Healthcare cost savings estimator tool for chronic disease self-management program: a new tool for program administrators and decision makers.

PubMed

Ahn, SangNam; Smith, Matthew Lee; Altpeter, Mary; Post, Lindsey; Ory, Marcia G

2015-01-01

Chronic disease self-management education (CDSME) programs have been delivered to more than 100,000 older Americans with chronic conditions. As one of the Stanford suite of evidence-based CDSME programs, the chronic disease self-management program (CDSMP) has been disseminated in diverse populations and settings. The objective of this paper is to introduce a practical, universally applicable tool to assist program administrators and decision makers plan implementation efforts and make the case for continued program delivery. This tool was developed utilizing data from a recent National Study of CDSMP to estimate national savings associated with program participation. Potential annual healthcare savings per CDSMP participant were calculated based on averted emergency room visits and hospitalizations. While national data can be utilized to estimate cost savings, the tool has built-in features allowing users to tailor calculations based on their site-specific data. Building upon the National Study of CDSMP's documented potential savings of $3.3 billion in healthcare costs by reaching 5% of adults with one or more chronic conditions, two heuristic case examples were also explored based on different population projections. The case examples show how a small county and large metropolitan city were not only able to estimate healthcare savings ($38,803 for the small county; $732,290 for the large metropolitan city) for their existing participant populations but also to project significant healthcare savings if they plan to reach higher proportions of middle-aged and older adults. Having a tool to demonstrate the monetary value of CDSMP can contribute to the ongoing dissemination and sustainability of such community-based interventions. Next steps will be creating a user-friendly, internet-based version of Healthcare Cost Savings Estimator Tool: CDSMP, followed by broadening the tool to consider cost savings for other evidence-based programs.

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.

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.

Doula care, birth outcomes, and costs among Medicaid beneficiaries.

PubMed

Kozhimannil, Katy Backes; Hardeman, Rachel R; Attanasio, Laura B; Blauer-Peterson, Cori; O'Brien, Michelle

2013-04-01

We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.

Energy Impacts of Wide Band Gap Semiconductors in U.S. Light-Duty Electric Vehicle Fleet

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

Warren, Joshua A.; Riddle, Matthew E.; Graziano, Diane J.

2015-08-12

Silicon carbide and gallium nitride, two leading wide band gap semiconductors with significant potential in electric vehicle power electronics, are examined from a life cycle energy perspective and compared with incumbent silicon in U.S. light-duty electric vehicle fleet. Cradle-to-gate, silicon carbide is estimated to require more than twice the energy as silicon. However, the magnitude of vehicle use phase fuel savings potential is comparatively several orders of magnitude higher than the marginal increase in cradle-to-gate energy. Gallium nitride cradle-to-gate energy requirements are estimated to be similar to silicon, with use phase savings potential similar to or exceeding that of siliconmore » carbide. Potential energy reductions in the United States vehicle fleet are examined through several scenarios that consider the market adoption potential of electric vehicles themselves, as well as the market adoption potential of wide band gap semiconductors in electric vehicles. For the 2015–2050 time frame, cumulative energy savings associated with the deployment of wide band gap semiconductors are estimated to range from 2–20 billion GJ depending on market adoption dynamics.« less

Rohm and Haas: Company Uses Knoxville Plant Assessment Results to Develop Best Practices Guidelines and Benchmark for Its Other Sites (Revised)

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

Not Available

2003-07-01

Rohm and Haas conducted a plant-wide energy assessment at its Knoxville, Tennessee, chemicals manufacturing facility. The assessment identified potential annual energy savings of nearly 47,000 MMBtu in steam and fuel and 11,000 MWh in electricity. Annual cost savings were estimated at almost$1.5 million. After the assessment was replicated in California and Kentucky plants, the companys additional estimated cost savings were$500,000 annually. Additional annual energy savings were about 23,000 MMBtu and 6,000 MWh. The assessments also indicated the plants would reduce nitrous oxide emissions.

Rohm and Haas: Company Uses Knoxville Plant Assessment Results to Develop Best Practices Guidelines and Benchmark for Its Other Sites

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

None

2003-05-01

Rohm and Haas conducted a plant-wide energy assessment at its Knoxville, Tennessee, chemicals manufacturing facility. The assessment identified potential annual energy savings of nearly 47,000 MMBtu in steam and fuel and 11,000 MWh in electricity. Annual cost savings were estimated at almost $1.5 million. After the assessment was replicated in California and Kentucky plants, the company's additional estimated cost savings were $500,000 annually. Additional annual energy savings were about 23,000 MMBtu and 6,000 MWh. The assessments also indicated the plants would reduce nitrous oxide emissions.

Electric energy savings from new technologies. Revision 1

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

Harrer, B.J.; Kellogg, M.A.; Lyke, A.J.

1986-09-01

Purpose of the report is to provide information about the electricity-saving potential of new technologies to OCEP that it can use in developing alternative long-term projections of US electricity consumption. Low-, base-, and high-case scenarios of the electricity savings for 10 technologies were prepared. The total projected annual savings for the year 2000 for all 10 technologies were 137 billion kilowatt hours (BkWh), 279 BkWh, and 470 BkWh, respectively, for the three cases. The magnitude of these savings projections can be gauged by comparing them to the Department's reference case projection for the 1985 National Energy Policy Plan. In themore » Department's reference case, total consumption in 2000 is projected to be 3319 BkWh. Because approximately 75% of the base-case estimate of savings are already incorporated into the reference projection, only 25% of the savings estimated here should be subtracted from the reference projection for analysis purposes.« less

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

Potential impacts of Brayton and Stirling cycle engines

NASA Astrophysics Data System (ADS)

Heft, R. C.

1980-11-01

Two engine technologies (Brayton cycle and Stirling cycle) are examined for their potential economic impact and fuel utilization. An economic analysis of the expected response of buyers to the attributes of the alternative engines was performed. Hedonic coefficients for vehicle fuel efficiency, performance and size were estimated for domestic cars based upon historical data. The marketplace value of the fuel efficiency enhancement provided by Brayton or Stirling engines was estimated. Under the assumptions of 10 years for plant conversions and 1990 and 1995 as the introduction data for turbine and Stirling engines respectively, the comparative fuel savings and present value of the future savings in fuel costs were estimated.

Potential impacts of Brayton and Stirling cycle engines

NASA Technical Reports Server (NTRS)

Heft, R. C.

1980-01-01

Two engine technologies (Brayton cycle and Stirling cycle) are examined for their potential economic impact and fuel utilization. An economic analysis of the expected response of buyers to the attributes of the alternative engines was performed. Hedonic coefficients for vehicle fuel efficiency, performance and size were estimated for domestic cars based upon historical data. The marketplace value of the fuel efficiency enhancement provided by Brayton or Stirling engines was estimated. Under the assumptions of 10 years for plant conversions and 1990 and 1995 as the introduction data for turbine and Stirling engines respectively, the comparative fuel savings and present value of the future savings in fuel costs were estimated.

Photovoltaics as a terrestrial energy source. Volume 2: System value

NASA Technical Reports Server (NTRS)

Smith, J. L.

1980-01-01

Assumptions and techniques employed by the electric utility industry and other electricity planners to make estimates of the future value of photovoltaic (PV) systems interconnected with U.S. electric utilities were examined. Existing estimates of PV value and their interpretation and limitations are discussed. PV value is defined as the marginal private savings accruing to potential PV owners. For utility-owned PV systems, these values are shown to be the after-tax savings in conventional fuel and capacity displaced by the PV output. For non-utility-owned (distributed) systems, the utility's savings in fuel and capacity must first be translated through the electric rate structure (prices) to the potential PV system owner. Base-case estimates of the average value of PV systems to U.S. utilities are presented. The relationship of these results to the PV Program price goals and current energy policy is discussed; the usefulness of PV output quantity goals is also reviewed.

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 potential for secondary mass savings in vehicle lightweighting.

PubMed

Alonso, Elisa; Lee, Theresa M; Bjelkengren, Catarina; Roth, Richard; Kirchain, Randolph E

2012-03-06

Secondary mass savings are mass reductions that may be achieved in supporting (load-bearing) vehicle parts when the gross vehicle mass (GVM) is reduced. Mass decompounding is the process by which it is possible to identify further reductions when secondary mass savings result in further reduction of GVM. Maximizing secondary mass savings (SMS) is a key tool for maximizing vehicle fuel economy. In today's industry, the most complex parts, which require significant design detail (and cost), are designed first and frozen while the rest of the development process progresses. This paper presents a tool for estimating SMS potential early in the design process and shows how use of the tool to set SMS targets early, before subsystems become locked in, maximizes mass savings. The potential for SMS in current passenger vehicles is estimated with an empirical model using engineering analysis of vehicle components to determine mass-dependency. Identified mass-dependent components are grouped into subsystems, and linear regression is performed on subsystem mass as a function of GVM. A Monte Carlo simulation is performed to determine the mean and 5th and 95th percentiles for the SMS potential per kilogram of primary mass saved. The model projects that the mean theoretical secondary mass savings potential is 0.95 kg for every 1 kg of primary mass saved, with the 5th percentile at 0.77 kg/kg when all components are available for redesign. The model was used to explore an alternative scenario where realistic manufacturing and design limitations were implemented. In this case study, four key subsystems (of 13 total) were locked-in and this reduced the SMS potential to a mean of 0.12 kg/kg with a 5th percentile of 0.1 kg/kg. Clearly, to maximize the impact of mass reduction, targets need to be established before subsystems become locked in.

Design and evaluation of Continuous Descent Approach as a fuel-saving procedure

NASA Astrophysics Data System (ADS)

Jin, Li

Continuous Descent Approach (CDA), which is among the key concepts of the Next Generation Air Transportation System (NextGen), is a fuel economical procedure, but requires increased separation to accommodate spacing uncertainties among arriving aircraft. Such negative impact is often overlooked when benefits are estimated. Although a considerable number of researches have been devoted to the estimation of potential fuel saving of CDA, few have attempted to explain the fuel saving observed in field tests from an analytical point of view. This research gives insights into the reasons why CDA saves fuel, and a number of design guidelines for CDA procedures are derived. The analytical relationship between speed, altitude, and time-cumulative fuel consumption is derived based on Base of Aircraft Data (BADA) Total Energy Model. Theoretical analysis implies that speed profile has an impact as substantial as, if not more than, vertical profile on the fuel consumption in the terminal area. In addition, CDA is not intrinsically a fuel-saving procedure: whether CDA saves fuel or not is contingent upon whether the speed profile is properly designed or not. Based on this model, the potential fuel savings due to CDA at San Francisco International Airport were estimated, and the accuracy of this estimation is analyzed. Possible uncertainties in this fuel estimation primarily resulted from the modeled CDA procedure and the inaccuracy of BADA. This thesis also investigates the fuel savings due to CDAs under high traffic conditions, counting not only the savings benefiting from optimal vertical profiles but also the extra fuel burn resulting from the increased separations. The simulated CDAs traffic is based on radar track data, and deconflicted by a scheduling algorithm that targets minimized delays. The delays are absorbed by speed change and path stretching, accounting for the air traffic controls that are entailed by CDAs. The fuel burn statistics calculated based on the BADA Total Energy Model reveals that the CDAs save on average 171.87 kg per arrival, but the number is discounted by delay absorption. The savings diminish as the arrival demand increases, and could be even negative due to large delays. The throughput analysis demonstrated that the impact of CDA on airport capacity is insignificant and tolerable. The Atlanta International Airport was used as the testbed for sensitivity analysis, and the New York Metroplex was used as the test bed for throughput analysis.

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness.

PubMed

Khandelwal, Nita; Benkeser, David C; Coe, Norma B; Curtis, J Randall

2016-08-01

To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness. Decision analysis using literature estimates and inpatient administrative data from Premier. Patients with chronic, life-limiting illness admitted to a hospital within the Premier network. None. Using Premier data (2008-2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions' efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (SD, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (SD, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients. In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers.

12 CFR 3.153 - Internal models approach (IMA).

Code of Federal Regulations, 2014 CFR

2014-01-01

... models that: (i) Assess the potential decline in value of its modeled equity exposures; (ii) Are...) The national bank's or Federal savings association's model must produce an estimate of potential losses for its modeled equity exposures that is no less than the estimate of potential losses produced by...

Green Routing Fuel Saving Opportunity Assessment: A Case Study on California Large-Scale Real-World Travel Data: Preprint

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

Zhu, Lei; Holden, Jacob; Gonder, Jeff

New technologies, such as connected and automated vehicles, have attracted more and more researchers for improving the energy efficiency and environmental impact of current transportation systems. The green routing strategy instructs a vehicle to select the most fuel-efficient route before the vehicle departs. It benefits the current transportation system with fuel saving opportunity through identifying the greenest route. This paper introduces an evaluation framework for estimating benefits of green routing based on large-scale, real-world travel data. The framework has the capability to quantify fuel savings by estimating the fuel consumption of actual routes and comparing to routes procured by navigationmore » systems. A route-based fuel consumption estimation model, considering road traffic conditions, functional class, and road grade is proposed and used in the framework. An experiment using a large-scale data set from the California Household Travel Survey global positioning system trajectory data base indicates that 31% of actual routes have fuel savings potential with a cumulative estimated fuel savings of 12%.« less

Green Routing Fuel Saving Opportunity Assessment: A Case Study on California Large-Scale Real-World Travel Data

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

Zhu, Lei; Holden, Jacob; Gonder, Jeffrey D

New technologies, such as connected and automated vehicles, have attracted more and more researchers for improving the energy efficiency and environmental impact of current transportation systems. The green routing strategy instructs a vehicle to select the most fuel-efficient route before the vehicle departs. It benefits the current transportation system with fuel saving opportunity through identifying the greenest route. This paper introduces an evaluation framework for estimating benefits of green routing based on large-scale, real-world travel data. The framework has the capability to quantify fuel savings by estimating the fuel consumption of actual routes and comparing to routes procured by navigationmore » systems. A route-based fuel consumption estimation model, considering road traffic conditions, functional class, and road grade is proposed and used in the framework. An experiment using a large-scale data set from the California Household Travel Survey global positioning system trajectory data base indicates that 31% of actual routes have fuel savings potential with a cumulative estimated fuel savings of 12%.« less

Energy consumption characteristics of transports using the prop-fan concept

NASA Technical Reports Server (NTRS)

1976-01-01

The fuel saving and economic potentials of the prop-fan high-speed propeller concept were evaluated for twin-engine commercial transport airplanes designed for 3333.6 km range, 180 passengers, and Mach 0.8 cruise. A fuel saving of 9.7% at the design range was estimated for a prop-fan airplane having wing-mounted engines, while a 5.8% saving was estimated for a design having the engines mounted on the aft body. The fuel savings and cost were found to be sensitive to the propeller noise level and to aerodynamic drag effects due to wing-slipstream interaction. Uncertainties in these effects could change the fuel savings as much as + or - 50%. A modest improvement in direct operating cost (DOC) was estimated for the wing-mounted prop-fan at current fuel prices. This improvement could become substantial in the event of further relative increases in the price of oil. The improvement in DOC requires the achievement of the nominal fuel saving and reductions in propeller and gearbox maintenance costs relative to current experience.

Análisis de costo-beneficio: prevención del VIH/sida en migrantes en Centroamérica

PubMed Central

Alarid-Escudero, Fernando; Sosa-Rubí, Sandra G.; Fernández, Bertha; Galárraga, Omar

2014-01-01

Objective To quantify the costs and benefits of three HIV prevention interventions in migrants in Central America: voluntary counseling and testing, treatment of sexually transmitted infections, and condom distribution. Materials and methods The methods were: a) identification and quantification of costs; b) quantification of benefits, defined as the potential savings in antiretroviral treatment of HIV cases prevented; and c) estimation of the cost-benefit ratio. Results The model estimated that 9, 21 and 8 cases of HIV were prevented by voluntary counseling and testing, treatment for sexually transmitted infections and condom distribution per 10 000 migrants, respectively. In Panama, condom distribution and treatment for sexually transmitted infections had a return of US$131/USD and US$69.8/USD. Returns in El Salvador were US$2.0/USD and US$42.3/USD in voluntary counseling and testing and condom distribution, respectively. Conclusion The potential savings on prevention have a large variation between countries. Nevertheless, the cost-benefit estimates suggest that the HIV prevention programs in Central America can potentially result in monetary savings in the long run. PMID:23918053

New Manufacturing Method for Paper Filler and Fiber Material

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

Doelle, Klaus

2013-08-25

The use of fillers in printing and writing papers has become a prerequisite for competing in a global market to reduce the cost of materials. Use of calcium carbonates (ranging from 18% to 30%) as filler is a common practice in the paper industry but the choices of fillers for each type of papers vary widely according to its use. The market for uncoated digital printing paper is one that continues to introduce exciting growth projections. and it is important to understand the effect that new manufacturing methods of calcium carbonates have on the energy efficiency and paper production. Research conducted under this award showed that the new fiber filler composite material has the potential to increase the paper filler content by up to 5% without losing mechanical properties. Benefits of the technology can be summarized as follows for a 1% filler increase per metric ton of paper produced: (i) production cost savings overmore » $$12, (ii) Energy savings of 100,900 btu, (iii) CO{sub 2} emission savings of 33 lbs, and additional savings for wood preparation, pulping, recovery of 203593 btu with a 46lbs of CO{sub 2} emission savings per 1% filler increase. In addition the technology has the potential to save: (i) additional $$3 per ton of bleached pulp produced, (ii) bleaching energy savings of 170,000 btu, (iii) bleaching CO{sub 2} emission savings of 39 lbs, and (iv) additional savings for replacing conventional bleaching chemicals with a sustainable bleaching chemical is estimated to be 900,000 btu with a 205 lbs of CO{sub 2} emission savings per ton of bleached pulp produced. All the above translates to a estimated annual savings for a 12% filler increase of 296 trillion buts or 51 million barrel of oil equivalent (BOE) or 13.7% of the industries energy demand. This can lead to a increase of renewable energy usage from 56% to close to 70% for the industry sector. CO{sub 2} emission of the industry at a 12% filler increase could be lowered by over 39 million tons annually. If the new technology could be implemented for bleaching process a total annual estimated energy savings potential of 64 trillion buts or 11 million barrel of oil equivalent (BOE) equal to 3% of the paper industries energy demand could be realized. This could lead to a increase of renewable energy usage from 56% to close to 60% for the industry. CO{sub 2} emissions could be lowered by over 7.4 million tons annually. It is estimated that an installed system could also yield a 75 to 100% return of investment (ROI) rate for the capital equipment that need to be installed for the fiber filler composite manufacturing process.« less

Potential cost savings of medication therapy management in safety-net clinics.

