herse, Fredrik; Karjalainen, Jussi; Klaukka, Timo; Linna, Miika; Leskelä, Riikka-Leena; Selroos, Olof; Reissell, Eeva

2017-02-01

The Finnish National Asthma Program 1994-2004 markedly improved asthma care in the 1990s. We evaluated the changes in costs during 26 years from 1987 to 2013. Direct and indirect costs were calculated by using data from national registries. Costs from both the societal and patient perspectives were included. The costs were based on patients with persistent, physician-diagnosed asthma verified by lung function measurements. We constructed minimum and maximum scenarios to assess the effect of improved asthma care on total costs. The number of patients with persistent asthma in the national drug reimbursement register increased from 83,000 to 247,583. Improved asthma control reduced health care use and disability, resulting in major cost savings. Despite a 3-fold increase in patients, the total costs decreased by 14%, from €222 million to €191 million. Costs for medication and primary care visits increased, but overall annual costs per patient decreased by 72%, from €2656 to €749. The theoretical total cost savings for 2013, comparing actual with predicted costs, were between €120 and €475 million, depending on the scenario used. The Finnish Asthma Program resulted in significant cost savings at both the societal and patient levels during a 26-year period. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement.

PubMed

Egede, Leonard E; Gebregziabher, Mulugeta; Dismuke, Clara E; Lynch, Cheryl P; Axon, R Neal; Zhao, Yumin; Mauldin, Patrick D

2012-12-01

To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories. Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value. Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼$661 million (MPR <0.6 vs. ≥0.6) to ∼$1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 ($204,530,778) among MNA subjects. Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called "triple aim" of achieving better health, better quality care, and lower cost.

Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany.

PubMed

Mertens, Janina; Stock, Stephanie; Lüngen, Markus; von Berg, Andrea; Krämer, Ursula; Filipiak-Pittroff, Birgit; Heinrich, Joachim; Koletzko, Sibylle; Grübl, Armin; Wichmann, H-Erich; Bauer, Carl-P; Reinhardt, Dietrich; Berdel, Dietrich; Gerber, Andreas

2012-09-01

The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula. © 2012 John Wiley & Sons A/S.

[The cost-effectiveness of Haemophilus influenzae type b vaccine for children under 2 years of age in Colombia].

PubMed

Alvis Guzmán, Nelson; De La Hoz Restrepo, Fernando; Vivas Consuelo, David

2006-10-01

Conjugate vaccines are the best public health tools available for preventing most invasive diseases caused by Haemophilus influenzae type b (Hib), but the high cost of the vaccines has so far kept them from being introduced worldwide. The objective of this study was to estimate the cost-effectiveness of introducing Hib conjugate vaccines for the prevention of meningitis and pneumonia among children under 2 years of age in Colombia. We estimated the direct and indirect costs of managing in-hospital pneumonia and meningitis cases. In addition, following the recommendations of the World Health Organization, we assessed the cost-effectiveness of Hib vaccination programs. We also estimated the costs for preventing Hib cases, and the cost per year of life saved in two hypothetical situations: (1) with vaccination against Hib (with 90% coverage) and (2) without vaccination. The average in-hospital treatment costs were 611.50 US$ (95% confidence interval (95% CI) = 532.2 to 690.8 US$) per case of pneumonia and 848.9 US$ (95% CI = 716.8 to 981.0 US$) per case of meningitis. The average cost per Hib case prevented was 316.7 US$ (95% CI = 294.2 to 339.2 US$). In terms of cost-effectiveness, the cost would be 2.38 US$ per year of life saved for vaccination, versus 3.81 US$ per year of life saved without vaccination. Having an adequate Hib vaccination program in Colombia could prevent around 25,000 cases of invasive disease per year, representing a cost savings of at least 15 million US$ annually. Furthermore, the program could prevent some 700 deaths per year and save 44,054 years of life per year.

Cost profiles and budget impact of rechargeable versus non-rechargeable sacral neuromodulation devices in the treatment of overactive bladder syndrome.

PubMed

Noblett, Karen L; Dmochowski, Roger R; Vasavada, Sandip P; Garner, Abigail M; Liu, Shan; Pietzsch, Jan B

2017-03-01

Sacral neuromodulation (SNM) is a guideline-recommended third-line treatment option for managing overactive bladder. Current SNM devices are not rechargeable, and require neurostimulator replacement every 3-6 years. Our study objective was to assess potential cost effects to payers of adopting a rechargeable SNM neurostimulator device. We constructed a cost-consequence model to estimate the costs of long-term SNM-treatment with a rechargeable versus non-rechargeable device. Costs were considered from the payer perspective at 2015 reimbursement levels. Adverse events, therapy discontinuation, and programming rates were based on the latest published data. Neurostimulator longevity was assumed to be 4.4 and 10.0 years for non-rechargeable and rechargeable devices, respectively. A 15-year horizon was modeled, with costs discounted at 3% per year. Total budget impact to the United States healthcare system was estimated based on the computed per-patient cost findings. Over the 15-year horizon, per-patient cost of treatment with a non-rechargeable device was $64,111 versus $36,990 with a rechargeable device, resulting in estimated payer cost savings of $27,121. These cost savings were found to be robust across a wide range of scenarios. Longer analysis horizon, younger patient age, and longer rechargeable neurostimulator lifetime were associated with increased cost savings. Over a 15-year horizon, adoption of a rechargeable device strategy was projected to save the United States healthcare system up to $12 billion. At current reimbursement rates, our analysis suggests that rechargeable neurostimulator SNM technology for managing overactive bladder syndrome may deliver significant cost savings to payers over the course of treatment. Neurourol. Urodynam. 36:727-733, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The cost-effectiveness of three interventions for providing preventive services to low-income children.

PubMed

Johnson, Ben; Serban, Nicoleta; Griffin, Paul M; Tomar, Scott L

2017-12-01

We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia. We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes. Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by <1% and cost over $38 million. Given one parameter set, SBSPs could serve over 27 000 children with an intervention cost between $500 000 and $1.3 million with a potential cost saving of $1.1 million. Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000. The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Winglets Save Billions of Dollars in Fuel Costs

NASA Technical Reports Server (NTRS)

2010-01-01

The upturned ends now featured on many airplane wings are saving airlines billions of dollars in fuel costs. Called winglets, the drag-reducing technology was advanced through the research of Langley Research Center engineer Richard Whitcomb and through flight tests conducted at Dryden Flight Research Center. Seattle-based Aviation Partners Boeing -- a partnership between Aviation Partners Inc., of Seattle, and The Boeing Company, of Chicago -- manufactures Blended Winglets, a unique design featured on Boeing aircraft around the world. These winglets have saved more than 2 billion gallons of jet fuel to date, representing a cost savings of more than $4 billion and a reduction of almost 21.5 million tons in carbon dioxide emissions.

ESCOs: Helping Schools Save Money and Energy.

ERIC Educational Resources Information Center

School Planning & Management, 2000

2000-01-01

Discusses the use of energy savings performance contracts to help reduce costs and improve school infrastructure and the educational environment. Further discussed are how indoor air quality reduces health, productivity, and costs; and examples are provided of how other schools have achieved better school environments and reduced energy costs. (GR)

Cardiovascular Magnetic Resonance Imaging-Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study.

PubMed

Hegde, Vinayak A; Biederman, Robert Ww; Mikolich, J Ronald

2017-01-01

This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. Cardiovascular magnetic resonance imaging provides diagnostic image quality in >98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner.

Cardiovascular Magnetic Resonance Imaging—Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study

PubMed Central

Hegde, Vinayak A; Biederman, Robert WW; Mikolich, J Ronald

2017-01-01

BACKGROUND This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. CONCLUSIONS Cardiovascular magnetic resonance imaging provides diagnostic image quality in >98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner. PMID:28579858

Cardiopulmonary resuscitation and automatic external defibrillator training in schools: "is anyone learning how to save a life?".