PubMed

Truong, Hoai-An; Groves, C Nicole; Congdon, Heather B; Dang, Diem-Thanh Tanya; Botchway, Rosemary; Thomas, Jennifer

2015-01-01

To evaluate potential cost savings based on estimated cost avoidance from medication therapy management (MTM) services delivered in safety-net clinics over 4 years. High-risk patients taking multiple medications and with chronic conditions were referred for MTM services in primary care safety-net clinics in Maryland from October 1, 2009, to September 30, 2013. Medication-related problems (MRPs) were identified and pharmacists' costs determined to evaluate the estimated cost savings and return on investment (ROI). A range of potential economic outcomes for each MRP identified was assigned to a cost avoidance for outpatient visit, urgent care visit, emergency department visit, and/or hospitalization. Over 4 years, 246 patients received MTM, nearly 2,100 medications were reviewed, and 814 MRPs were identified. The most common MRPs identified were subtherapeutic doses, nonadherence, and untreated indications, with respective prevalences of 38%, 19%, and 16%. The corresponding costs of medical services were estimated at $115,220-$614,570 for all MRPs identified, yielding a mean of $141.55-$755.00 per identified MRP. Pharmacists' expenses for encounters were calculated at a total expenditure of $57,307.50 for 16,965 minutes. ROI based on the time spent during billable face-to-face encounters ranged from 1:5 to 1:25. Pharmacist-provided MTM in safety-net clinics yielded potential economic benefits to the organization. The Primary Care Coalition of Montgomery County plans to expand MTM services to additional clinics to improve patient care and increase cost savings through preventable medical services.

Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy.

PubMed

Borrero, Sonya; Zite, Nikki; Potter, Joseph E; Trussell, James; Smith, Kenneth

2013-12-01

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds. Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year. © 2013.

Energy and emissions saving potential of additive manufacturing: the case of lightweight aircraft components

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

Huang, Runze; Riddle, Matthew; Graziano, Diane

Additive manufacturing (AM) holds great potential for improving materials efficiency, reducing life-cycle impacts, and enabling greater engineering functionality compared to conventional manufacturing (CM), and AM has been increasingly adopted by aircraft component manufacturers for lightweight, cost-effective designs. This study estimates the net changes in life-cycle primary energy and greenhouse gas emissions associated with AM technologies for lightweight metallic aircraft components through the year 2050, to shed light on the environmental benefits of a shift from CM to AM processes in the U.S. aircraft industry. A systems modeling framework is presented, with integrates engineering criteria, life-cycle environmental data, aircraft fleet stockmore » and fuel use models under different AM adoption scenarios. Estimated fleet-wide life-cycle primary energy savings at most reach 70-173 million GJ/year in 2050, with cumulative savings of 1.2–2.8 billion GJ. Associated cumulative GHG emission reductions were estimated at 92.1–215.0 million metric tons. In addition, thousands of tons of aluminum, titanium and nickel alloys could be potentially saved per year in 2050. The results indicate a significant role of AM technologies in helping society meet its long-term energy use and GHG emissions reduction goals, and highlight barriers and opportunities for AM adoption for the aircraft industry.« less

Energy and emissions saving potential of additive manufacturing: the case of lightweight aircraft components

DOE PAGES

Huang, Runze; Riddle, Matthew; Graziano, Diane; ...

2015-05-08

Additive manufacturing (AM) holds great potential for improving materials efficiency, reducing life-cycle impacts, and enabling greater engineering functionality compared to conventional manufacturing (CM) processes. For these reasons, AM has been adopted by a growing number of aircraft component manufacturers to achieve more lightweight, cost-effective designs. This study estimates the net changes in life-cycle primary energy and greenhouse gas emissions associated with AM technologies for lightweight metallic aircraft components through the year 2050, to shed light on the environmental benefits of a shift from CM to AM processes in the U.S. aircraft industry. A systems modeling framework is presented, with integratesmore » engineering criteria, life-cycle environmental data, and aircraft fleet stock and fuel use models under different AM adoption scenarios. Estimated fleetwide life-cycle primary energy savings in a rapid adoption scenario reach 70-174 million GJ/year in 2050, with cumulative savings of 1.2-2.8 billion GJ. Associated cumulative emission reduction potentials of CO2e were estimated at 92.8-217.4 million metric tons. About 95% of the savings is attributed to airplane fuel consumption reductions due to lightweighting. In addition, about 4050 tons aluminum, 7600 tons titanium and 8100 tons of nickel alloys could be saved per year in 2050. The results indicate a significant role of AM technologies in helping society meet its long-term energy use and GHG emissions reduction goals, and highlight barriers and opportunities for AM adoption for the aircraft industry.« less

Energy and emissions saving potential of additive manufacturing: the case of lightweight aircraft components

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

Huang, Runze; Riddle, Matthew; Graziano, Diane

Additive manufacturing (AM) holds great potential for improving materials efficiency, reducing life-cycle impacts, and enabling greater engineering functionality compared to conventional manufacturing (CM) processes. For these reasons, AM has been adopted by a growing number of aircraft component manufacturers to achieve more lightweight, cost-effective designs. This study estimates the net changes in life-cycle primary energy and greenhouse gas emissions associated with AM technologies for lightweight metallic aircraft components through the year 2050, to shed light on the environmental benefits of a shift from CM to AM processes in the U.S. aircraft industry. A systems modeling framework is presented, with integratesmore » engineering criteria, life-cycle environmental data, and aircraft fleet stock and fuel use models under different AM adoption scenarios. Estimated fleetwide life-cycle primary energy savings in a rapid adoption scenario reach 70-174 million GJ/year in 2050, with cumulative savings of 1.2-2.8 billion GJ. Associated cumulative emission reduction potentials of CO2e were estimated at 92.8-217.4 million metric tons. About 95% of the savings is attributed to airplane fuel consumption reductions due to lightweighting. In addition, about 4050 tons aluminum, 7600 tons titanium and 8100 tons of nickel alloys could be saved per year in 2050. The results indicate a significant role of AM technologies in helping society meet its long-term energy use and GHG emissions reduction goals, and highlight barriers and opportunities for AM adoption for the aircraft industry.« less

DSM Electricity Savings Potential in the Buildings Sector in APP Countries

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

McNeil, MIchael; Letschert, Virginie; Shen, Bo

2011-01-12

The global economy has grown rapidly over the past decade with a commensurate growth in the demand for electricity services that has increased a country's vulnerability to energy supply disruptions. Increasing need of reliable and affordable electricity supply is a challenge which is before every Asia Pacific Partnership (APP) country. Collaboration between APP members has been extremely fruitful in identifying potential efficiency upgrades and implementing clean technology in the supply side of the power sector as well established the beginnings of collaboration. However, significantly more effort needs to be focused on demand side potential in each country. Demand side managementmore » or DSM in this case is a policy measure that promotes energy efficiency as an alternative to increasing electricity supply. It uses financial or other incentives to slow demand growth on condition that the incremental cost needed is less than the cost of increasing supply. Such DSM measures provide an alternative to building power supply capacity The type of financial incentives comprise of rebates (subsidies), tax exemptions, reduced interest loans, etc. Other approaches include the utilization of a cap and trade scheme to foster energy efficiency projects by creating a market where savings are valued. Under this scheme, greenhouse gas (GHG) emissions associated with the production of electricity are capped and electricity retailers are required to meet the target partially or entirely through energy efficiency activities. Implementation of DSM projects is very much in the early stages in several of the APP countries or localized to a regional part of the country. The purpose of this project is to review the different types of DSM programs experienced by APP countries and to estimate the overall future potential for cost-effective demand-side efficiency improvements in buildings sectors in the 7 APP countries through the year 2030. Overall, the savings potential is estimated to be 1.7 thousand TWh or 21percent of the 2030 projected base case electricity demand. Electricity savings potential ranges from a high of 38percent in India to a low of 9percent in Korea for the two sectors. Lighting, fans, and TV sets and lighting and refrigeration are the largest contributors to residential and commercial electricity savings respectively. This work presents a first estimates of the savings potential of DSM programs in APP countries. While the resulting estimates are based on detailed end-use data, it is worth keeping in mind that more work is needed to overcome limitation in data at this time of the project.« less

An Audit of Repeat Testing at an Academic Medical Center: Consistency of Order Patterns With Recommendations and Potential Cost Savings.

PubMed

Hueth, Kyle D; Jackson, Brian R; Schmidt, Robert L

2018-05-31

To evaluate the prevalence of potentially unnecessary repeat testing (PURT) and the associated economic burden for an inpatient population at a large academic medical facility. We evaluated all inpatient test orders during 2016 for PURT by comparing the intertest times to published recommendations. Potential cost savings were estimated using the Centers for Medicare & Medicaid Services maximum allowable reimbursement rate. We evaluated result positivity as a determinant of PURT through logistic regression. Of the evaluated 4,242 repeated target tests, 1,849 (44%) were identified as PURT, representing an estimated cost-savings opportunity of $37,376. Collectively, the association of result positivity and PURT was statistically significant (relative risk, 1.2; 95% confidence interval, 1.1-1.3; P < .001). PURT contributes to unnecessary health care costs. We found that a small percentage of providers account for the majority of PURT, and PURT is positively associated with result positivity.

Estimated cost savings of increased use of intravenous tissue plasminogen activator for acute ischemic stroke in Canada.

PubMed

Yip, Todd R; Demaerschalk, Bart M

2007-06-01

Intravenous tissue plasminogen activator (tPA) is an economically worthwhile but underused treatment option for acute ischemic stroke. We sought to identify the extent of tPA use in Canadian medical centers and the potential savings associated with increased use nationally and by province. We determined the nationwide annual incidence of ischemic stroke from the Canadian Institute of Health Information. The proportion of all ischemic stroke patients who received tPA was derived from published data. Economic analyses that report the expected annual cost savings of tPA were consulted. The analysis was conducted from the perspective of a universal health care system during 1 year. We estimated cost-savings with incrementally (eg, 2%, 4%, 6%, 8%, 10%, 15%, and 20%) increased use of tPA for acute ischemic stroke nationally and provincially. The current average national tPA utilization is 1.4%. For every increase of 2 percentage points in utilization, $757,204 (Canadian) could possibly be saved annually (95% CI maximum loss of $3,823,992 to a maximum savings of $2,201,252). With a 20% rate, >$7.5 million (Canadian) could be saved nationwide the first year. We estimate that even small increases in the proportion of all Canadian ischemic stroke patients receiving tPA could result in substantial realized savings for Canada's health care system.

Vehicle lightweighting energy use impacts in U.S. light-duty vehicle fleet

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

Das, Sujit; Graziano, Diane; Upadhyayula, Venkata K. K.

In this article, we estimate the potential energy benefits of lightweighting the light-duty vehicle fleet from both vehicle manufacturing and use perspectives using plausible lightweight vehicle designs involving several alternative lightweight materials, low- and high-end estimates of vehicle manufacturing energy, conventional and alternative powertrains, and two different market penetration scenarios for alternative powertrain light-duty vehicles at the fleet level. Cumulative life cycle energy savings (through 2050) across the nine material scenarios based on the conventional powertrain in the U.S. vehicle fleet range from -29 to 94 billion GJ, with the greatest savings achieved by multi-material vehicles that select different lightweightmore » materials to meet specific design purposes. Lightweighting alternative-powertrain vehicles could produce significant energy savings in the U.S. vehicle fleet, although their improved powertrain efficiencies lessen the energy savings opportunities for lightweighting. A maximum level of cumulative energy savings of lightweighting the U.S. light-duty vehicle through 2050 is estimated to be 66.1billion GJ under the conventional-vehicle dominated business-as-usual penetration scenario.« less

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

PubMed

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

2017-04-01

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

A low-cost uterine balloon tamponade for management of postpartum hemorrhage: modeling the potential impact on maternal mortality and morbidity in sub-Saharan Africa.

PubMed

Herrick, Tara; Mvundura, Mercy; Burke, Thomas F; Abu-Haydar, Elizabeth

2017-11-13

Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide. This study sought to quantify the potential health impact (morbidity and mortality reductions) that a low-cost uterine balloon tamponade (UBT) could have on women suffering from uncontrolled PPH due to uterine atony in sub-Saharan Africa. The Maternal and Neonatal Directed Assessment of Technology (MANDATE) model was used to estimate maternal deaths, surgeries averted, and cases of severe anemia prevented through UBT use among women with PPH who receive a uterotonic drug but fail this therapy in a health facility. Estimates were generated for the year 2018. The main outcome measures were lives saved, surgeries averted, and severe anemia prevented. The base case model estimated that widespread use of a low-cost UBT in clinics and hospitals could save 6547 lives (an 11% reduction in maternal deaths), avert 10,823 surgeries, and prevent 634 severe anemia cases in sub-Saharan Africa annually. A low-cost UBT has a strong potential to save lives and reduce morbidity. It can also potentially reduce costly downstream interventions for women who give birth in a health care facility. This technology may be especially useful for meeting global targets for reducing maternal mortality as identified in Sustainable Development Goal 3.

Assessment of Energy Efficiency Improvement and CO2 Emission Reduction Potentials in India's Cement Industry

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

Morrow, III, William R.; Hasanbeigi, Ali; Xu, Tengfang

2012-12-03

India’s cement industry is the second largest in the world behind China with annual cement production of 168 Mt in 2010 which accounted for slightly greater than six percent of the world’s annual cement production in the same year. To produce that amount of cement, the industry consumed roughly 700 PJ of fuel and 14.7 TWh of electricity. We identified and analyzed 22 energy efficiency technologies and measures applicable to the processes in the Indian cement industry. The Conservation Supply Curve (CSC) used in this study is an analytical tool that captures both the engineering and the economic perspectives ofmore » energy conservation. Using a bottom-up electricity CSC model and compared to an electricity price forecast the cumulative cost-effective plant-level electricity savings potential for the Indian cement industry for 2010- 2030 is estimated to be 83 TWh, and the cumulative plant-level technical electricity saving potential is 89 TWh during the same period. The grid-level CO2 emissions reduction associated with cost-effective electricity savings is 82 Mt CO2 and the electric grid-level CO2 emission reduction associated with technical electricity saving potential is 88 Mt CO2. Compared to a fuel price forecast, an estimated cumulative cost-effective fuel savings potential of 1,029 PJ with associated CO2 emission reduction of 97 Mt CO2 during 2010-2030 is possible. In addition, a sensitivity analysis with respect to the discount rate used is conducted to assess the effect of changes in this parameter on the results. The result of this study gives a comprehensive and easy to understand perspective to the Indian cement industry and policy makers about the energy efficiency potential and its associated cost over the next twenty years.« less

Energy Savings Calculations for Heat Island Reduction Strategies in Baton Rouge, Sacramento and Salt Lake City

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

Konopacki, S.; Akbari, H.

2000-03-01

In 1997, the US Environmental Protection Agency (EPA) established the ''Heat Island Reduction Initiative'', to quantify the potential benefits of Heat Island Reduction (HIR) strategies (i.e., shade trees, reflective roofs, reflective pavements and urban vegetation) to reduce cooling energy use in buildings, lower the ambient air temperature and improve urban air quality in cities, and reduce CO2 emissions from power plants. Under this initiative, the Urban Heat Island Pilot Project (UHIPP) was created with the objective to investigate the potential of HIR strategies in residential and commercial buildings in three initial UHIPP cities: Baton Rouge, Sacramento and Salt Lake City.more » This paper summarizes our efforts to calculate the annual energy savings, peak power avoidance and annual C02 reduction of HIR strategies in the three initial cities. In this analysis, we focused on three building types that offer most savings potential: single-family residence, office and retail store. Each building type was characterized in detail by old or new construction and with a gas furnace or an electric heat pump. We defined prototypical building characteristics for each building type and simulated the impact of HIR strategies on building cooling and heating energy use and peak power demand using the DOE-2.IE model. Our simulations included the impact of (1) strategically-placed shade trees near buildings [direct effect], (2) use of high-albedo roofing material on building [direct effect], (3) combined strategies I and 2 [direct effect], (4) urban reforestation with high-albedo pavements and building surfaces [indirect effect] and (5) combined strategies 1, 2 and 4 [direct and indirect effects]. We then estimated the total roof area of air-conditioned buildings in each city using readily obtainable data to calculate the metropolitan-wide impact of HIR strategies. The results show, that in Baton Rouge, potential annual energy savings of $15M could be realized by rate-payers from the combined direct and indirect effects of HIR strategies. Additionally, peak power avoidance is estimated at 133 MW and the reduction in annual carbon emissions at 41 kt. In Sacramento, the potential annual energy savings is estimated at $26M, with an avoidance of 486 MW in peak power and a reduction in annual carbon of 92 kt. In Salt Lake City, the potential annual energy savings is estimated at $4M, with an avoidance of 85 MW in peak power and a reduction in annual carbon of 20 kt.« less

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

PubMed

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

2010-05-01

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

Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

PubMed Central

Borrero, Sonya; Zite, Nikki; Potter, Joseph E.; Trussell, James; Smith, Kenneth

2013-01-01

Objective Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly-funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. Study design We constructed a cost effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a post-partum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. Results With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. Conclusion A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies, and save a significant amount of public funds. Implication Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly-funded, post-partum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to a cost savings of $215 million each year. PMID:24028751

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

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.

Development of the Workplace Health Savings Calculator: a practical tool to measure economic impact from reduced absenteeism and staff turnover in workplace health promotion.

PubMed

Baxter, Siyan; Campbell, Sharon; Sanderson, Kristy; Cazaly, Carl; Venn, Alison; Owen, Carole; Palmer, Andrew J

2015-09-18

Workplace health promotion is focussed on improving the health and wellbeing of workers. Although quantifiable effectiveness and economic evidence is variable, workplace health promotion is recognised by both government and business stakeholders as potentially beneficial for worker health and economic advantage. Despite the current debate on whether conclusive positive outcomes exist, governments are investing, and business engagement is necessary for value to be realised. Practical tools are needed to assist decision makers in developing the business case for workplace health promotion programs. Our primary objective was to develop an evidence-based, simple and easy-to-use resource (calculator) for Australian employers interested in workplace health investment figures. Three phases were undertaken to develop the calculator. First, evidence from a literature review located appropriate effectiveness measures. Second, a review of employer-facilitated programs aimed at improving the health and wellbeing of employees was utilised to identify change estimates surrounding these measures, and third, currently available online evaluation tools and models were investigated. We present a simple web-based calculator for use by employers who wish to estimate potential annual savings associated with implementing a successful workplace health promotion program. The calculator uses effectiveness measures (absenteeism and staff turnover rates) and change estimates sourced from 55 case studies to generate the annual savings an employer may potentially gain. Australian wage statistics were used to calculate replacement costs due to staff turnover. The calculator was named the Workplace Health Savings Calculator and adapted and reproduced on the Healthy Workers web portal by the Australian Commonwealth Government Department of Health and Ageing. The Workplace Health Savings Calculator is a simple online business tool that aims to engage employers and to assist participation, development and implementation of workplace health promotion programs.

Contribution of individual waste fractions to the environmental impacts from landfilling of municipal solid waste.