PubMed

Hart, Devin; Flores-Medrano, Oscar; Brooks, Steve; Buick, Jason E; Morrison, Laurie J

2013-09-01

Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED), save lives in cardiac arrest cases. School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. The study objective was to determine the rates of CPR and AED training in Toronto secondary schools and to identify barriers to training and training techniques. This prospective study consisted of telephone interviews conducted with key school staff knowledgeable about CPR and AED teaching. An encrypted Web-based tool with prespecified variables and built-in logic was employed to standardize data collection. Of 268 schools contacted, 93% were available for interview and 83% consented to participate. Students and staff were trained in CPR in 51% and 80% of schools, respectively. Private schools had the lowest training rate (39%). Six percent of schools provided AED training to students and 47% provided AED training to staff. Forty-eight percent of schools had at least one AED installed, but 25% were unaware if their AED was registered with emergency services dispatch. Cost (17%), perceived need (11%), and school population size (10%) were common barriers to student training. Frequently employed training techniques were interactive (32%), didactic instruction (30%) and printed material (16%). CPR training rates for staff and students were moderate overall and lowest in private schools, whereas training rates in AED use were poor in all schools. Identified barriers to training include cost and student population size (perceived to be too small to be cost-effective or too large to be implemented). Future studies should assess the application of convenient and cost-effective teaching alternatives not presently in use.

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

Baxter, Van D.; Munk, Jeffrey D.; Gehl, Anthony C.

The field study is planned to continue through the 2016 cooling season with the draft final project report due by September 30, 2016. This report provides a description of both installations and preliminary 2015 cooling and fall season performance results for the Knoxville site. For the August 18 through December 14 period, the Knoxville site GS-IHP provided 53.6% total source energy savings compared to a baseline electric RTU/heat pump and electric WH. Peak demand savings ranged from 33% to 59% per month. Energy cost savings of 53.1% have been achieved to date with more than half of that coming frommore » reduced demand charges. Data on installation and maintenance costs are being collected and will be combined with total test period energy savings data for a payback analysis to be included in the project final report. The GS-IHP also saved a significant amount of carbon emissions. The total emission savings for the Knoxville site for the August-December 2015 period were ~0.8 metric tons. If trading for carbon credits ever becomes a reality, additional cost savings would be realized.« less

Holographic daylighting

NASA Astrophysics Data System (ADS)

Ludman, Jacques E.; Riccobono, Juanita R.; Savant, Gajendra D.; Jannson, Joanna L.; Campbell, Eugene W.; Hall, Robyn

1995-09-01

Daylighting techniques are an effective means of reducing both lighting and cooling costs; however, many of the standard techniques have flaws which reduce their effectiveness. Daylighting holograms are an efficient and effective method for diffracting sunlight up onto the ceiling, deep in a room, without diffracting the light at eye-level. They need only cover the top half of a window to produce significant energy savings. They may be used as part of a new glazing system or as a retrofit to existing windows. These holograms are broadband and are able to passively track the movement of the sun across the sky, throughout the day and year.

Global ablation techniques.

PubMed

Woods, Sarah; Taylor, Betsy

2013-12-01

Global endometrial ablation techniques are a relatively new surgical technology for the treatment of heavy menstrual bleeding that can now be used even in an outpatient clinic setting. A comparison of global ablation versus earlier ablation technologies notes no significant differences in success rates and some improvement in patient satisfaction. The advantages of the newer global endometrial ablation systems include less operative time, improved recovery time, and decreased anesthetic risk. Ablation procedures performed in an outpatient surgical or clinic setting provide advantages both of potential cost savings for patients and the health care system and improved patient convenience. Copyright © 2013. Published by Elsevier Inc.

Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.

PubMed

van Nieuwenhoven, Christianne A; Buskens, Erik; Bergmans, Dennis C; van Tiel, Frank H; Ramsay, Graham; Bonten, Marc J M

2004-01-01

Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were 351 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients. Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is <0.923, the costs of the intervention are less than 2,500 dollars, and the prevalence of VAP without intervention is >4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.

Potential Cost Savings for Use of 3D Printing Combined With 3D Imaging and CPLM for Fleet Maintenance and Revitalization

DTIC Science & Technology

2014-04-30

bäÉîÉåíÜ=^ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = Potential Cost Savings for Use of 3D Printing Combined With 3D...TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Potential Cost Savings for Use of 3D Printing Combined With 3D Imaging and...Chair: RADM David Lewis, USN Program Executive Officer, SHIPS Potential Cost Savings for Use of 3D Printing Combined With 3D Imaging and CPLM for

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

PubMed

Claxton, L; Taylor, M; Kay, E

2016-02-12

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

Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

PubMed

Cedillo, Sergio; Sicras-Mainar, Antoni; Jiménez-Ruiz, Carlos A; Fernández de Bobadilla, Jaime; Rejas-Gutiérrez, Javier

2017-01-01

The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation. © 2016 S. Karger AG, Basel.

[Cost- effectiveness analysis of pneumococcal vaccination in Iceland].

PubMed

Björnsdóttir, Margrét

2010-09-01

Pneumococcus is a common cause of disease among children and the elderly. With the emergence of resistant serotypes, antibiotic treatment is getting limited. Many countries have therefore introduced a vaccination program among children against the most common serotypes. The aim of this study was to analyse cost-effectiveness of adding a vaccination program against pneumococcus in Iceland. A cost-effectiveness analysis was carried out from a societal perspective where the cost-effectiveness ratio ICER was estimated from the cost of each additional life and life year saved. The analyse was based on the year 2008 and all cost were calculated accordingly. The rate of 3% was used for net present-value calculation. Annual societal cost due to pneumococcus in Iceland was estimated to be 718.146.252 ISK if children would be vaccinated but 565.026.552 ISK if they would not be vaccinated. The additional cost due to the vaccination program was therefore 153.119.700 ISK . The vaccination program could save 0,669 lives among children aged 0-4 years old and 21.11 life years. The cost was 228.878.476 ISK for each additional life saved and 7.253.420 ISK for each additional life year saved. Given initial assumptions the results indicate that a vaccination programme against pneumococcal disease in Iceland would be cost effective.

Vibration transfer mobility measurements using maximum length sequences

NASA Astrophysics Data System (ADS)

Singleton, Herbert L.

2005-09-01

Vibration transfer mobility measurements are required under Federal Transit Administration guidelines when developing detailed predictions of ground-borne vibration for rail transit systems. These measurements typically use a large instrumented hammer to generate impulses in the soil. These impulses are measured by an array of accelerometers to characterize the transfer mobility of the ground in a localized area. While effective, these measurements often make use of heavy, custom-engineered equipment to produce the impulse signal. To obtain satisfactory signal-to-noise ratios, it is necessary to generate multiple impulses to generate an average value, but this process involves considerable physical labor in the field. To address these shortcomings, a transfer mobility measurement system utilizing a tactile transducer and maximum length sequences (MLS) was developed. This system uses lightweight off-the-shelf components to significantly reduce the weight and cost of the system. The use of MLS allows for adequate signal-to-noise ratio from the tactile transducer, while minimizing the length of the measurement. Tests of the MLS system show good agreement with the impulse-based method. The combination of the cost savings and reduced weight of this new system facilitates transfer mobility measurements that are less physically demanding, and more economical when compared with current methods.