PubMed

Manfredi, Simone; Tonini, Davide; Christensen, Thomas H

2010-03-01

A number of LCA-based studies have reported on the environmental performance of landfilling of mixed waste, but little is known about the relative contributions of individual waste fractions to the overall impact potentials estimated for the mixed waste. In this paper, an empirical model has been used to estimate the emissions to the environment from landfilling of individual waste fractions. By means of the LCA-model EASEWASTE, the emissions estimated have been used to quantify how much of the overall impact potential for each impact category is to be attributed to the individual waste fractions. Impact potentials are estimated for 1 tonne of mixed waste disposed off in a conventional landfill with bottom liner, leachate collection and treatment and gas collection and utilization for electricity generation. All the environmental aspects are accounted for 100 years after disposal and several impact categories have been considered, including standard categories, toxicity-related categories and groundwater contamination. Amongst the standard and toxicity-related categories, the highest potential impact is estimated for human toxicity via soil (HTs; 12 mPE/tonne). This is mostly caused by leaching of heavy metals from ashes (e.g. residues from roads cleaning and vacuum cleaning bags), batteries, paper and metals. On the other hand, substantial net environmental savings are estimated for the categories Global Warming (GW; -31 mPE/tonne) and Eco-Toxicity in water chronic (ETwc; -53 mPE/tonne). These savings are mostly determined by the waste fractions characterized by a high content of biogenic carbon (paper, organics, other combustible waste). These savings are due to emissions from energy generation avoided by landfill gas utilization, and by the storage of biogenic carbon in the landfill due to incomplete waste degradation. Copyright 2009 Elsevier Ltd. All rights reserved.

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.

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

Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention.

PubMed

Wright, David; Twigg, Michael; Thornley, Tracey

2015-02-01

This study aims to pilot a community pharmacy chronic obstructive pulmonary disease (COPD) case finding service in England, estimating costs and effects. Patients potentially at risk of COPD were screened with validated tools. Smoking cessation was offered to all smokers identified as potentially having undiagnosed COPD. Cost and effects of the service were estimated. Twenty-one community pharmacies screened 238 patients over 9 months. One hundred thirty-five patients were identified with potentially undiagnosed COPD; 88 were smokers. Smoking cessation initiation provided a project gain of 38.62 life years, 19.92 quality-adjusted life years and a cost saving of £392.67 per patient screened. COPD case finding by community pharmacists potentially provides cost-savings and improves quality of life. © 2014 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

Health benefits and evaluation of healthcare cost savings if oils rich in monounsaturated fatty acids were substituted for conventional dietary oils in the United States

PubMed Central

Abdullah, Mohammad M. H.; Jew, Stephanie; Jones, Peter J. H.

2017-01-01

The impact of nutritional behaviors on health is beyond debate and has the potential to affect the economic outputs of societies in significant ways. Dietary fatty acids have become a central theme in nutrition research in recent years, and the popularity of dietary oils rich in healthy fatty acids, such as monounsaturated fatty acid (MUFA), for cooking applications and use in food products has increased. Here, the objective is to summarize the health effects of MUFA-rich diets and to systematically estimate the potential healthcare and societal cost savings that could be realized by increasing MUFA intakes compared with other dietary fat intakes in the United States. Using a scoping review approach, the literature of randomized controlled clinical trials was searched and a 4-step cost-of-illness analysis was developed, which included estimates of success rate, disease biomarker reduction, disease incidence reduction, and cost savings. Findings revealed improvements in established biomarkers and in incidence of coronary heart disease and type 2 diabetes, along with potentially substantial annual healthcare and societal cost savings when recommendations for daily MUFA intake were followed. In summary, beyond the beneficial health effects of MUFA-rich diets, potential economic benefits suggest practical implications for consumers, food processors, and healthcare authorities alike. PMID:28158733

Using dew points to estimate savings during a planned cooling shutdown

NASA Astrophysics Data System (ADS)

Friedlein, Matthew T.; Changnon, David; Musselman, Eric; Zielinski, Jeff

2005-12-01

In an effort to save money during the summer of 2003, Northern Illinois University (NIU) administrators instituted a four-day working week and stopped air conditioning buildings for the three-day weekends (Friday through Sunday). Shutting down the air conditioning systems caused a noticeable drop in electricity usage for that part of the campus that features in our study, with estimated total electricity savings of 1,268,492 kilowatt-hours or 17% of the average usage during that eight-week period. NIU's air conditioning systems, which relied on evaporative cooling to function, were sensitive to dew point levels. Greatest savings during the shutdown period occurred on days with higher dew points. An examination of the regional dew point climatology (1959 2003) indicated that the average summer daily dew point for 2003 was 14.9°C (58.8°F), which fell in the lowest 20% of the distribution. Based on the relationship between daily average dew points and electrical usage, a predictive model that could estimate electrical daily savings was created. This model suggests that electrical savings related to any future three-day shutdowns over summer could be much greater in more humid summers. Studies like this demonstrate the potential value of applying climatological information and of integrating this information into practical decision-making.

Aerosol corrosion prevention and energy-saving strategies in the design of green data centers.

PubMed

Ferrero, Luca; Sangiorgi, Giorgia; Ferrini, Barbara S; Perrone, Maria G; Moscatelli, Marco; D'Angelo, Luca; Rovelli, Grazia; Ariatta, Alberto; Truccolo, Redy; Bolzacchini, Ezio

2013-04-16

The energy demands of data centers (DCs) worldwide are rapidly increasing, as are their environmental and economic costs. This paper presents a study conducted at Sannazzaro de' Burgondi (Po Valley), Italy, specifically aimed at optimizing the operating conditions of a DC designed for the Italian Oil and Gas Company (Eni) (5200 m(2) of Information Technology installed, 30 MW) and based on a direct free cooling (DFC) system. The aim of the study was to save the largest possible quantity of energy, while at the same time preventing aerosol corrosion. The aerosol properties (number size distribution, chemical composition, deliquescence relative humidity (DRH), acidity) and meteorological parameters were monitored and utilized to determine the potential levels of aerosol entering the DC (equivalent ISO class), together with its DRH. These data enabled us both to select the DC's filtering system (MERV13 filters) and to optimize the cooling cycle through calculation of the most reliable humidity cycle (60% of maximum allowed RH) applicable to the DFC. A potential energy saving of 81%, compared to a traditional air conditioning cooling system, was estimated: in one year, for 1 kW of installed information technology, the estimated energy saving is 7.4 MWh, resulting in 2.7 fewer tons of CO2 being emitted, and a financial saving of € 1100.

Providing More Home-Delivered Meals Is One Way To Keep Older Adults With Low Care Needs Out Of Nursing Homes

PubMed Central

Thomas, Kali S.; Mor, Vincent

2014-01-01

Programs that help older adults live independently in the community can also deliver net savings to states on the costs of long-term supports and services. We estimate that if all states had increased by 1 percent the number of adults age sixty-five or older who received home-delivered meals in 2009 under Title III of the Older Americans Act, total annual savings to states’ Medicaid programs could have exceeded $109 million. The projected savings primarily reflect decreased Medicaid spending for an estimated 1,722 older adults with low-care needs who would no longer require nursing home care— instead, they could remain at home, sustained by home-delivered meals. Twenty-six states could have realized net savings in 2009 from the expansion of their home-delivered meals programs, while twenty-two states would have incurred net costs. Programs such as home-delivered meals have the potential to provide substantial savings to some states’ Medicaid programs. PMID:24101071

A Randomized Trial Assessing the Impact of a Personal Printed Feedback Portrait on Statin Prescribing in Primary Care

ERIC Educational Resources Information Center

Dormuth, Colin R.; Carney, Greg; Taylor, Suzanne; Bassett, Ken; Maclure, Malcolm

2012-01-01

Introduction: Knowledge translation (KT) initiatives have the potential to improve prescribing quality and produce savings that exceed the cost of the KT program itself, including the cost of evaluation using pragmatic study methods. Our objective was to measure the impact and estimated savings resulting from the distribution of individualized…

Potential energy savings in buildings by an urban tree planting programme in California

Treesearch

E.G. McPherson; J.R. Simpson

2003-01-01

Tree canopy cover data from aerial photographs and building energy simulations were applied to estimate energy savings from existing trees and new plantings in California. There are approximately 177.3 million energy-conserving trees in California communities and 241.6 million empty planting sites. Existing trees are projected to reduce annual air conditioning energy...

Optimising boiler performance.

PubMed

Mayoh, Paul

2009-01-01

Soaring fuel costs continue to put the squeeze on already tight health service budgets. Yet it is estimated that combining established good practice with improved technologies could save between 10% and 30% of fuel costs for boilers. Paul Mayoh, UK technical manager at Spirax Sarco, examines some of the practical measures that healthcare organisations can take to gain their share of these potential savings.

Study to evaluate the effect of EVA on payload systems. Volume 1: Executive summary. [project planning of space missions employing extravehicular activity as a means of cost reduction

NASA Technical Reports Server (NTRS)

Patrick, J. W.; Kraly, E. F.

1975-01-01

Programmatic benefits to payloads are examined which can result from the routine use of extravehicular activity (EVA) during space missions. Design and operations costs were compared for 13 representative baseline payloads to the costs of those payloads adapted for EVA operations. The EVA-oriented concepts developed in the study were derived from these baseline concepts and maintained mission and program objectives as well as basic configurations. This permitted isolation of cost saving factors associated specifically with incorporation of EVA in a variety of payload designs and operations. The study results were extrapolated to a total of 74 payload programs. Using appropriate complexity and learning factors, net EVA savings were extrapolated to over $551M for NASA and U.S. civil payloads for routine operations. Adding DOD and ESRO payloads increases the net estimated savings of $776M. Planned maintenance by EVA indicated an estimated $168M savings due to elimination of automated service equipment. Contingency problems of payloads were also analyzed to establish expected failure rates for shuttle payloads. The failure information resulted in an estimated potential for EVA savings of $1.9 B.

Cost implications for changing candidacy or access to service within a publicly funded healthcare system?

PubMed

O'Neill, Ciaran; Lamb, Brian; Archbold, Sue

2016-04-01

Undue attention in the allocation of healthcare resources can be given to expenditures as opposed to expenditures avoided. This can be particularly apparent when expenditures avoided fall across different budget holders and budgetary pressures are strained. The paper presents estimates of the potential savings attributable to the adoption of new hearing assistive technologies in Britain between 1992 and 2014 based on multivariate analyses of survey data. The reduction in service use among the hearing impaired between 1992 and 2014 is estimated to amount to between £53 and £92 million per annum. Issues in estimating the impact of widening candidature for cochlear implants on costs exist related to potential savings. This research begins to lay a firmer evidence base for such work as well as identifying some of the challenges.

Using Cool Roofs to Reduce Energy Use, Greenhouse Gas Emissions, and Urban Heat-island Effects: Findings from an India Experiment

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

Akbari, Hashem; Xu, Tengfang; Taha, Haider

Cool roofs, cool pavements, and urban vegetation reduce energy use in buildings, lower local air pollutant concentrations, and decrease greenhouse gas emissions from urban areas. This report summarizes the results of a detailed monitoring project in India and related simulations of meteorology and air quality in three developing countries. The field results quantified direct energy savings from installation of cool roofs on individual commercial buildings. The measured annual energy savings potential from roof-whitening of previously black roofs ranged from 20-22 kWh/m2 of roof area, corresponding to an air-conditioning energy use reduction of 14-26% in commercial buildings. The study estimated thatmore » typical annual savings of 13-14 kWh/m2 of roof area could be achieved by applying white coating to uncoated concrete roofs on commercial buildings in the Metropolitan Hyderabad region, corresponding to cooling energy savings of 10-19%. With the assumption of an annual increase of 100,000 square meters of new roof construction for the next 10 years in the Metropolitan Hyderabad region, the annual cooling energy savings due to whitening concrete roof would be 13-14 GWh of electricity in year ten alone, with cumulative 10-year cooling energy savings of 73-79 GWh for the region. The estimated savings for the entire country would be at least 10 times the savings in Hyderabad, i.e., more than 730-790 GWh. We estimated that annual direct CO2 reduction associated with reduced energy use would be 11-12 kg CO2/m2 of flat concrete roof area whitened, and the cumulative 10-year CO2 reduction would be approximately 0.60-0.65 million tons in India. With the price of electricity estimated at seven Rupees per kWh, the annual electricity savings on air-conditioning would be approximately 93-101 Rupees per m2 of roof. This would translate into annual national savings of approximately one billion Rupees in year ten, and cumulative 10-year savings of over five billion Rupees for cooling energy in India. Meteorological simulations in this study indicated that a reduction of 2C in air temperature in the Hyderabad area would be likely if a combination of increased surface albedo and vegetative cover are used as urban heat-island control strategies. In addition, air-temperature reductions on the order of 2.5-3.5C could be achieved if moderate and aggressive heat-island mitigation measures are adopted, respectively. A large-scale deployment of mitigation measures can bring additional indirect benefit to the urban area. For example, cooling outside air can improve the efficiency of cooling systems, reduce smog and greenhouse gas (GHG) emissions, and indirectly reduce pollution from power plants - all improving environmental health quality. This study has demonstrated the effectiveness of cool-roof technology as one of the urban heat-island control strategies for the Indian industrial and scientific communities and has provided an estimate of the national energy savings potential of cool roofs in India. These outcomes can be used for developing cool-roof building standards and related policies in India. Additional field studies, built upon the successes and lessons learned from this project, may be helpful to further confirm the scale of potential energy savings from the application of cooler roofs in various regions of India. In the future, a more rigorous meteorological simulation using urbanized (meso-urban) meteorological models should be conducted, which may produce a more accurate estimate of the air-temperature reductions for the entire urban area.« less

Environmental benefit analysis of strategies for potable water savings in residential buildings.

PubMed

Marinoski, Ana Kelly; Rupp, Ricardo Forgiarini; Ghisi, Enedir

2018-01-15

The objective of this study is to assess the environmental benefit of using rainwater, greywater, water-efficient appliances and their combinations in low-income houses. The study was conducted surveying twenty households located in southern Brazil, which resulted in water end-uses estimation. Then, embodied energy, potential for potable water savings and sewage reduction when using the different strategies were estimated. The environmental benefit analysis of these strategies was performed using an indicator that includes embodied energy, potable water savings, reduction of sewage and energy consumption in the water utility, and sewage production during the life cycle of the system. The results indicated that the strategy with the greatest environmental benefit is the use of water-efficient appliances, which resulted in substantial water savings and reduction of sewage, causing low environmental impact due to lower embodied energy over the life cycle. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimate of Cost-Effective Potential for Minimum Efficiency Performance Standards in 13 Major World Economies Energy Savings, Environmental and Financial Impacts

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

Letschert, Virginie E.; Bojda, Nicholas; Ke, Jing

2012-07-01

This study analyzes the financial impacts on consumers of minimum efficiency performance standards (MEPS) for appliances that could be implemented in 13 major economies around the world. We use the Bottom-Up Energy Analysis System (BUENAS), developed at Lawrence Berkeley National Laboratory (LBNL), to analyze various appliance efficiency target levels to estimate the net present value (NPV) of policies designed to provide maximum energy savings while not penalizing consumers financially. These policies constitute what we call the “cost-effective potential” (CEP) scenario. The CEP scenario is designed to answer the question: How high can we raise the efficiency bar in mandatory programsmore » while still saving consumers money?« less

The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis.

PubMed

Guy, Gery P; Zhang, Yuanhui; Ekwueme, Donatus U; Rim, Sun Hee; Watson, Meg

2017-02-01

Indoor tanning is associated with an increased risk of melanoma. The US Food and Drug Administration proposed prohibiting indoor tanning among minors younger than 18 years. We sought to estimate the health and economic benefits of reducing indoor tanning in the United States. We used a Markov model to estimate the expected number of melanoma cases and deaths averted, life-years saved, and melanoma treatment costs saved by reducing indoor tanning. We examined 5 scenarios: restricting indoor tanning among minors younger than 18 years, and reducing the prevalence by 20%, 50%, 80%, and 100%. Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 million youth age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced. Limitations include the reliance on available data and not examining compliance to indoor tanning laws. Reducing indoor tanning has the potential to reduce melanoma incidence, mortality, and treatment costs. These findings help quantify and underscore the importance of continued efforts to reduce indoor tanning and prevent melanoma. Published by Elsevier Inc.

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.

Estimated incident cost savings in shipping due to inspections.

PubMed

Knapp, Sabine; Bijwaard, Govert; Heij, Christiaan

2011-07-01

The effectiveness of safety inspections of ships has been analysed from various angles, but until now, relatively little attention has been given to translate risk reduction into incident cost savings. This paper provides a monetary quantification of the cost savings that can be attributed to port state control inspections and industry vetting inspections. The dataset consists of more than half a million ship arrivals between 2002 and 2007 and contains inspections of port state authorities in the USA and Australia and of three industry vetting regimes. The effect of inspections in reducing the risk of total loss accidents is estimated by means of duration models, in terms of the gained probability of survival. The monetary benefit of port state control inspections is estimated to range, on average, from about 70 to 190 thousand dollars, with median values ranging from about 20 to 45 thousand dollars. Industry inspections have even higher benefits, especially for tankers. The savings are in general higher for older and larger vessels, and also for vessels with undefined flag and unknown classification society. As inspection costs are relatively low in comparison to potential cost savings, the results underline the importance of determining ships with relatively high risk of total loss. Copyright © 2011 Elsevier Ltd. All rights reserved.

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.

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.

Benefits of information technology-enabled diabetes management.

PubMed

Bu, Davis; Pan, Eric; Walker, Janice; Adler-Milstein, Julia; Kendrick, David; Hook, Julie M; Cusack, Caitlin M; Bates, David W; Middleton, Blackford

2007-05-01

To determine the financial and clinical benefits of implementing information technology (IT)-enabled disease management systems. A computer model was created to project the impact of IT-enabled disease management on care processes, clinical outcomes, and medical costs for patients with type 2 diabetes aged >25 years in the U.S. Several ITs were modeled (e.g., diabetes registries, computerized decision support, remote monitoring, patient self-management systems, and payer-based systems). Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy, and retinopathy clinical outcomes. All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

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 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.