Influence of computational fluid dynamics on experimental aerospace facilities: A fifteen year projection

NASA Technical Reports Server (NTRS)

1983-01-01

An assessment was made of the impact of developments in computational fluid dynamics (CFD) on the traditional role of aerospace ground test facilities over the next fifteen years. With improvements in CFD and more powerful scientific computers projected over this period it is expected to have the capability to compute the flow over a complete aircraft at a unit cost three orders of magnitude lower than presently possible. Over the same period improvements in ground test facilities will progress by application of computational techniques including CFD to data acquisition, facility operational efficiency, and simulation of the light envelope; however, no dramatic change in unit cost is expected as greater efficiency will be countered by higher energy and labor costs.

An Analysis of the Cost and Performance of Photovoltaic Systems as a Function of Module Area

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

Horowitz, Kelsey A.W.; Fu, Ran; Silverman, Tim

We investigate the potential effects of module area on the cost and performance of photovoltaic systems. Applying a bottom-up methodology, we analyzed the costs associated with mc-Si and thin-film modules and systems as a function of module area. We calculate a potential for savings of up to $0.04/W, $0.10/W, and $0.13/W in module manufacturing costs for mc-Si, CdTe, and CIGS respectively, with large area modules. We also find that an additional $0.05/W savings in balance-of-systems costs may be achieved. However, these savings are dependent on the ability to maintain efficiency and manufacturing yield as area scales. Lifetime energy yield mustmore » also be maintained to realize reductions in the levelized cost of energy. We explore the possible effects of module size on efficiency and energy production, and find that more research is required to understand these issues for each technology. Sensitivity of the $/W cost savings to module efficiency and manufacturing yield is presented. We also discuss non-cost barriers to adoption of large area modules.« less

Cost-effectiveness of the Health X Project for tuberculosis control in China.

PubMed

Wang, W-B; Zhang, H; Petzold, M; Zhao, Q; Xu, B; Zhao, G-M

2014-08-01

Between 2002 and 2008, China's National Tuberculosis Control Programme created the Health X Project, financed in part by a World Bank loan, with additional funding from the UK Department for International Development. To assess the cost-effectiveness of the Project and its impact from a financial point of view on tuberculosis (TB) control in China. A decision-analytic model was used to evaluate the cost-effectiveness of the Project. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results. The primary outcome of the study was cost per disability-adjusted life-year (DALY) saved and incremental DALYs saved. In comparison with alternative scenario 1, the Project detected 1.6 million additional cases, 44 000 deaths were prevented and a total of 18.4 million DALYs saved. The Project strategies cost approximately Chinese yuan (CNY) 953 per DALY saved (vs. CNY1140 in the control areas), and saved an estimated CNY17.5 billion in comparison with the unchanged alternative scenario (scenario 1) or CNY10.8 billion with the control scenario (scenario 2). The Project strategies were affordable and of comparable cost-effectiveness to those of other developing countries. The results also provide strong support for the existing policy of scaling up DOTS in China.

Societal economic costs and benefits from death: another look.

PubMed

Stack, Steven

2007-04-01

B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide.

Productivity Savings from Colorectal Cancer Prevention and Control Strategies

PubMed Central

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

2011-01-01

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

Productivity savings from colorectal cancer prevention and control strategies.

PubMed

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

2011-08-01

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

Future Warfare: Anthology Revised Edition

DTIC Science & Technology

2001-06-01

film “ Saving Private Ryan ” are compelling and chilling. But the information age promises to make ground combat considerably less destructive that the...116 Saving Private Ryan , 80–81 Schwarzkopf, Norman, 242, 243–244 Science and technology, 191–202 Scipio, 44 Security beyond the year 2010, 128–131, 137... Private Ryan ” where the true horror of face-to-face ground combat is driven into the psyche of the movie goer. I am increasingly convinced, however

Agricultural costs of the Chesapeake Bay total maximum daily load.