Building Energy Model Development for Retrofit Homes

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

Chasar, David; McIlvaine, Janet; Blanchard, Jeremy

2012-09-30

Based on previous research conducted by Pacific Northwest National Laboratory and Florida Solar Energy Center providing technical assistance to implement 22 deep energy retrofits across the nation, 6 homes were selected in Florida and Texas for detailed post-retrofit energy modeling to assess realized energy savings (Chandra et al, 2012). However, assessing realized savings can be difficult for some homes where pre-retrofit occupancy and energy performance are unknown. Initially, savings had been estimated using a HERS Index comparison for these homes. However, this does not account for confounding factors such as occupancy and weather. This research addresses a method to moremore » reliably assess energy savings achieved in deep energy retrofits for which pre-retrofit utility bills or occupancy information in not available. A metered home, Riverdale, was selected as a test case for development of a modeling procedure to account occupancy and weather factors, potentially creating more accurate estimates of energy savings. This “true up” procedure was developed using Energy Gauge USA software and post-retrofit homeowner information and utility bills. The 12 step process adjusts the post-retrofit modeling results to correlate with post-retrofit utility bills and known occupancy information. The “trued” post retrofit model is then used to estimate pre-retrofit energy consumption by changing the building efficiency characteristics to reflect the pre-retrofit condition, but keeping all weather and occupancy-related factors the same. This creates a pre-retrofit model that is more comparable to the post-retrofit energy use profile and can improve energy savings estimates. For this test case, a home for which pre- and post- retrofit utility bills were available was selected for comparison and assessment of the accuracy of the “true up” procedure. Based on the current method, this procedure is quite time intensive. However, streamlined processing spreadsheets or incorporation into existing software tools would improve the efficiency of the process. Retrofit activity appears to be gaining market share, and this would be a potentially valuable capability with relevance to marketing, program management, and retrofit success metrics.« less

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.

Energy Savings Potential and Research, Development, & Demonstration Opportunities for Commercial Building Heating, Ventilation, and Air Conditioning Systems

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

none,

2011-09-01

This report covers an assessment of 182 different heating, ventilation, and air-conditioning (HVAC) technologies for U.S. commercial buildings to identify and provide analysis on 17 priority technology options in various stages of development. The analyses include an estimation of technical energy-savings potential, description of technical maturity, description of non-energy benefits, description of current barriers for market adoption, and description of the technology’s applicability to different building or HVAC equipment types. From these technology descriptions, are suggestions for potential research, development and demonstration (RD&D) initiatives that would support further development of the priority technology options.

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

Estimate of mortality reduction with implementation of advanced automatic collision notification.

PubMed

Lee, Ellen; Wu, Jingshu; Kang, Thomas; Craig, Matthew

2017-05-29

Advanced Automatic Collision Notification (AACN) is a system on a motor vehicle that notifies a public safety answering point (PSAP), either directly or through a third party, that the vehicle has had a crash. AACN systems enable earlier notification of a motor vehicle crash and provide an injury prediction that can help dispatchers and first responders make better decisions about how and where to transport the patient, thus getting the patient to definitive care sooner. The purposes of the current research are to identify the target population that could benefit from AACN, and to develop a reasonable estimate range of potential lives saved with implementation of AACN within the vehicle fleet. Data from the Fatality Analysis Reporting System (FARS) years 2009-2015 and National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) years 2000-2015 were obtained. FARS data were used to determine absolute estimates of the target population who may receive benefit from AACN. These estimates accounted for a number of factors, such as whether a fatal occupant had nearby access to a trauma center and also was correctly identified by the injury severity prediction algorithm as having a "high probability of severe injury." NASS-CDS data were used to provide relative comparisons among subsets of the population. Specifically, relative survival rate ratios between occupants treated at trauma centers versus at non-trauma centers were determined using the nonparametric Kaplan-Meier estimator. Finally, the fatality reduction rate associated with trauma center care was combined with the previously published fatality reduction rate for faster notification time to develop a range for possible lives saved. Two relevant target populations were identified. A larger subset of 6893 fatalities can benefit only from earlier notification associated with AACN. A smaller subgroup of between 1495 and 2330 fatalities can benefit from both earlier notification and change in treatment destination (i.e., non-trauma center to trauma center). A Kaplan-Meier life curve and a multiple proportional hazard model were used to predict the benefits associated with transport to a trauma center. The resulting range for potential lives saved annually was 360 to 721. This analysis provides the estimates of lives that could potentially be saved with full implementation of AACN and universal cell coverage availability. This represents a fatality reduction of approximately 1.6% to 3.3% per year, and more than double the lives saved by earlier notification alone. In conclusion, AACN is a postcrash technology with a promising potential for safety benefit. AACN is therefore a key component of integrated safety systems that aim to protect occupants across the entire crash spectrum.

A critique of recent economic evaluations of community water fluoridation

PubMed Central

Ko, Lee; Thiessen, Kathleen M

2015-01-01

Background: Although community water fluoridation (CWF) results in a range of potential contaminant exposures, little attention has been given to many of the possible impacts. A central argument for CWF is its cost-effectiveness. The U.S. Government states that $1 spent on CWF saves $38 in dental treatment costs. Objective: To examine the reported cost-effectiveness of CWF. Methods: Methods and underlying data from the primary U.S. economic evaluation of CWF are analyzed and corrected calculations are described. Other recent economic evaluations are also examined. Results: Recent economic evaluations of CWF contain defective estimations of both costs and benefits. Incorrect handling of dental treatment costs and flawed estimates of effectiveness lead to overestimated benefits. The real-world costs to water treatment plants and communities are not reflected. Conclusions: Minimal correction reduced the savings to $3 per person per year (PPPY) for a best-case scenario, but this savings is eliminated by the estimated cost of treating dental fluorosis. PMID:25471729

Effect of electronic prescribing with formulary decision support on medication use and cost.

PubMed

Fischer, Michael A; Vogeli, Christine; Stedman, Margaret; Ferris, Timothy; Brookhart, M Alan; Weissman, Joel S

2008-12-08

Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices. Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier. More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845,000 per 100,000 patients. Higher levels of e-prescribing use would increase these savings. Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.

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.

The economic benefits of reducing physical inactivity: an Australian example

PubMed Central

2011-01-01

Background Physical inactivity has major impacts on health and productivity. Our aim was to estimate the health and economic benefits of reducing the prevalence of physical inactivity in the 2008 Australian adult population. The economic benefits were estimated as 'opportunity cost savings', which represent resources utilized in the treatment of preventable disease that are potentially available for re-direction to another purpose from fewer incident cases of disease occurring in communities. Methods Simulation models were developed to show the effect of a 10% feasible, reduction target for physical inactivity from current Australian levels (70%). Lifetime cohort health benefits were estimated as fewer incident cases of inactivity-related diseases; deaths; and Disability Adjusted Life Years (DALYs) by age and sex. Opportunity costs were estimated as health sector cost impacts, as well as paid and unpaid production gains and leisure impacts from fewer disease events associated with reduced physical inactivity. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of physically active and inactive adults, and valued using the friction cost approach. The impact of an improvement in health status on unpaid household production and leisure time were modeled from time use survey data, as applied to the exposed and non-exposed population subgroups and valued by suitable proxy. Potential costs associated with interventions to increase physical activity were not included. Multivariable uncertainty analyses and univariate sensitivity analyses were undertaken to provide information on the strength of the conclusions. Results A 10% reduction in physical inactivity would result in 6,000 fewer incident cases of disease, 2,000 fewer deaths, 25,000 fewer DALYs and provide gains in working days (114,000), days of home-based production (180,000) while conferring a AUD96 million reduction in health sector costs. Lifetime potential opportunity cost savings in workforce production (AUD12 million), home-based production (AUD71 million) and leisure-based production (AUD79 million) was estimated (total AUD162 million 95% uncertainty interval AUD136 million, AUD196 million). Conclusions Opportunity cost savings and health benefits conservatively estimated from a reduction in population-level physical inactivity may be substantial. The largest savings will benefit individuals in the form of unpaid production and leisure gains, followed by the health sector, business and government. PMID:21943093

The economic benefits of reducing physical inactivity: an Australian example.

PubMed

Cadilhac, Dominique A; Cumming, Toby B; Sheppard, Lauren; Pearce, Dora C; Carter, Rob; Magnus, Anne

2011-09-24

Physical inactivity has major impacts on health and productivity. Our aim was to estimate the health and economic benefits of reducing the prevalence of physical inactivity in the 2008 Australian adult population. The economic benefits were estimated as 'opportunity cost savings', which represent resources utilized in the treatment of preventable disease that are potentially available for re-direction to another purpose from fewer incident cases of disease occurring in communities. Simulation models were developed to show the effect of a 10% feasible, reduction target for physical inactivity from current Australian levels (70%). Lifetime cohort health benefits were estimated as fewer incident cases of inactivity-related diseases; deaths; and Disability Adjusted Life Years (DALYs) by age and sex. Opportunity costs were estimated as health sector cost impacts, as well as paid and unpaid production gains and leisure impacts from fewer disease events associated with reduced physical inactivity. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of physically active and inactive adults, and valued using the friction cost approach. The impact of an improvement in health status on unpaid household production and leisure time were modeled from time use survey data, as applied to the exposed and non-exposed population subgroups and valued by suitable proxy. Potential costs associated with interventions to increase physical activity were not included. Multivariable uncertainty analyses and univariate sensitivity analyses were undertaken to provide information on the strength of the conclusions. A 10% reduction in physical inactivity would result in 6,000 fewer incident cases of disease, 2,000 fewer deaths, 25,000 fewer DALYs and provide gains in working days (114,000), days of home-based production (180,000) while conferring a AUD96 million reduction in health sector costs. Lifetime potential opportunity cost savings in workforce production (AUD12 million), home-based production (AUD71 million) and leisure-based production (AUD79 million) was estimated (total AUD162 million 95% uncertainty interval AUD136 million, AUD196 million). Opportunity cost savings and health benefits conservatively estimated from a reduction in population-level physical inactivity may be substantial. The largest savings will benefit individuals in the form of unpaid production and leisure gains, followed by the health sector, business and government.

Short-term versus long-term rainfall time series in the assessment of potable water savings by using rainwater in houses.

PubMed

Ghisi, Enedir; Cardoso, Karla Albino; Rupp, Ricardo Forgiarini

2012-06-15

The main objective of this article is to assess the possibility of using short-term instead of long-term rainfall time series to evaluate the potential for potable water savings by using rainwater in houses. The analysis was performed considering rainfall data from 1960 to 1995 for the city of Santa Bárbara do Oeste, located in the state of São Paulo, southeastern Brazil. The influence of the rainfall time series, roof area, potable water demand and percentage rainwater demand on the potential for potable water savings was evaluated. The potential for potable water savings was estimated using computer simulations considering a set of long-term rainfall time series and different sets of short-term rainfall time series. The ideal rainwater tank capacity was also assessed for some cases. It was observed that the higher the percentage rainwater demand and the shorter the rainfall time series, the larger the difference between the potential for potable water savings and the greater the variation in the ideal rainwater tank size. The sets of short-term rainfall time series considered adequate for different scenarios ranged from 1 to 13 years depending on the roof area, percentage rainwater demand and potable water demand. The main finding of the research is that sets of short-term rainfall time series can be used to assess the potential for potable water savings by using rainwater, as the results obtained are similar to those obtained from the long-term rainfall time series. Copyright © 2012 Elsevier Ltd. All rights reserved.

Quantifying Adoption Rates and Energy Savings Over Time for Advanced Manufacturing Technologies

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

Hanes, Rebecca; Carpenter Petri, Alberta C; Riddle, Matt

Energy-efficient manufacturing technologies can reduce energy consumption and lower operating costs for an individual manufacturing facility, but increased process complexity and the resulting risk of disruption means that manufacturers may be reluctant to adopt such technologies. In order to quantify potential energy savings at scales larger than a single facility, it is necessary to account for how quickly and how widely the technology will be adopted by manufacturers. This work develops a methodology for estimating energy-efficient manufacturing technology adoption rates using quantitative, objectively measurable technology characteristics, including energetic, economic and technical criteria. Twelve technology characteristics are considered, and each characteristicmore » is assigned an importance weight that reflects its impact on the overall technology adoption rate. Technology characteristic data and importance weights are used to calculate the adoption score, a number between 0 and 1 that represents how quickly the technology is likely to be adopted. The adoption score is then used to estimate parameters for the Bass diffusion curve, which quantifies the change in the number of new technology adopters in a population over time. Finally, energy savings at the sector level are calculated over time by multiplying the number of new technology adopters at each time step with the technology's facility-level energy savings. The proposed methodology will be applied to five state-of-the-art energy-efficient technologies in the carbon fiber composites sector, with technology data obtained from the Department of Energy's 2016 bandwidth study. Because the importance weights used in estimating the Bass curve parameters are subjective, a sensitivity analysis will be performed on the weights to obtain a range of parameters for each technology. The potential energy savings for each technology and the rate at which each technology is adopted in the sector are quantified and used to identify the technologies which offer the greatest cumulative sector-level energy savings over a period of 20 years. Preliminary analysis indicates that relatively simple technologies, such as efficient furnaces, will be adopted more quickly and result in greater cumulative energy savings compared to more complex technologies that require process retrofitting, such as advanced control systems.« less

The potential health and economic benefits of preventing recurrent respiratory papillomatosis through quadrivalent human papillomavirus vaccination.

PubMed

Chesson, Harrell W; Forhan, Sara E; Gottlieb, Sami L; Markowitz, Lauri E

2008-08-18

We estimated the health and economic benefits of preventing recurrent respiratory papillomatosis (RRP) through quadrivalent human papillomavirus (HPV) vaccination. We applied a simple mathematical model to estimate the averted costs and quality-adjusted life years (QALYs) saved by preventing RRP in children whose mothers had been vaccinated at age 12 years. Under base case assumptions, the prevention of RRP would avert an estimated USD 31 (range: USD 2-178) in medical costs (2006 US dollars) and save 0.00016 QALYs (range: 0.00001-0.00152) per 12-year-old girl vaccinated. Including the benefits of RRP reduced the estimated cost per QALY gained by HPV vaccination by roughly 14-21% in the base case and by <2% to >100% in the sensitivity analyses. More precise estimates of the incidence of RRP are needed, however, to quantify this impact more reliably.

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.

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.

Estimating the Relevance of World Disturbances to Explain Savings, Interference and Long-Term Motor Adaptation Effects

PubMed Central

Berniker, Max; Kording, Konrad P.

2011-01-01

Recent studies suggest that motor adaptation is the result of multiple, perhaps linear processes each with distinct time scales. While these models are consistent with some motor phenomena, they can neither explain the relatively fast re-adaptation after a long washout period, nor savings on a subsequent day. Here we examined if these effects can be explained if we assume that the CNS stores and retrieves movement parameters based on their possible relevance. We formalize this idea with a model that infers not only the sources of potential motor errors, but also their relevance to the current motor circumstances. In our model adaptation is the process of re-estimating parameters that represent the body and the world. The likelihood of a world parameter being relevant is then based on the mismatch between an observed movement and that predicted when not compensating for the estimated world disturbance. As such, adapting to large motor errors in a laboratory setting should alert subjects that disturbances are being imposed on them, even after motor performance has returned to baseline. Estimates of this external disturbance should be relevant both now and in future laboratory settings. Estimated properties of our bodies on the other hand should always be relevant. Our model demonstrates savings, interference, spontaneous rebound and differences between adaptation to sudden and gradual disturbances. We suggest that many issues concerning savings and interference can be understood when adaptation is conditioned on the relevance of parameters. PMID:21998574

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.

Alcoa Lafayette Operations Energy Efficiency Assessment

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

None, None

2001-01-01

The energy efficiency assessment performed at Alcoa's Lafayette Operations aluminum extrusion plant identified potential annual savings of $1,974,300 in eight high-energy-use areas with an estimated initial capital requirement of $2,308,500.

Value drivers: an approach for estimating health and disease management program savings.

PubMed

Phillips, V L; Becker, Edmund R; Howard, David H

2013-12-01

Health and disease management (HDM) programs have faced challenges in documenting savings related to their implementation. The objective of this eliminate study was to describe OptumHealth's (Optum) methods for estimating anticipated savings from HDM programs using Value Drivers. Optum's general methodology was reviewed, along with details of 5 high-use Value Drivers. The results showed that the Value Driver approach offers an innovative method for estimating savings associated with HDM programs. The authors demonstrated how real-time savings can be estimated for 5 Value Drivers commonly used in HDM programs: (1) use of beta-blockers in treatment of heart disease, (2) discharge planning for high-risk patients, (3) decision support related to chronic low back pain, (4) obesity management, and (5) securing transportation for primary care. The validity of savings estimates is dependent on the type of evidence used to gauge the intervention effect, generating changes in utilization and, ultimately, costs. The savings estimates derived from the Value Driver method are generally reasonable to conservative and provide a valuable framework for estimating financial impacts from evidence-based interventions.

Cost and Savings Estimates the Air Force Used to Decide Against Relocating the Electromagnetic Compatibility Analysis Center from Annapolis, Maryland, to Duluth, Minnesota.

DTIC Science & Technology

1983-03-09

that maximize electromagnetic compatibility potential. -- Providing direct assistance on an reimbursable basis to DOD and other Government agencies on...value, we estimated that reimburs - able real estate expenses would average about $6,458 rather than $4,260 included in the Air Force estimate. When the...of estimated reimbursement was assumed to be necessary to encourage the relocation of more professional employees and increase their estimated

Estimating the potential of energy saving and carbon emission mitigation of cassava-based fuel ethanol using life cycle assessment coupled with a biogeochemical process model.

PubMed

Jiang, Dong; Hao, Mengmeng; Fu, Jingying; Tian, Guangjin; Ding, Fangyu

2017-09-14

Global warming and increasing concentration of atmospheric greenhouse gas (GHG) have prompted considerable interest in the potential role of energy plant biomass. Cassava-based fuel ethanol is one of the most important bioenergy and has attracted much attention in both developed and developing countries. However, the development of cassava-based fuel ethanol is still faced with many uncertainties, including raw material supply, net energy potential, and carbon emission mitigation potential. Thus, an accurate estimation of these issues is urgently needed. This study provides an approach to estimate energy saving and carbon emission mitigation potentials of cassava-based fuel ethanol through LCA (life cycle assessment) coupled with a biogeochemical process model-GEPIC (GIS-based environmental policy integrated climate) model. The results indicate that the total potential of cassava yield on marginal land in China is 52.51 million t; the energy ratio value varies from 0.07 to 1.44, and the net energy surplus of cassava-based fuel ethanol in China is 92,920.58 million MJ. The total carbon emission mitigation from cassava-based fuel ethanol in China is 4593.89 million kgC. Guangxi, Guangdong, and Fujian are identified as target regions for large-scale development of cassava-based fuel ethanol industry. These results can provide an operational approach and fundamental data for scientific research and energy planning.

Estimating the potential of energy saving and carbon emission mitigation of cassava-based fuel ethanol using life cycle assessment coupled with a biogeochemical process model

NASA Astrophysics Data System (ADS)

Jiang, Dong; Hao, Mengmeng; Fu, Jingying; Tian, Guangjin; Ding, Fangyu

2017-09-01

Global warming and increasing concentration of atmospheric greenhouse gas (GHG) have prompted considerable interest in the potential role of energy plant biomass. Cassava-based fuel ethanol is one of the most important bioenergy and has attracted much attention in both developed and developing countries. However, the development of cassava-based fuel ethanol is still faced with many uncertainties, including raw material supply, net energy potential, and carbon emission mitigation potential. Thus, an accurate estimation of these issues is urgently needed. This study provides an approach to estimate energy saving and carbon emission mitigation potentials of cassava-based fuel ethanol through LCA (life cycle assessment) coupled with a biogeochemical process model—GEPIC (GIS-based environmental policy integrated climate) model. The results indicate that the total potential of cassava yield on marginal land in China is 52.51 million t; the energy ratio value varies from 0.07 to 1.44, and the net energy surplus of cassava-based fuel ethanol in China is 92,920.58 million MJ. The total carbon emission mitigation from cassava-based fuel ethanol in China is 4593.89 million kgC. Guangxi, Guangdong, and Fujian are identified as target regions for large-scale development of cassava-based fuel ethanol industry. These results can provide an operational approach and fundamental data for scientific research and energy planning.

Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization.

PubMed

Ho, Jonhan; Ahlers, Stefan M; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L; Kuzmishin, John A; Montalto, Michael C; Parwani, Anil V

2014-01-01

Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology "slide less" clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types. The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.

Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

PubMed Central

Ho, Jonhan; Ahlers, Stefan M.; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L.; Kuzmishin, John A.; Montalto, Michael C.; Parwani, Anil V.

2014-01-01

Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types. Conclusions: The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS. PMID:25250191

Practical Considerations of Waste Heat Reuse for a Mars Mission Advanced Life Support System

NASA Technical Reports Server (NTRS)

Levri, Julie; Finn, Cory; Luna, Bernadette (Technical Monitor)

2000-01-01

Energy conservation is a key issue in design optimization of Advanced Life Support Systems (ALSS) for long-term space missions. By considering designs for conservation at the system level, energy saving opportunities arise that would otherwise go unnoticed. This paper builds on a steady-state investigation of system-level waste heat reuse in an ALSS with a low degree of crop growth for a Mars mission. In past studies, such a system has been defined in terms of technology types, hot and cold stream identification and stream energy content. The maximum steady-state potential for power and cooling savings within the system was computed via the Pinch Method. In this paper, several practical issues are considered for achieving a pragmatic estimate of total system savings in terms of equivalent system mass (ESM), rather than savings solely in terms of power and cooling. In this paper, more realistic ESM savings are computed by considering heat transfer inefficiencies during material transfer. An estimate of the steady-state mass, volume and crewtime requirements associated with heat exchange equipment is made by considering heat exchange equipment material type and configuration, stream flow characteristics and associated energy losses during the heat exchange process. Also, previously estimated power and cooling savings are adjusted to reflect the impact of such energy losses. This paper goes one step further than the traditional Pinch Method of considering waste heat reuse in heat exchangers to include ESM savings that occur with direct reuse of a stream. For example, rather than exchanging heat between crop growth lamp cooling air and air going to a clothes dryer, air used to cool crop lamps might be reused directly for clothes drying purposes. When thermodynamically feasible, such an approach may increase ESM savings by minimizing the mass, volume and crewtime requirements associated with stream routing equipment.

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.

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

The business case for quality improvement: oral anticoagulation for atrial fibrillation.

PubMed

Rose, Adam J; Berlowitz, Dan R; Ash, Arlene S; Ozonoff, Al; Hylek, Elaine M; Goldhaber-Fiebert, Jeremy D

2011-07-01

The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation. Our population consisted of 67 077 Veterans Health Administration patients anticoagulated for atrial fibrillation between October 1, 2006, and September 30, 2008. We simulated the number of adverse events and their associated costs and utilities, both before and after various degrees of improvement in percent time in therapeutic range (TTR). The simulation had a 2-year time horizon, and costs were calculated from the perspective of the payer. In the base-case analysis, improving TTR by 5% prevented 1114 adverse events, including 662 deaths; it gained 863 quality-adjusted life-years and saved $15.9 million compared with the status quo, not accounting for the cost of the quality improvement program. Improving TTR by 10% prevented 2087 events, gained 1606 quality-adjusted life-years, and saved $29.7 million. In sensitivity analyses, costs were most sensitive to the estimated risk of stroke and the expected stroke reduction from improved TTR. Utilities were most sensitive to the estimated risk of death and the expected mortality benefit from improved TTR. A quality improvement program to improve anticoagulation control probably would be cost-saving for the payer, even if it were only modestly effective in improving control and even without considering the value of improved health. This study demonstrates how to make a business case for a quality improvement initiative.

The potential benefit of improving the dissemination of agricultural weather information to the Mississippi cotton farmer

NASA Technical Reports Server (NTRS)

Priddy, K. T.; Marlatt, W. E. (Principal Investigator)

1978-01-01

The author has identified the following significant results. The potential benefit of improved dissemination of weather information to the Mississippi cotton farmer was estimated at $36,000 per 1000 acres. This is 16% of production cost of cotton in 1976. On a statewide basis, the total potential savings exceeds 100 million dollars.

Effect of a pharmacist-managed hypertension program on health system costs: an evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN).

PubMed

Houle, Sherilyn K D; Chuck, Anderson W; McAlister, Finlay A; Tsuyuki, Ross T

2012-06-01

To quantify the potential cost savings of a community pharmacy-based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program. An economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1-year period. The SCRIP-HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.6 mm Hg than patients receiving usual care. For our model, published meta-analysis data were used to compute cardiovascular event absolute risk reductions associated with a 5.6-mm Hg reduction in systolic blood pressure over 6 months. Costs/event were obtained from administrative data, and probabilistic sensitivity analyses were performed to assess the robustness of the results. Two program scenarios were evaluated-one with monthly follow-up for a total of 1 year with sustained blood pressure reduction, and the other in which pharmacist care ended after the 6-month program but the effects on systolic blood pressure diminished over time. The cost saving results from the economic model were then compared with the costs of the program. Annual estimated cost savings (in 2011 Canadian dollars) from avoided cardiovascular events were $265/patient (95% confidence interval [CI] $63-467) if the program lasted 1 year or $221/patient (95%CI $72-371) if pharmacist care ceased after 6 months with an assumed loss of effect afterward. Estimated pharmacist costs were $90/patient for 6 months or $150/patient for 1 year, suggesting that pharmacist-managed programs are cost saving, with the annual net total cost savings/patient estimated to be $131 for a program lasting 6 months or $115 for a program lasting 1 year. Our model found that community pharmacist interventions capable of reducing systolic blood pressure by 5.6 mm Hg within 6 months are cost saving and result in improved patient outcomes. Wider adoption of pharmacist-managed hypertension care for patients with diabetes and hypertension is encouraged. © 2012 Pharmacotherapy Publications, Inc.

Fuel Savings and Aerodynamic Drag Reduction from Rail Car Covers

NASA Technical Reports Server (NTRS)

Storms, Bruce; Salari, Kambiz; Babb, Alex

2008-01-01

The potential for energy savings by reducing the aerodynamic drag of rail cars is significant. A previous study of aerodynamic drag of coal cars suggests that a 25% reduction in drag of empty cars would correspond to a 5% fuel savings for a round trip [1]. Rail statistics for the United States [2] report that approximately 5.7 billion liters of diesel fuel were consumed for coal transportation in 2002, so a 5% fuel savings would total 284 million liters. This corresponds to 2% of Class I railroad fuel consumption nationwide. As part of a DOE-sponsored study, the aerodynamic drag of scale rail cars was measured in a wind tunnel. The goal of the study was to measure the drag reduction of various rail-car cover designs. The cover designs tested yielded an average drag reduction of 43% relative to empty cars corresponding to an estimated round-trip fuel savings of 9%.

Potential savings from redetermining disability among children receiving supplemental security income benefits.

PubMed

Pulcini, Christian D; Kotelchuck, Milton; Kuhlthau, Karen A; Nozzolillo, Alixandra A; Perrin, James M

2012-01-01

To compare the costs of redetermining disability to potential savings in Supplemental Security Income payments associated with different strategies for implementing Continuing Disability Reviews (CDRs) among children potentially enrolled in SSI from 2012 to 2021. We reviewed publicly available reports from the Social Security Administration and Government Accountability Office to estimate costs and savings. We considered CDRs for children ages 1-17 years, excluding mandated low-birth weight and age 18 redeterminations that SSA routinely has performed. If in 2012 the Social Security Administration performs the same number of CDRs for children as in 2010 (16,677, 1% of eligibles) at a cessation rate of 15%, the agency would experience net savings of approximately $145 million in benefit payments. If CDR numbers increased to the greatest level ever (183,211, 22% of eligibles, in 1999) at the same cessation rate, the agency would save approximately $1.6 billion in benefit payments. Increasing the numbers of CDRs for children represents a considerable opportunity for savings. Recognizing the dynamic nature of disability, the agency could reassess the persistence of disability systematically; doing so could free up resources from children who are no longer eligible and help the agency better direct its benefits to recipients with ongoing disability and whose families need support to meet the extra costs associated with raising a child with a major disability. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Potential savings in prescription drug costs for hypertension, hyperlipidemia, and diabetes mellitus by equivalent drug substitution in Austria: a nationwide cohort study.

PubMed

Heinze, Georg; Hronsky, Milan; Reichardt, Berthold; Baumgärtel, Christoph; Müllner, Marcus; Bucsics, Anna; Winkelmayer, Wolfgang C

2015-04-01

Healthcare systems spend considerable proportions of their budgets on pharmaceutical treatment of hypertension, hyperlipidemia, and diabetes mellitus. From data on almost all residents of Austria, a country with mandatory health insurance and universal health coverage, we estimated potential cost savings by substituting prescribed medicines with the cheapest medicines that were of the same chemical substance and strength, and available during the same time. Data from 8.3 million persons (98.5 % of the total Austrian insured population) from 2009-2012 were analyzed. Real prescription costs for antihypertensive, lipid-lowering, and hypoglycemic medicines achievable by same-substance, same-strength drug substitution were computed for each active ingredient, and per gender and 1-year age category of patients. In 2012, health insurance providers spent 231.3 million, 77.8 million, and 91.9 million for antihypertensive, lipid-lowering, and diabetes medications, of which 52.2 million (22.6 %), 15.9 million (20.5 %), and 4.1 million (4.5 %), respectively, could have been saved by same-substance drug substitution. Highest potential savings were calculated for amlodipine (8.0 million, 65.4 %), simvastatin (12.2 million, 59.3 %), and metformin (2.4 million, 54.6 %), respectively. Higher savings for men than for women resulted from differing prescribed cumulative dosages and proportions of patients with co-payment waiver. Potential cost savings in antihypertensive and lipid-lowering drugs increased from 2009-2012. Our study highlights the cost-savings potential from arguably the most acceptable of interventions, simply switching to the cheapest available same-substance, same-strength product. In 2012, this strategy could have reduced costs for antihypertensive, lipid-lowering, and hypoglycemic treatment by up to 18.0 %.

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

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

PubMed Central

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

2013-01-01

Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare beneficiaries with MIS fusion in the hospital inpatient setting could save Medicare $660 million over patients’ lifetimes. PMID:24348055

Energy performance and greenhouse gas emissions of kelp cultivation for biogas and fertilizer recovery in Sweden.

PubMed

Pechsiri, Joseph S; Thomas, Jean-Baptiste E; Risén, Emma; Ribeiro, Mauricio S; Malmström, Maria E; Nylund, Göran M; Jansson, Anette; Welander, Ulrika; Pavia, Henrik; Gröndahl, Fredrik

2016-12-15

The cultivation of seaweed as a feedstock for third generation biofuels is gathering interest in Europe, however, many questions remain unanswered in practise, notably regarding scales of operation, energy returns on investment (EROI) and greenhouse gas (GHG) emissions, all of which are crucial to determine commercial viability. This study performed an energy and GHG emissions analysis, using EROI and GHG savings potential respectively, as indicators of commercial viability for two systems: the Swedish Seafarm project's seaweed cultivation (0.5ha), biogas and fertilizer biorefinery, and an estimation of the same system scaled up and adjusted to a cultivation of 10ha. Based on a conservative estimate of biogas yield, neither the 0.5ha case nor the up-scaled 10ha estimates met the (commercial viability) target EROI of 3, nor the European Union Renewable Energy Directive GHG savings target of 60% for biofuels, however the potential for commercial viability was substantially improved by scaling up operations: GHG emissions and energy demand, per unit of biogas, was almost halved by scaling operations up by a factor of twenty, thereby approaching the EROI and GHG savings targets set, under beneficial biogas production conditions. Further analysis identified processes whose optimisations would have a large impact on energy use and emissions (such as anaerobic digestion) as well as others embodying potential for further economies of scale (such as harvesting), both of which would be of interest for future developments of kelp to biogas and fertilizer biorefineries. Copyright © 2016. Published by Elsevier B.V.

Modeling potential effects of reduced calories in kids' meals with toy giveaways.

PubMed

Freij, Maysoun Y; Sell, Randall L; Bozack, Anne K; Weiss, Linda J; Garcia, Ana C

2014-02-01

Given the large proportion of daily calories attributable to fast food, there is growing interest in considering whether ordinances that restrict calories in kids' meals with toy giveaways could avert weight gain among children. Based upon a literature review and stakeholder feedback, a model was developed to estimate the potential number of children that could be affected by a statewide toy giveaway ordinance and the caloric savings should such a policy effectively reduce the number of calories in kids' meals with toy giveaways. Assumptions included the estimated number of children that eat fast food each day, the proportion that choose a kids' meal with a toy, the caloric savings of a kids' meal that meets nutrition standards, and the degree to which these savings could result in weight gain averted per child per year. Using New York as a case study, the model estimates that, on a typical day, 5% (163,571) of children 0-12 years of age in New York could be affected by a toy ordinance. A child who typically consumes fast food two times per week could avoid gaining approximately 2 pounds per year with an ordinance requiring kids' meals to be ≤550 calories. The amount of weight gain averted would vary according to the calorie limit set by the law and the frequency of consumption per week. Our model indicates that a reduction in calories in kids' meals with toy giveaways has the potential to positively affect weight gain in a considerable percentage of children. Limitations of the model are considered.

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.

Energy savings for heat-island reduction strategies in Chicago and Houston (including updates for Baton Rouge, Sacramento, and Salt Lake City)

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

Konopacki, S.; Akbari, H.

2002-02-28

In 1997, the U.S. Environmental Protection Agency (EPA) established the ''Heat Island Reduction Initiative'' to quantify the potential benefits of Heat-Island Reduction (HIR) strategies (i.e., shade trees, reflective roofs, reflective pavements and urban vegetation) to reduce cooling-energy use in buildings, lower the ambient air temperature and improve urban air quality in cities, and reduce CO2 emissions from power plants. Under this initiative, the Urban Heat Island Pilot Project (UHIPP) was created with the objective of investigating the potential of HIR strategies in residential and commercial buildings in three initial UHIPP cities: Baton Rouge, LA; Sacramento, CA; and Salt Lake City,more » UT. Later two other cities, Chicago, IL and Houston, TX were added to the UHIPP. In an earlier report we summarized our efforts to calculate the annual energy savings, peak power avoidance, and annual CO2 reduction obtainable from the introduction of HIR strategies in the initial three cities. This report summarizes the results of our study for Chicago and Houston. In this analysis, we focused on three building types that offer the highest potential savings: single-family residence, office and retail store. Each building type was characterized in detail by vintage and system type (i.e., old and new building constructions, and gas and electric heat). We used the prototypical building characteristics developed earlier for each building type and simulated the impact of HIR strategies on building cooling- and heating-energy use and peak power demand using the DOE-2.1E model. Our simulations included the impact of (1) strategically-placed shade trees near buildings [direct effect], (2) use of high-albedo roofing material on the building [direct effect], (3) urban reforestation with high-albedo pavements and building surfaces [indirect effect] and (4) combined strategies 1, 2, and 3 [direct and indirect effects]. We then estimated the total roof area of air-conditioned buildings in each city using readily obtainable data to calculate the metropolitan-wide impact of HIR strategies. The results show that in Chicago, potential annual energy savings of $30M could be realized by ratepayers from the combined direct and indirect effects of HIR strategies. Additionally, peak power avoidance is estimated at 400 MW and the reduction in annual carbon emissions at 58 ktC. In Houston, the potential annual energy savings are estimated at $82M, with an avoidance of 730 MW in peak power and a reduction in annual carbon emissions of 170 ktC.« less

Cost analysis of medical assistance in dying in Canada.

PubMed

Trachtenberg, Aaron J; Manns, Braden

2017-01-23

The legalization of medical assistance in dying will affect health care spending in Canada. Our aim was to determine the potential costs and savings associated with the implementation of medical assistance in dying. Using published data from the Netherlands and Belgium, where medically assisted death is legal, we estimated that medical assistance in dying will account for 1%-4% of all deaths; 80% of patients will have cancer; 50% of patients will be aged 60-80 years; 55% will be men; 60% of patients will have their lives shortened by 1 month; and 40% of patients will have their lives shortened by 1 week. We combined current mortality data for the Canadian population with recent end-of-life cost data to calculate a predicted range of savings associated with the implementation of medical assistance in dying. We also estimated the direct costs associated with offering medically assisted death, including physician consultations and drug costs. Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5-$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of mdedical assistance in dying will likely remain at least cost neutral. Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system, and could result in substantial savings. Additional data on patients who choose medical assistance in dying in Canada should be collected to enable more precise estimates of the impact of medically assisted death on health care spending and to enable further economic evaluation. © 2017 Canadian Medical Association or its licensors.

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 the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

PubMed Central

2010-01-01

Background Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved) Conclusions Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina. PMID:20961456

Using GIS to evaluate a fire safety program in North Carolina.

PubMed

Dudley, Thomas; Creppage, Kathleen; Shanahan, Meghan; Proescholdbell, Scott

2013-10-01

Evaluating program impact is a critical aspect of public health. Utilizing Geographic Information Systems (GIS) is a novel way to evaluate programs which try to reduce residential fire injuries and deaths. The purpose of this study is to demonstrate the application of GIS within the evaluation of a smoke alarm installation program in North Carolina. This approach incorporates national fire incident data which, when linked with program data, provides a clear depiction of the 10 years impact of the Get Alarmed, NC! program and estimates the number of potential lives saved. We overlapped Get Alarmed, NC! program installation data with national information on fires using GIS to identify homes that experienced a fire after an alarm was installed and calculated potential lives saved based on program documentation and average housing occupancy. We found that using GIS was an efficient and quick way to match addresses from two distinct sources. From this approach we estimated that between 221 and 384 residents were potentially saved due to alarms installed in their homes by Get Alarmed, NC!. Compared with other program evaluations that require intensive and costly participant telephone surveys and/or in-person interviews, the GIS approach is inexpensive, quick, and can easily analyze large disparate datasets. In addition, it can be used to help target the areas most at risk from the onset. These benefits suggest that by incorporating previously unutilized data, the GIS approach has the potential for broader applications within public health program evaluation.