PubMed

Kaufman, Zach; Abler, David; Shortle, James; Harper, Jayson; Hamlett, James; Feather, Peter

2014-12-16

This study estimates costs to agricultural producers of the Watershed Implementation Plans (WIPs) developed by states in the Chesapeake Bay Watershed to comply with the Chesapeake Bay total maximum daily load (TMDL) and potential cost savings that could be realized by a more efficient selection of agricultural Best Management Practices (BMPs) and spatial targeting of BMP implementation. The cost of implementing the WIPs between 2011 and 2025 is estimated to be about $3.6 billion (in 2010 dollars). The annual cost associated with full implementation of all WIP BMPs from 2025 onward is about $900 million. Significant cost savings can be realized through careful and efficient BMP selection and spatial targeting. If retiring up to 25% of current agricultural land is included as an option, Bay-wide cost savings of about 60% could be realized compared to the WIPs.

Is fenofibrate a cost-saving treatment for middle-aged individuals with type 2 diabetes? A South African private-sector perspective.

PubMed

Wessels, Francois

2010-01-01

This project was based on the FIELD trial. It is a localisation of the study by Carrington and Stewart. The aim of the original study was to determine the impact of fenofibrate therapy on healthcare costs of middle-aged patients with type 2 diabetes at high risk of future cardiovascular events. The methodology used in the Carrington article was adopted for this study. The clinical foundation for the analysis was derived from the findings of the FIELD study. All costs were sourced from electronic databases obtained from private-sector South African funders of healthcare. Event costs for the cardiovascular events were determined and added to the treatment costs for the individual treatment arms. The cost saving was determined as the difference between the event costs saved and the additional treatment costs associated with fenofibrate treatment. All costs were reported as 2008 ZAR and a discount rate of 10% was used. The study adopted a South African private-sector funder perspective. If the same approach is followed as in the Carrington and Stewart study, a cost saving of 18% results. This is the difference between the total costs associated with the placebo and fenofibrate arms, respectively (R3 480 471 compared to R2 858 598 per 1 000 patient years for the placebo and fenofibrate arms, respectively). The total costs were determined as the sum of associated event costs and treatment costs for each of the comparators. Based on this exploratory analysis, it seems that Lipanthyl treatment in middle-aged patients resulted in a cost saving due to the prevention of cardiovascular events when it was used in the treatment of type 2 diabetics, as in the FIELD study. It should therefore be considered to be cost effective, even when just the cardiovascular risk reduction effect is considered.

Electroformed Nickel-Graphite Composite

NASA Technical Reports Server (NTRS)

Xiong-Skiba, Pei

2005-01-01

Future x-ray astronomy will demand larger optics than Chandra, currently in orbit. Ways must be devised to produce cheaper and lighter x-ray mirrors to save the cost of manufacturing and launching this future telescope. One technique, being developed at Marshall Space Flight Center and elsewhere, is electroformed nickel replication technique, wherein mirror shells are electroformed (using pure nickel or a nickel alloy) onto super-polished and figured aluminum mandrels and are subsequently released by cooling. This technique can produce relatively inexpensive mirrors, but is hampered by the high density of nickel (8.9 g / cm3). An alternative is to develop a composite, with lower mass density and compatible mechanical properties to the nickel cobalt alloy, as the mirror shell material.

Short Duration Base Heating Test Improvements

NASA Technical Reports Server (NTRS)

Bender, Robert L.; Dagostino, Mark G.; Engel, Bradley A.; Engel, Carl D.

1999-01-01

Significant improvements have been made to a short duration space launch vehicle base heating test technique. This technique was first developed during the 1960's to investigate launch vehicle plume induced convective environments. Recent improvements include the use of coiled nitrogen buffer gas lines upstream of the hydrogen / oxygen propellant charge tubes, fast acting solenoid valves, stand alone gas delivery and data acquisition systems, and an integrated model design code. Technique improvements were successfully demonstrated during a 2.25% scale X-33 base heating test conducted in the NASA/MSFC Nozzle Test Facility in early 1999. Cost savings of approximately an order of magnitude over previous tests were realized due in large part to these improvements.

Cost-benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals.

PubMed

Diel, Roland; Nienhaus, Albert; Hillemann, Doris; Richter, Elvira

2016-02-01

Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects. Copyright ©ERS 2016.