Estimating the potential for industrial waste heat reutilization in urban district energy systems: method development and implementation in two Chinese provinces

NASA Astrophysics Data System (ADS)

Tong, Kangkang; Fang, Andrew; Yu, Huajun; Li, Yang; Shi, Lei; Wang, Yangjun; Wang, Shuxiao; Ramaswami, Anu

2017-12-01

Utilizing low-grade waste heat from industries to heat and cool homes and businesses through fourth generation district energy systems (DES) is a novel strategy to reduce energy use. This paper develops a generalizable methodology to estimate the energy saving potential for heating/cooling in 20 cities in two Chinese provinces, representing cold winter and hot summer regions respectively. We also conduct a life-cycle analysis of the new infrastructure required for energy exchange in DES. Results show that heating and cooling energy use reduction from this waste heat exchange strategy varies widely based on the mix of industrial, residential and commercial activities, and climate conditions in cities. Low-grade heat is found to be the dominant component of waste heat released by industries, which can be reused for both district heating and cooling in fourth generation DES, yielding energy use reductions from 12%-91% (average of 58%) for heating and 24%-100% (average of 73%) for cooling energy use in the different cities based on annual exchange potential. Incorporating seasonality and multiple energy exchange pathways resulted in energy savings reductions from 0%-87%. The life-cycle impact of added infrastructure was small (<3% for heating) and 1.9% ~ 6.5% (cooling) of the carbon emissions from fuel use in current heating or cooling systems, indicating net carbon savings. This generalizable approach to delineate waste heat potential can help determine suitable cities for the widespread application of industrial waste heat re-utilization.

Conducting polymers: Synthesis and industrial applications

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

Gottesfeld, S.

1997-04-01

The Conducting Polymer project funded by the AIM Program has developed new methods for the synthesis of conducting polymers and evaluated new industrial applications for these materials which will result in significant reductions in energy usage or industrial waste. The applications specifically addressed during FY 1996 included two ongoing efforts on membranes for gas separation and on electrochemical capacitors and a third new application: electrochemical reactors (ECRs) based on polymeric electrolytes. As a gas separation membrane, conducting polymers offer high selectivity and the potential to chemically or electrically adapt the membrane for specific gas combinations. Potential energy savings in themore » US for this application are estimated at 1 to 3 quads/yr. As an active material in electrochemical capacitors, electronically conducting polymers have the potential of storing large amounts of electric energy in low cost materials. Potential energy savings estimated at 1 quad/yr would result from introduction of electrochemical capacitors as energy storage devices in power trains of electric and hybrid vehicles, once such vehicles reach 20% of the total transportation market in the US. In the chlor-alkali industry, electrochemical reactors based on polymer electrolyte membranes consume around 1 % of the total electric power in the US. A new activity, started in FY 1996, is devoted to energy efficient ECRs. In the case of the chlor-alkali industry, energy savings as high as 50% seem possible with the novel ECR technology demonstrated by the author in 1996.« less

Cost-effectiveness of volumetric alcohol taxation in Australia.

PubMed

Byrnes, Joshua M; Cobiac, Linda J; Doran, Christopher M; Vos, Theo; Shakeshaft, Anthony P

2010-04-19

To estimate the potential health benefits and cost savings of an alcohol tax rate that applies equally to all alcoholic beverages based on their alcohol content (volumetric tax) and to compare the cost savings with the cost of implementation. Mathematical modelling of three scenarios of volumetric alcohol taxation for the population of Australia: (i) no change in deadweight loss, (ii) no change in tax revenue, and (iii) all alcoholic beverages taxed at the same rate as spirits. Estimated change in alcohol consumption, tax revenue and health benefit. The estimated cost of changing to a volumetric tax rate is $18 million. A volumetric tax that is deadweight loss-neutral would increase the cost of beer and wine and reduce the cost of spirits, resulting in an estimated annual increase in taxation revenue of $492 million and a 2.77% reduction in annual consumption of pure alcohol. The estimated net health gain would be 21 000 disability-adjusted life-years (DALYs), with potential cost offsets of $110 million per annum. A tax revenue-neutral scenario would result in an 0.05% decrease in consumption, and a tax on all alcohol at a spirits rate would reduce consumption by 23.85% and increase revenue by $3094 million [corrected]. All volumetric tax scenarios would provide greater health benefits and cost savings to the health sector than the existing taxation system, based on current understandings of alcohol-related health effects. An equalized volumetric tax that would reduce beer and wine consumption while increasing the consumption of spirits would need to be approached with caution. Further research is required to examine whether alcohol-related health effects vary by type of alcoholic beverage independent of the amount of alcohol consumed to provide a strong evidence platform for alcohol taxation policies.

Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages.

PubMed

Ruhago, George M; Ngalesoni, Frida N; Norheim, Ole F

2012-12-27

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

PubMed Central

2012-01-01

Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal) and −0.12 (children) to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs. PMID:23270489

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.

An economic analysis comparison of stationary and dual-axis tracking grid-connected photovoltaic systems in the US Upper Midwest

NASA Astrophysics Data System (ADS)

Choi, Wongyu; Pate, Michael B.; Warren, Ryan D.; Nelson, Ron M.

2018-05-01

This paper presents an economic analysis of stationary and dual-axis tracking photovoltaic (PV) systems installed in the US Upper Midwest in terms of life-cycle costs, payback period, internal rate of return, and the incremental cost of solar energy. The first-year performance and energy savings were experimentally found along with documented initial cost. Future PV performance, savings, and operating and maintenance costs were estimated over 25-year assumed life. Under the given assumptions and discount rates, the life-cycle savings were found to be negative. Neither system was found to have payback periods less than the assumed system life. The lifetime average incremental costs of energy generated by the stationary and dual-axis tracking systems were estimated to be 0.31 and 0.37 per kWh generated, respectively. Economic analyses of different scenarios, each having a unique set of assumptions for costs and metering, showed a potential for economic feasibility under certain conditions when compared to alternative investments with assumed yields.

Solar thermal technology development: Estimated market size and energy cost savings. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Gates, W. R.

1983-01-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. The fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. STT R&D is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), dependng on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest.

Solar thermal technology development: Estimated market size and energy cost savings. Volume 1: Executive summary

NASA Astrophysics Data System (ADS)

Gates, W. R.

1983-02-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. The fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. STT R&D is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), dependng on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest.

The health and economic benefits of reducing intimate partner violence: an Australian example.

PubMed

Cadilhac, Dominique A; Sheppard, Lauren; Cumming, Toby B; Thayabaranathan, Tharshanah; Pearce, Dora C; Carter, Rob; Magnus, Anne

2015-07-09

Intimate partner violence (IPV) has important impacts on the health of women in society. Our aim was to estimate the health and economic benefits of reducing the prevalence of IPV in the 2008 Australian female adult population. Simulation models were developed to show the effect of a 5 percentage point absolute feasible reduction target in the prevalence of IPV from current Australian levels (27%). IPV is not measured in national surveys. Levels of psychological distress were used as a proxy for exposure to IPV since psychological conditions represent three-quarters of the disease burden from IPV. Lifetime cohort health benefits for females were estimated as fewer incident cases of violence-related disease and injury; deaths; and Disability Adjusted Life Years (DALYs). Opportunity cost savings were estimated for the health sector, paid and unpaid production and leisure from reduced incidence of IPV-related disease and deaths. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of females with moderate psychological distress (lifetime IPV exposure) against high or very high distress (current IPV exposure), and valued using the friction cost approach (FCA). The impact of improved health status on unpaid household production and leisure time were modelled from time use survey data. Potential costs associated with interventions to reduce IPV were not considered. Multivariable uncertainty analyses and univariable sensitivity analyses were undertaken. A 5 percentage point absolute reduction in the lifetime prevalence of IPV in the 2008 Australian female population was estimated to produce 6000 fewer incident cases of disease/injury, 74 fewer deaths, 5000 fewer DALYs lost and provide gains of 926,000 working days, 371,000 days of home-based production and 428,000 leisure days. Overall, AUD371 million in opportunity cost savings could be achievable. The greatest economic savings would be home-based production (AUD147 million), followed by leisure time (AUD98 million), workforce production (AUD94 million) and reduced health sector costs (AUD38 million). This study contributes new knowledge about the economic impact of IPV in females. The findings provide evidence of large potential opportunity cost savings from reducing the prevalence of IPV and reinforce the need to reduce IPV in Australia, and elsewhere.

Performance assessment of a photonic radiative cooling system for office buildings

DOE PAGES

Wang, Weimin; Fernandez, Nick; Katipamula, Srinivas; ...

2017-11-08

Recent advances in materials have demonstrated the ability to maintain radiator surfaces at below-ambient temperatures in the presence of intense, direct sunlight. Daytime radiative cooling is promising for building applications. Here, this paper estimates the energy savings from daytime radiative cooling, specifically based on photonic materials. A photonic radiative cooling system was proposed and modeled using the whole energy simulation program EnergyPlus. A typical medium-sized office building was used for the simulation analysis. Several reference systems were established to quantify the potential of energy savings from the photonic radiative cooling system. The reference systems include a variable-air-volume (VAV) system, amore » hydronic radiant system, and a nighttime radiative cooling system. The savings analysis was made for a number of locations with different climates. Simulation results showed that the photonic radiative cooling system saved between 45% and 68% cooling electricity relative to the VAV system and between 9% and 23% relative to the nighttime radiative cooling system featured with the best coating commercially available on market. Finally, a simple economic analysis was also made to estimate the maximum acceptable incremental cost for upgrading from nighttime cooling to photonic radiative cooling.« less

Performance assessment of a photonic radiative cooling system for office buildings

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

Wang, Weimin; Fernandez, Nick; Katipamula, Srinivas

Recent advances in materials have demonstrated the ability to maintain radiator surfaces at below-ambient temperatures in the presence of intense, direct sunlight. Daytime radiative cooling is promising for building applications. Here, this paper estimates the energy savings from daytime radiative cooling, specifically based on photonic materials. A photonic radiative cooling system was proposed and modeled using the whole energy simulation program EnergyPlus. A typical medium-sized office building was used for the simulation analysis. Several reference systems were established to quantify the potential of energy savings from the photonic radiative cooling system. The reference systems include a variable-air-volume (VAV) system, amore » hydronic radiant system, and a nighttime radiative cooling system. The savings analysis was made for a number of locations with different climates. Simulation results showed that the photonic radiative cooling system saved between 45% and 68% cooling electricity relative to the VAV system and between 9% and 23% relative to the nighttime radiative cooling system featured with the best coating commercially available on market. Finally, a simple economic analysis was also made to estimate the maximum acceptable incremental cost for upgrading from nighttime cooling to photonic radiative cooling.« less

40 CFR 246.200-8 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures..., storage, and transportation costs have been made, and estimated tonnages of both recoverable high-grade... for revenue from paper sales and savings from diverting recycled materials from disposal. Potential...

40 CFR 246.202-6 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., storage and transportation costs have been made, and estimated tonnages of both recoverable material and...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... paper sales and savings from diverting recycled materials from disposal. Potential costs to upgrade...

40 CFR 246.201-7 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., storage and transportation costs have been made, and estimated tonnages of both recoverable materials and...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... paper sales and savings from diverting recycled materials from disposal. Potential costs to upgrade...

Hybrid vehicle assessment. Phase 1: Petroleum savings analysis

NASA Technical Reports Server (NTRS)

Levin, R.; Liddle, S.; Deshpande, G.; Trummel, M.; Vivian, H. C.

1984-01-01

The results of a comprehensive analysis of near term electric hybrid vehicles are presented, with emphasis on their potential to save significant amounts of petroleum on a national scale in the 1990s. Performance requirements and expected annual usage patterns of these vehicles are first modeled. The projected U.S. fleet composition is estimated, and conceptual hybrid vehicle designs are conceived and analyzed for petroleum use when driven in the expected annual patterns. These petroleum consumption estimates are then compared to similar estimates for projected 1990 conventional vehicles having the same performance and driven in the same patterns. Results are presented in the form of three utility functions and comparisons of sevral conceptual designs are made. The Hybrid Vehicle (HV) design and assessment techniques are discussed and a general method is explained for selecting the optimum energy management strategy for any vehicle mission battery combination. Conclusions and recommendations are presented, and development recommendations are identified.

Preventable drug waste among anesthesia providers: opportunities for efficiency.

PubMed

Atcheson, Carrie Leigh Hamby; Spivack, John; Williams, Robert; Bryson, Ethan O

2016-05-01

Health care service bundling experiments at the state and regional levels have showed reduced costs by providing a single lump-sum reimbursement for anesthesia services, surgery, and postoperative care. Potential for cost savings related to the provision of anesthesia care has the potential to significantly impact sustainability. This study defines and quantifies routine and preventable anesthetic drug waste and the patient, procedure, and anesthesia provider characteristics associated with increased waste. Over a 12-month period, the type and quantity of clean drugs prepared by the anesthesia team for the first case of the day were recorded. The amount of each drug administered was obtained from the computerized anesthesia record, and data were analyzed to determine the incidence and cost of routine and preventable drug waste. The monthly and yearly cost of preventable waste, including the cost of pharmacy tech labor and materials where applicable, was estimated based on surgical case volume at the study institution. All analyses were performed using SAS software v9.2. Anesthetic drugs prepared for 543 separate surgical cases were observed. Less than 20% of cases generated routine waste. Preventable waste was generated most frequently for ephedrine (59.5% of cases), succinylcholine (33.7%), and lidocaine (25.1%), and least frequently for ondansetron (1.3%), phenylephrine (2.6%), and dexamethasone (2.8%). The estimated yearly cost of preventable anesthetic drug waste was $185,250. Significant potential savings with little impact on clinically significant availability may be achieved through the use of prefilled syringes for some commonly used anesthetic drugs. An intelligently implemented switch to prefilled syringes for select drugs is a potential cost saving measure, but savings might be diminished by disposal of prefilled syringes when they expire, hidden costs in the hospital pharmacy, and inability to supply some medications in prefilled syringes due to stability or manufacturing issues. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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

Assessment of Energy Efficiency Improvement in the United States Petroleum Refining Industry

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

Morrow, William R.; Marano, John; Sathaye, Jayant

2013-02-01

Adoption of efficient process technologies is an important approach to reducing CO 2 emissions, in particular those associated with combustion. In many cases, implementing energy efficiency measures is among the most cost-effective approaches that any refiner can take, improving productivity while reducing emissions. Therefore, careful analysis of the options and costs associated with efficiency measures is required to establish sound carbon policies addressing global climate change, and is the primary focus of LBNL’s current petroleum refining sector analysis for the U.S. Environmental Protection Agency. The analysis is aimed at identifying energy efficiency-related measures and developing energy abatement supply curves andmore » CO 2 emissions reduction potential for the U.S. refining industry. A refinery model has been developed for this purpose that is a notional aggregation of the U.S. petroleum refining sector. It consists of twelve processing units and account s for the additional energy requirements from steam generation, hydrogen production and water utilities required by each of the twelve processing units. The model is carbon and energy balanced such that crud e oil inputs and major refinery sector outputs (fuels) are benchmarked to 2010 data. Estimates of the current penetration for the identified energy efficiency measures benchmark the energy requirements to those reported in U.S. DOE 2010 data. The remaining energy efficiency potential for each of the measures is estimated and compared to U.S. DOE fuel prices resulting in estimates of cost- effective energy efficiency opportunities for each of the twelve major processes. A combined cost of conserved energy supply curve is also presented along with the CO 2 emissions abatement opportunities that exist in the U.S. petroleum refinery sector. Roughly 1,200 PJ per year of primary fuels savings and close to 500 GWh per y ear of electricity savings are potentially cost-effective given U.S. DOE fuel price forecasts. This represents roughly 70 million metric tonnes of CO 2 emission reductions assuming 2010 emissions factor for grid electricity. Energy efficiency measures resulting in an additional 400 PJ per year of primary fuels savings and close to 1,700 GWh per year of electricity savings, and an associated 24 million metric tonnes of CO 2 emission reductions are not cost-effective given the same assumption with respect to fuel prices and electricity emissions factors. Compared to the modeled energy requirements for the U.S. petroleum refining sector, the cost effective potential represents a 40% reduction in fuel consumption and a 2% reduction in electricity consumption. The non-cost-effective potential represents an additional 13% reduction in fuel consumption and an additional 7% reduction in electricity consumption. The relative energy reduction potentials are mu ch higher for fuel consumption than electricity consumption largely in part because fuel is the primary energy consumption type in the refineries. Moreover, many cost effective fuel savings measures would increase electricity consumption. The model also has the potential to be used to examine the costs and benefits of the other CO 2 mitigation options, such as combined heat and power (CHP), carbon capture, and the potential introduction of biomass feedstocks. However, these options are not addressed in this report as this report is focused on developing the modeling methodology and assessing fuels savings measures. These opportunities to further reduce refinery sector CO 2 emissions and are recommended for further research and analysis.« less

Carbon-Carbon Recuperators in Closed-Brayton-Cycle Space Power Systems

NASA Technical Reports Server (NTRS)

Barrett, Michael J.; Johnson, Paul K.; Naples, Andrew G.

2006-01-01

The feasibility of using carbon-carbon (C-C) recuperators in conceptual closed-Brayton-cycle space power conversion systems was assessed. Recuperator performance expectations were forecast based on notional thermodynamic cycle state values for potential planetary missions. Resulting thermal performance, mass and volume for plate-fin C-C recuperators were estimated and quantitatively compared with values for conventional offset-strip-fin metallic designs. Mass savings of 30 to 60 percent were projected for C-C recuperators with effectiveness greater than 0.9 and thermal loads from 25 to 1400 kWt. The smaller thermal loads corresponded with lower mass savings; however, 60 percent savings were forecast for all loads above 300 kWt. System-related material challenges and compatibility issues were also discussed.

Integrated HIV testing, malaria, and diarrhea prevention campaign in Kenya: modeled health impact and cost-effectiveness.

PubMed

Kahn, James G; Muraguri, Nicholas; Harris, Brian; Lugada, Eric; Clasen, Thomas; Grabowsky, Mark; Mermin, Jonathan; Shariff, Shahnaaz

2012-01-01

Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign. We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease. Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20. A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive.

Vehicle Technology Simulation and Analysis Tools | Transportation Research

Science.gov Websites

| NREL Vehicle Technology Simulation and Analysis Tools Vehicle Technology Simulation and vehicle technologies with the potential to achieve significant fuel savings and emission reductions. NREL : Automotive Deployment Options Projection Tool The ADOPT modeling tool estimates vehicle technology

The cost-saving effect and prevention of medication errors by clinical pharmacist intervention in a nephrology unit.

PubMed

Chen, Chia-Chi; Hsiao, Fei-Yuan; Shen, Li-Jiuan; Wu, Chien-Chih

2017-08-01

Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward.This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared.The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist.The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

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.

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.

Industrial demand side management: A status report

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

Hopkins, M.F.; Conger, R.L.; Foley, T.J.

This report provides an overview of and rationale for industrial demand side management (DSM) programs. Benefits and barriers are described, and data from the Manufacturing Energy Consumption Survey are used to estimate potential energy savings in kilowatt hours. The report presents types and examples of programs and explores elements of successful programs. Two in-depth case studies (from Boise Cascade and Eli Lilly and Company) illustrate two types of effective DSM programs. Interviews with staff from state public utility commissions indicate the current thinking about the status and future of industrial DSM programs. A comprehensive bibliography is included, technical assistance programsmore » are listed and described, and a methodology for evaluating potential or actual savings from projects is delineated.« less

Estimating the Effects of Module Area on Thin-Film Photovoltaic System Costs: Preprint

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

Horowitz, Kelsey A; Fu, Ran; Silverman, Timothy J

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 thin-film modules and systems as a function of module area. We calculate a potential for savings of up to 0.10 dollars/W and 0.13 dollars/W in module manufacturing costs for CdTe and CIGS respectively, with large area modules. We also find that an additional 0.04 dollars/W savings in balance-of-systems costs may be achieved. Sensitivity of the dollar/W cost savings to module efficiency, manufacturing yield, and other parameters is presented. Lifetime energy yield must also bemore » maintained to realize reductions in the levelized cost of energy; the effects of module size on energy yield for monolithic thin-film modules are not yet well understood. Finally, we discuss possible non-cost barriers to adoption of large area modules.« less

Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation.

PubMed

Hayashi, Toshinobu; Ikesue, Hiroaki; Esaki, Taito; Fukazawa, Mami; Abe, Motoaki; Ohno, Shinji; Tomizawa, Tatsuru; Oishi, Ryozo

2012-08-01

The purposes of this study were to evaluate the effect of implementation of institutional guidelines for low emetic risk chemotherapy with docetaxel and estimate the cost saving for all low emetic risk chemotherapies. We examined the clinical effect of preparing and implementing institutional antiemetic guidelines for the breast cancer patients receiving adjuvant docetaxel therapy. Although the antiemetic medication for such patients used to be ondansetron 4 mg plus dexamethasone 8 mg (OND + DEX), it was changed to dexamethasone (DEX) 12 mg alone after implementation of the institutional guidelines. The effectiveness and adverse effects of DEX alone (56 patients, 205 courses) were compared with those of OND + DEX (41 patients, 151 courses). The cost saving was calculated from the antiemetic costs in both groups. The annual cost saving was estimated from the number of all low emetic risk chemotherapies in a year. The incidences of nausea (19.5% versus 16.1%), vomiting (2.4% versus 0%), constipation (34.1% versus 30.4%), and insomnia (17.1% versus 17.9%) were not significantly different between the OND + DEX group and DEX alone group. In all low emetic risk chemotherapies, US $78,883 of potential cost saving was estimated in the first year after changing the antiemetic treatment. The present results suggest that DEX alone is equally effective for preventing nausea and vomiting and less expensive compared with a 5-HT(3) receptor antagonist plus DEX in low emetic risk chemotherapy with docetaxel.

White Nail Radio Transmitter: Billion Dollar Savings through Energy Efficiency

DTIC Science & Technology

2011-05-10

increase efficiency and reduce overall energy consumption ashore by 50 percent CNO, Navy Energy Vision, P 10 White Nail Vision Your Cell Phone Cell...Estimated Total Number of transmitters 3,000,000 Estimated total power saved Watt 1,250,000,000 Cell Phone Transmitter Efficiency 1.25 Gigawatts saved...Greenhouse Gas Power 4 1 Energy Navy Use 7.3 Billion kWh White Nail Cell Phone Savings 11 Billion kWh One and a half times!!! Saves the output of four of

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.

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.

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.

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.

Energy and Economic Impacts of U.S. Federal Energy and Water Conservation Standards Adopted From 1987 Through 2015

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

Meyers, Stephen; Williams, Alison; Chan, Peter

This paper presents estimates of the key impacts of Federal energy and water conservation standards adopted from 1987 through 2015. The standards for consumer products and commercial and industrial equipment include those set by legislation as well as standards adopted by DOE through rulemaking. In 2015, the standards saved an estimated 4.49 quads of primary energy, which is equivalent to 5% of total U.S. energy consumption. The savings in operating costs for households and businesses totaled $63.4 billion. The average household saved $320 in operating costs as a result of residential appliance standards. The estimated reduction in CO2 emissions associatedmore » with the standards in 2015 was 238 million metric tons, which is equivalent to 4.3% of total U.S. CO2 emissions. The estimated cumulative energy savings over the period 1990-2090 amount to 216.9 quads. Accounting for the increased upfront costs of more-efficient products and the operating cost (energy and water) savings over the products’ lifetime, the standards have a cumulative net present value (NPV) of consumer benefit of between $1,627 billion and $1,887 billion, using 7 percent and 3 percent discount rates, respectively. The water conservation standards, together with energy conservation standards that also save water, reduced water use by 1.9 trillion gallons in 2015 and estimated cumulative water savings by 2090 amount to 55 trillion gallons. The estimated consumer savings in 2015 from reduced water use amounted to $12 billon.« less

Energy-saving approaches to solid state street lighting

NASA Astrophysics Data System (ADS)

Vitta, Pranciškus; Stanikūnas, Rytis; Tuzikas, Arūnas; Reklaitis, Ignas; Stonkus, Andrius; Petrulis, Andrius; Vaitkevičius, Henrikas; Žukauskas, Artūras

2011-10-01

We consider the energy-saving potential of solid-state street lighting due to improved visual performance, weather sensitive luminance control and tracking of pedestrians and vehicles. A psychophysical experiment on the measurement of reaction time with a decision making task was performed under mesopic levels of illumination provided by a highpressure sodium (HPS) lamp and different solid-state light sources, such as daylight and warm-white phosphor converted light-emitting diodes (LEDs) and red-green-blue LED clusters. The results of the experiment imply that photopic luminances of road surface provided by solid-state light sources with an optimized spectral power distribution might be up to twice as low as those provided by the HPS lamp. Dynamical correction of road luminance against road surface conditions typical of Lithuanian climate was estimated to save about 20% of energy in comparison with constant-level illumination. The estimated energy savings due to the tracking of pedestrians and vehicles amount at least 25% with the cumulative effect of intelligent control of at least 40%. A solid-state street lighting system with intelligent control was demonstrated using a 300 m long test ground consisting of 10 solid-state street luminaires, a meteorological station and microwave motion sensor network operated via power line communication.

Home Energy Saver

Science.gov Websites

Energy Saver (HES) Licensing Information The Home Energy Saver is a web-based residential energy calculator and web service that provides customized estimates of residential energy use, energy bills, and potential energy-saving strategies and ranks them in order of cost-effectiveness. Use of the web-services

Modeling the Frequency and Costs Associated with Postsurgical Gastrointestinal Adverse Events for Tapentadol IR versus Oxycodone IR

PubMed Central

Paris, Andrew; Kozma, Chris M.; Chow, Wing; Patel, Anisha M.; Mody, Samir H.; Kim, Myoung S.

2013-01-01

Background Few studies have estimated the economic effect of using an opioid that is associated with lower rates of gastrointestinal (GI) adverse events (AEs) than another opioid for postsurgical pain. Objective To estimate the number of postsurgical GI events and incremental hospital costs, including potential savings, associated with lower GI AE rates, for tapentadol immediate release (IR) versus oxycodone IR, using a literature-based calculator. Methods An electronic spreadsheet–based cost calculator was developed to estimate the total number of GI AEs (ie, nausea, vomiting, or constipation) and incremental costs to a hospital when using tapentadol IR 100 mg versus oxycodone IR 15 mg, in a hypothetical cohort of 1500 hospitalized patients requiring short-acting opioids for postsurgical pain. Data inputs were chosen from recently published, well-designed studies, including GI AE rates from a previously published phase 3 clinical trial of postsurgical patients who received these 2 opioids; GI event–related incremental length of stay from a large US hospital database; drug costs using wholesale acquisition costs in 2011 US dollars; and average hospitalization cost from the 2009 Healthcare Cost and Utilization Project database. The base case assumed that 5% (chosen as a conservative estimate) of patients admitted to the hospital would shift from oxycodone IR to tapentadol IR. Results In this hypothetical cohort of 1500 hospitalized patients, replacing 5% of oxycodone IR 15-mg use with tapentadol IR 100-mg use predicted reductions in the total number of GI events from 1095 to 1085, and in the total cost of GI AEs from $2,978,400 to $2,949,840. This cost reduction translates to a net savings of $22,922 after factoring in drug cost. For individual GI events, the net savings were $26,491 for nausea; $12,212 for vomiting; and $7187 for constipation. Conclusion Using tapentadol IR in place of a traditional μ-opioid shows the potential for reduced GI events and subsequent cost-savings in the postsurgical hospital setting. In the absence of sufficient real-world data, this literature-based cost calculator may assist hospital Pharmacy & Therapeutics committees in their evaluation of the costs of opioid-related GI events. PMID:24991383

Benefits of Leapfrogging to Superefficiency and Low Global Warming Potential Refrigerants in Room Air Conditioning

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

Shah, Nihar; Wei, Max; Letschert, Virginie

2015-10-01

Hydrofluorocarbons (HFCs) emitted from uses such as refrigerants and thermal insulating foam, are now the fastest growing greenhouse gases (GHGs), with global warming potentials (GWP) thousands of times higher than carbon dioxide (CO2). Because of the short lifetime of these molecules in the atmosphere, mitigating the amount of these short-lived climate pollutants (SLCPs) provides a faster path to climate change mitigation than control of CO2 alone. This has led to proposals from Africa, Europe, India, Island States, and North America to amend the Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) to phase-down high-GWP HFCs. Simultaneously, energymore » efficiency market transformation programs such as standards, labeling and incentive programs are endeavoring to improve the energy efficiency for refrigeration and air conditioning equipment to provide life cycle cost, energy, GHG, and peak load savings. In this paper we provide an estimate of the magnitude of such GHG and peak electric load savings potential, for room air conditioning, if the refrigerant transition and energy efficiency improvement policies are implemented either separately or in parallel. We find that implementing HFC refrigerant transition and energy efficiency improvement policies in parallel for room air conditioning, roughly doubles the benefit of either policy implemented separately. We estimate that shifting the 2030 world stock of room air conditioners from the low efficiency technology using high-GWP refrigerants to higher efficiency technology and low-GWP refrigerants in parallel would save between 340-790 gigawatts (GW) of peak load globally, which is roughly equivalent to avoiding 680-1550 peak power plants of 500MW each. This would save 0.85 GT/year annually in China equivalent to over 8 Three Gorges dams and over 0.32 GT/year annually in India equivalent to roughly twice India’s 100GW solar mission target. While there is some uncertainty associated with emissions and growth projections, moving to efficient room air conditioning (~30% more efficient than current technology) in parallel with low-GWP refrigerants in room air conditioning could avoid up to ~25 billion tonnes of CO2 in 2030, ~33 billion in 2040, and ~40 billion in 2050, i.e. cumulative savings up to 98 billion tonnes of CO2 by 2050. Therefore, superefficient room ACs using low-GWP refrigerants merit serious consideration to maximize peak load reduction and GHG savings.« less

Survey and Chart Review to Estimate Medicare Cost Savings for Home Health as an Alternative to Hospital Admission Following Emergency Department Treatment.

PubMed

Crowley, Christopher; Stuck, Amy R; Martinez, Tracy; Wittgrove, Alan C; Zeng, Feng; Brennan, Jesse J; Chan, Theodore C; Killeen, James P; Castillo, Edward M

2016-12-01

Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED. We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED. This is a prospective study of patients admitted from the ED. A survey tool was used to query both emergency physicians (EPs) and patient medical record data to identify potential candidates and treatments for home-based care alternatives. Patient preferences were also surveyed. Cost savings were estimated by developing a model of Medicare Home Health to serve as a counterpart to the actual hospital-based care. EPs identified 40% of the admitted patients included in the study as candidates for home-based care. The top three major diagnostic categories included diseases and disorders of the respiratory system, digestive system, and skin. Services included intravenous hydration, intravenous antibiotics, and laboratory testing. The average estimated cost savings between the Medicare inpatient reimbursement and the Home Health counterpart was approximately $4000. Of the candidate patients surveyed, 79% indicated a preference for home-based care after treatment in the ED. Some Medicare beneficiaries could be referred to Home Health from the ED with a concomitant reduction in Medicare expenditures. Additional studies are needed to compare outcomes, develop the logistical pathways, and analyze infrastructure costs and incentives to enable Medicare Home Health options from the ED. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis.

PubMed

Pearson-Stuttard, Jonathan; Kypridemos, Chris; Collins, Brendan; Mozaffarian, Dariush; Huang, Yue; Bandosz, Piotr; Capewell, Simon; Whitsel, Laurie; Wilde, Parke; O'Flaherty, Martin; Micha, Renata

2018-04-01

Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect estimates in the model are based on interventional and prospective observational studies. They are therefore subject to biases and confounding that may have influenced also our model estimates. Implementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings.

Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin.

PubMed

Kreling, D H

1989-01-01

Potential impacts from two methods of changing prescription drug ingredient reimbursement in the Wisconsin Medicaid program were estimated. Current reimbursement amounts were compared with those resulting from either direct prices for eight manufacturers' products and average wholesale price less 10.5 percent for other products or wholesaler cost plus 5.01 percent for all products. The resulting overall average ingredient cost reimbursement reductions were 6.64 percent ($0.56 per prescription) and 6.94 percent ($0.59 per prescription) for the two methods, respectively. The results should be viewed from the perspective of both program savings and reduced pharmacists' revenues.

The role of taxation in tobacco control and its potential economic impact in China

PubMed Central

Mao, Zhengzhong; Shi, Jian; Chen, Wendong

2010-01-01

Objectives To identify key economic issues involved in raising the tobacco tax and to recommend possible options for tobacco tax reform in China. Methods Estimated price elasticities of the demand for cigarettes, prevalence data and epidemiology are used to estimate the impact of a tobacco tax increase on cigarette consumption, government tax revenue, lives saved, employment and revenue loss in the cigarette industry and tobacco farming. Results The recent Chinese tax adjustment, if passed along to the retail price, would reduce the number of smokers by 630 000 saving 210 000 lives, at a price elasticity of −0.15. A tax increase of 1 RMB (or US$0.13) per pack of cigarettes would increase the Chinese government's tax revenue by 129 billion RMB (US 17.2 billion), decrease consumption by 3.0 billion packs of cigarettes, reduce the number of smokers by 3.42 million and save 1.14 million lives. Conclusion The empirical economic analysis and tax simulation results clearly indicate that increasing the tobacco tax in China is the most cost-effective instrument for tobacco control. PMID:20008158

Solar thermal technology development: Estimated market size and energy cost savings. Volume 2: Assumptions, methodology and results

NASA Astrophysics Data System (ADS)

Gates, W. R.

1983-02-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. Three fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. Solar thermal technology research and development (R&D) is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), depending on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest. Analysis is also provided regarding two federal incentives currently in use: The Federal Business Energy Tax Credit and direct R&D funding.

Solar thermal technology development: Estimated market size and energy cost savings. Volume 2: Assumptions, methodology and results

NASA Technical Reports Server (NTRS)

Gates, W. R.

1983-01-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. Three fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. Solar thermal technology research and development (R&D) is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), depending on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest. Analysis is also provided regarding two federal incentives currently in use: The Federal Business Energy Tax Credit and direct R&D funding.

The role of taxation in tobacco control and its potential economic impact in China.

PubMed

Hu, Teh-Wei; Mao, Zhengzhong; Shi, Jian; Chen, Wendong

2010-02-01

To identify key economic issues involved in raising the tobacco tax and to recommend possible options for tobacco tax reform in China. Estimated price elasticities of the demand for cigarettes, prevalence data and epidemiology are used to estimate the impact of a tobacco tax increase on cigarette consumption, government tax revenue, lives saved, employment and revenue loss in the cigarette industry and tobacco farming. The recent Chinese tax adjustment, if passed along to the retail price, would reduce the number of smokers by 630,000 saving 210,000 lives, at a price elasticity of -0.15. A tax increase of 1 RMB (or US$0.13) per pack of cigarettes would increase the Chinese government's tax revenue by 129 billion RMB (US 17.2 billion), decrease consumption by 3.0 billion packs of cigarettes, reduce the number of smokers by 3.42 million and save 1.14 million lives. The empirical economic analysis and tax simulation results clearly indicate that increasing the tobacco tax in China is the most cost-effective instrument for tobacco control.

Estimated medical cost savings in Utah by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2010-05-01

This report examines 2007 hospital discharge data reporting cases where the external cause of injury to : a vehicle occupant was a motor vehicle crash to predict the estimated savings to Utah if a primary seat : belt law is implemented. The savings a...

Estimated medical cost savings in Nevada by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2008-09-01

This report examines 2007 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Nevada if a primary seat belt law is implemented. The savings are...

Sokaogon Chippewa Community Emission-Free and Treaty Resource Protection Clean Energy Initiative

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

Quade, Ron

Final Report for DOE project DE-IE0000036 The Sokaogon Chippewa Community received a tribal clean energy initiative grant and installed a community wide solar system estimated to produce 606 kw of carbon free clean energy on seventeen (17) tribal buildings and three (3) residential homes significantly reducing the tribes’ energy bills over the life of the system, potentially saving the tribe up to $2.7 million in energy savings over a thirty (30) year time span. Fifteen (15) solar installations utilized aluminum roof-top mounting systems while two (2) installations utilized a ground mount aluminum racking system.

Promoting and sustaining a historical and global effort to prevent sepsis: the 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign.

PubMed

Martischang, Romain; Pires, Daniela; Masson-Roy, Sarah; Saito, Hiroki; Pittet, Didier

2018-04-13

Sepsis is estimated to affect more than 30 million patients with potentially five million deaths every year worldwide. Prevention of sepsis, as well as early recognition, diagnosis and treatment, can't be overlooked to mitigate this global public health threat. World Health Organization (WHO) promotes hand hygiene in health care through its annual global campaign, SAVE LIVES: Clean Your Hands campaign on 5 May every year. The 2018 campaign targets sepsis with the overall theme "It's in your hands; prevent sepsis in health care".

Potential Energy Cost Savings from Increased Commercial Energy Code Compliance

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

Rosenberg, Michael I.; Hart, Philip R.; Athalye, Rahul A.

2016-08-22

An important question for commercial energy code compliance is: “How much energy cost savings can better compliance achieve?” This question is in sharp contrast to prior efforts that used a checklist of code requirements, each of which was graded pass or fail. Percent compliance for any given building was simply the percent of individual requirements that passed. A field investigation method is being developed that goes beyond the binary approach to determine how much energy cost savings is not realized. Prototype building simulations were used to estimate the energy cost impact of varying levels of non-compliance for newly constructed officemore » buildings in climate zone 4C. Field data collected from actual buildings on specific conditions relative to code requirements was then applied to the simulation results to find the potential lost energy savings for a single building or for a sample of buildings. This new methodology was tested on nine office buildings in climate zone 4C. The amount of additional energy cost savings they could have achieved had they complied fully with the 2012 International Energy Conservation Code is determined. This paper will present the results of the test, lessons learned, describe follow-on research that is needed to verify that the methodology is both accurate and practical, and discuss the benefits that might accrue if the method were widely adopted.« less

Sharing simulation-based training courses between institutions: opportunities and challenges.

PubMed

Laack, Torrey A; Lones, Ellen A; Schumacher, Donna R; Todd, Frances M; Cook, David A

2017-01-01

Sharing simulation-based training (SBT) courses between institutions could reduce time to develop new content but also presents challenges. We evaluate the process of sharing SBT courses across institutions in a mixed method study estimating the time required and identifying barriers and potential solutions. Two US academic medical institutions explored instructor experiences with the process of sharing four courses (two at each site) using personal interviews and a written survey and estimated the time needed to develop new content vs implement existing SBT courses. The project team spent approximately 618 h creating a collaboration infrastructure to support course sharing. Sharing two SBT courses was estimated to save 391 h compared with developing two new courses. In the qualitative analysis, participants noted the primary benefit of course sharing was time savings. Barriers included difficulty finding information and understanding overall course flow. Suggestions for improvement included establishing a standardized template, clearly identifying the target audience, providing a course overview, communicating with someone familiar with the original SBT course, employing an intuitive file-sharing platform, and considering local culture, context, and needs. Sharing SBT courses between institutions is feasible but not without challenges. An initial investment in a sharing infrastructure may facilitate downstream time savings compared with developing content de novo.

The Impact of a Suicide Prevention Strategy on Reducing the Economic Cost of Suicide in the New South Wales Construction Industry

PubMed Central

2015-01-01

Abstract. Background: Little research has been conducted into the cost and prevention of self-harm in the workplace. Aims: To quantify the economic cost of self-harm and suicide among New South Wales (NSW) construction industry (CI) workers and to examine the potential economic impact of implementing Mates in Construction (MIC). Method: Direct and indirect costs were estimated. Effectiveness was measured using the relative risk ratio (RRR). In Queensland (QLD), relative suicide risks were estimated for 5-year periods before and after the commencement of MIC. For NSW, the difference between the expected (i.e., using NSW pre-MIC [2008–2012] suicide risk) and counterfactual suicide cases (i.e., applying QLD RRR) provided an estimate of potential suicide cases averted in the post-MIC period (2013–2017). Results were adjusted using the average uptake (i.e., 9.4%) of MIC activities in QLD. Economic savings from averted cases were compared with the cost of implementing MIC. Results: The cost of self-harm and suicide in the NSW CI was AU $527 million in 2010. MIC could potentially avert 0.4 suicides, 1.01 full incapacity cases, and 4.92 short absences, generating annual savings of AU $3.66 million. For every AU $1 invested, the economic return is approximately AU $4.6. Conclusion: MIC represents a positive economic investment in workplace safety. PMID:26695869

The Impact of a Suicide Prevention Strategy on Reducing the Economic Cost of Suicide in the New South Wales Construction Industry.

PubMed

Doran, Christopher M; Ling, Rod; Gullestrup, Jorgen; Swannell, Sarah; Milner, Allison

2016-03-01

Little research has been conducted into the cost and prevention of self-harm in the workplace. To quantify the economic cost of self-harm and suicide among New South Wales (NSW) construction industry (CI) workers and to examine the potential economic impact of implementing Mates in Construction (MIC). Direct and indirect costs were estimated. Effectiveness was measured using the relative risk ratio (RRR). In Queensland (QLD), relative suicide risks were estimated for 5-year periods before and after the commencement of MIC. For NSW, the difference between the expected (i.e., using NSW pre-MIC [2008-2012] suicide risk) and counterfactual suicide cases (i.e., applying QLD RRR) provided an estimate of potential suicide cases averted in the post-MIC period (2013-2017). Results were adjusted using the average uptake (i.e., 9.4%) of MIC activities in QLD. Economic savings from averted cases were compared with the cost of implementing MIC. The cost of self-harm and suicide in the NSW CI was AU $527 million in 2010. MIC could potentially avert 0.4 suicides, 1.01 full incapacity cases, and 4.92 short absences, generating annual savings of AU $3.66 million. For every AU $1 invested, the economic return is approximately AU $4.6. MIC represents a positive economic investment in workplace safety.

Residential energy use and potential conservation through reduced laundering temperatures in the United States and Canada.

PubMed

Sabaliunas, Darius; Pittinger, Charles; Kessel, Cristy; Masscheleyn, Patrick

2006-04-01

A residential energy-use model was developed to estimate energy budgets for household laundering practices in the United States and Canada. The thermal energy for heating water and mechanical energy for agitating clothes in conventional washing machines were calculated for representative households in the United States and Canada. Comparisons in energy consumption among hot-, warm-, and cold-water wash and rinse cycles, horizontal- and vertical-axis washing machines, and gas and electric water heaters, were calculated on a per-wash-load basis. Demographic data for current laundering practices in the United States and Canada were then incorporated to estimate household and national energy consumption on an annual basis for each country. On average, the thermal energy required to heat water using either gas or electric energy constitutes 80% to 85% of the total energy consumed per wash in conventional, vertical-axis (top-loading) washing machines. The balance of energy used is mechanical energy. Consequently, the potential energy savings per load in converting from hot-and-warm- to cold-wash temperatures can be significant. Annual potential energy and cost savings and reductions in carbon dioxide emissions are also estimated for each country, assuming full conversion to cold-wash water temperatures. This study provides useful information to consumers for conserving energy in the home, as well as to, manufacturers in the design of more energy-efficient laundry formulations and appliances.

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.

National Costs Of The Medical Liability System

PubMed Central

Mello, Michelle M.; Chandra, Amitabh; Gawande, Atul A.; Studdert, David M.

2011-01-01

Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending. PMID:20820010

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

Brown, A.; Repac, B.; Gonder, J.

This poster presents initial estimates of the net energy impacts of automated vehicles (AVs). Automated vehicle technologies are increasingly recognized as having potential to decrease carbon dioxide emissions and petroleum consumption through mechanisms such as improved efficiency, better routing, lower traffic congestion, and by enabling advanced technologies. However, some effects of AVs could conceivably increase fuel consumption through possible effects such as longer distances traveled, increased use of transportation by underserved groups, and increased travel speeds. The net effect on petroleum use and climate change is still uncertain. To make an aggregate system estimate, we first collect best estimates formore » the energy impacts of approximately ten effects of AVs. We then use a modified Kaya Identity approach to estimate the range of aggregate effects and avoid double counting. We find that depending on numerous factors, there is a wide range of potential energy impacts. Adoption of automated personal or shared vehicles can lead to significant fuel savings but has potential for backfire.« less

Rotavirus vaccination for Hong Kong children: an economic evaluation from the Hong Kong Government perspective.

PubMed

Ho, A M-H; Nelson, E A S; Walker, D G

2008-01-01

To perform an economic analysis of government-funded universal rotavirus vaccination in Hong Kong from the government's perspective. A Markov model of costs and effects (disability averted) associated with universal vaccination was compared with no vaccination. In both strategies, newborns were studied until 5 years of age or until they died, using cost, probability and utility data from the literature. The potential cost savings and cost effectiveness of vaccination were calculated and their sensitivities to changes in vaccine and health care costs, presumed decline in vaccine efficacy over time, and the use of discounting and age weights were determined. Depending on assumptions, the new rotavirus vaccines would be cost saving to the Hong Kong Government if they cost less than US$40-92 per course. Higher vaccine costs would quickly lead to an incremental cost-effectiveness ratio exceeding that of the gross national product per capita if the mortality rate of rotavirus gastroenteritis remained at zero. Based on 2002 demographic, cost and morbidity data and reasonable uncertainty estimates of these variables, a universal rotavirus vaccination programme paid for by the Hong Kong Government is cost neutral at a per course vaccine cost of US$40-92. For a fixed vaccine cost, the potential savings and cost effectiveness of the vaccine increase with higher estimated health care costs and vice versa.

Cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system

NASA Technical Reports Server (NTRS)

Kraus, E. F.; Vanabkoude, J. C.

1976-01-01

The fuel saving potential and cost effectiveness of numerous operational and technical options proposed for reducing the fuel consumption of the U.S. commercial airline fleet was examined and compared. The impact of the most promising fuel conserving options on fuel consumption, passenger demand, operating costs and airline profits when implemented in the U.S. domestic and international airline fleets was determined. A forecast estimate was made of the potential fuel savings achievable in the U.S. scheduled air transportation system. Specifically, the means for reducing the jet fuel consumption of the U.S. scheduled airlines in domestic and international passenger operations were investigated. A design analysis was made of two turboprop aircraft as possible fuel conserving derivatives of the DC-9-30.

Reducing airflow energy use in multiple zone vav systems

NASA Astrophysics Data System (ADS)

Tukur, Ahmed Gidado

Variable Air Volume (VAV) systems are the most popular HVAC systems in commercial buildings. VAV systems are designed to deliver airflows at design conditions which only occur for a few hours in a year. Minimizing energy use in VAV systems requires reducing the amount of airflow delivered through the system at part load conditions. Air Handling Unit (AHU) fans are the major drivers of airflow in VAV systems and installing a Variable Frequency Drive (VFD) is the most common method of regulating airflow in VAV systems. A VFD drive does not necessarily save energy without use of an appropriate control strategy. Static pressure reset (SPR) is considered to be the most energy efficient control strategy for AHU fans with VFDs installed. The implementation of SPR however has many challenges; for example, rogue zones--zones which have faulty sensors or failed controls and actuators, system dynamics like hunting and system diversity. By investigating the parameters associated with the implementation of SPR in VAV systems, a new, improved, more stable SPR algorithm was developed and validated. This approach was further improved using Fault Detection and Diagnostics (FDD) to eliminate rogue zones. Additionally, a CO2-Demand Control Ventilation (DCV) based minimum airflow control was used to further reduce ventilation airflow and save more energy from SPR. Energy savings ranging from 25% to 51% were recorded in actual buildings with the new SPR algorithm. Finally, a methodology that utilizes historical VAV data was developed to estimate the potential savings that could be realized using SPR. The approach employed first determines an effective system loss coefficient as a function of mean damper position using the historical duct static pressure, VAV damper positions and airflows. Additionally, the historical data is used to identify the maximum mean duct damper position realizable as a result of insuring a sufficient number of VAVs are fully open at any time. Savings are estimated by shifting the damper distribution mean at each time to this maximum value and reducing the static pressure to achieve the same overall system airflow rate. The methodology was tested on three different buildings with varying system characteristics. Savings estimates correlated well to the savings actually realized from SPR. This result has significant implications for energy service providers, who could use the predictions to guarantee savings from SPR.

Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada

PubMed Central

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

2015-01-01

Background: Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults. Methods: A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step. Results: Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million–$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD. Conclusion: Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers’ general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada. PMID:26321953

Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada.

PubMed

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

2015-01-01

Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults. A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step. Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million-$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD. Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers' general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada.

A method for estimating maternal and newborn lives saved from health-related investments funded by the UK government Department for International Development using the Lives Saved Tool.

PubMed

Friberg, Ingrid K; Baschieri, Angela; Abbotts, Jo

2017-11-07

In 2010, the UK Government Department for International Development (DFID) committed through its 'Framework for results for reproductive, maternal and newborn health (RMNH)' to save 50,000 maternal lives and 250,000 newborn lives by 2015. They also committed to monitoring the performance of this portfolio of investments to demonstrate transparency and accountability. Methods currently available to directly measure lives saved are cost-, time-, and labour-intensive. The gold standard for calculating the total number of lives saved would require measuring mortality with large scale population based surveys or annual vital events surveillance. Neither is currently available in all low- and middle-income countries. Estimating the independent effect of DFID support relative to all other effects on health would also be challenging. The Lives Saved Tool (LiST) is an evidence based software for modelling the effect of changes in health intervention coverage on reproductive, maternal, newborn and child mortality. A multi-country LiST-based analysis protocol was developed to retrospectively assess the total annual number of maternal and newborn lives saved from DFID aid programming in low- and middle-income countries. Annual LiST analyses using the latest program data from DFID country offices were conducted between 2013 and 2016, estimating the annual number of maternal and neonatal lives saved across 2010-2015. For each country, independent project results were aggregated into health intervention coverage estimates, with and in the absence of DFID funding. More than 80% of reported projects were suitable for inclusion in the analysis, with 151 projects analysed in the 2016 analysis. Between 2010 and 2014, it is estimated that DFID contributed to saving the lives of 15,000 women in pregnancy and childbirth with health programming and 88,000 with family planning programming. It is estimated that DFID health programming contributed to saving 187,000 newborn lives. It is feasible to estimate the overall contribution and impact of DFID's investment in RMNH from currently available information on interventions and coverage from individual country offices. This utilization of LiST, with estimated population coverage based on DFID program inputs, can be applied to similar types of datasets to quantify programme impact. The global data were used to estimate DFID's progress against the Framework for results targets to inform future programming. The identified limitations can also be considered to inform future monitoring and evaluation program design and implementation within DFID.

Economics of One Health: Costs and benefits of integrated West Nile virus surveillance in Emilia-Romagna.

PubMed

Paternoster, Giulia; Babo Martins, Sara; Mattivi, Andrea; Cagarelli, Roberto; Angelini, Paola; Bellini, Romeo; Santi, Annalisa; Galletti, Giorgio; Pupella, Simonetta; Marano, Giuseppe; Copello, Francesco; Rushton, Jonathan; Stärk, Katharina D C; Tamba, Marco

2017-01-01

Since 2013 in Emilia-Romagna, Italy, surveillance information generated in the public health and in the animal health sectors has been shared and used to guide public health interventions to mitigate the risk of West Nile virus (WNV) transmission via blood transfusion. The objective of the current study was to identify and estimate the costs and benefits associated with this One Health surveillance approach, and to compare it to an approach that does not integrate animal health information in blood donations safety policy (uni-sectoral scenario). Costs of human, animal, and entomological surveillance, sharing of information, and triggered interventions were estimated. Benefits were quantified as the averted costs of potential human cases of WNV neuroinvasive disease associated to infected blood transfusion. In the 2009-2015 period, the One Health approach was estimated to represent a cost saving of €160,921 compared to the uni-sectoral scenario. Blood donation screening was the main cost for both scenarios. The One Health approach further allowed savings of €1.21 million in terms of avoided tests on blood units. Benefits of the One Health approach due to short-term costs of hospitalization and compensation for transfusion-associated disease potentially avoided, were estimated to range from €0 to €2.98 million according to the probability of developing WNV neuroinvasive disease after receiving an infected blood transfusion.

Energy and Economic Impacts of U.S. Federal Energy and Water Conservation Standards Adopted From 1987 Through 2013

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

Meyers, Stephen; Williams, Alison; Chan, Peter

This paper presents estimates of the key impacts of Federal energy and water conservation standards adopted from 1987 through 2013. The standards for consumer products and commercial and industrial equipment include those set by legislation as well as standards adopted by DOE through rulemaking. In 2013, the standards saved an estimated 4.05 quads of primary energy, which is equivalent to 4% of total U.S. energy consumption. The savings in operating costs for households and businesses totaledmore » $56 billion. The average household saved $$361 in operating costs as a result of residential and plumbing product standards. The estimated reduction in CO{sub 2} emissions associated with the standards in 2013 was 218 million metric tons, which is equivalent to 4% of total U.S. CO{sub 2} emissions. The estimated cumulative energy savings over the period 1990-2090 amount to 181 quads. Accounting for the increased upfront costs of more-efficient products and the operating cost (energy and water) savings over the products’ lifetime, the standards have a past and projected cumulative net present value (NPV) of consumer benefit of between $$1,271 billion and $1,487 billion, using 7 percent and 3 percent discount rates, respectively. The water conservation standards, together with energy conservation standards that also save water, reduced water use by 1.9 trillion gallons in 2013, and will achieve cumulative water savings by 2090 of 55 trillion gallons. The estimated consumer savings in 2013 from reduced water use amounted to $16 billon.« less

Energy and Economic Impacts of U.S. Federal Energy and Water Conservation Standards Adopted From 1987 through 2012

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

Meyers, Stephen; Williams, Alison; Chan, Peter

This paper presents estimates of the key impacts of Federal energy and water conservation standards adopted from 1987 through 2012. The standards for consumer products and commercial and industrial equipment include those set by legislation as well as standards adopted by DOE through rulemaking. In 2012, the standards saved an estimated 3.6 quads of primary energy, which is equivalent to 3% of total U.S. energy consumption. The savings in operating costs for households and businesses totaled $51.4 billion. The average household saved $347 in operating costs as a result of residential and plumbing product standards. The estimated reduction in CO2more » emissions associated with the standards in 2012 was 198 million metric tons, which is equivalent to 3% of total U.S. CO2 emissions. The estimated cumulative energy savings over the period 1990-2070 amount to 179 quads. Accounting for the increased upfront costs of more-efficient products and the operating cost (energy and water) savings over the products’ lifetime, the standards have a past and projected cumulative net present value (NPV) of consumer benefit of between $1,104 billion and $1,390 billion, using 7 percent and 3 percent discount rates, respectively. The water conservation standards, together with energy conservation standards that also save water, reduced water use by 1.8 trillion gallons in 2012, and will achieve cumulative water savings by 2040 of 54 trillion gallons. The estimated consumer savings in 2012 from reduced water use amounted to $13 billon.« less

Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study.

PubMed

Barton, Pelham; Andronis, Lazaros; Briggs, Andrew; McPherson, Klim; Capewell, Simon

2011-07-28

To estimate the potential cost effectiveness of a population-wide risk factor reduction programme aimed at preventing cardiovascular disease. Economic modelling analysis. England and Wales. Population Entire population. Model Spreadsheet model to quantify the reduction in cardiovascular disease over a decade, assuming the benefits apply consistently for men and women across age and risk groups. Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome. A programme across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30,000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570,000 life years and generate NHS savings worth at least £230m a year. Any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. Given the conservative assumptions used in this model, the true benefits would probably be greater.

Recalculating the Economic Cost of Suicide

ERIC Educational Resources Information Center

Yang, Bijou; Lester, David

2007-01-01

These authors argue that estimates of the net economic cost of suicide should go beyond accounting for direct medical costs and indirect costs from loss of earnings by those who commit suicide. There are potential savings from (a) not having to treat the depressive and other psychiatric disorders of those who kill themselves; (b) avoidance of…

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

PubMed Central

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

2016-01-01

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

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.

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.

Estimating customer electricity savings from projects installed by the U.S. ESCO industry

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

Carvallo, Juan Pablo; Larsen, Peter H.; Goldman, Charles A.

The U.S. energy service company (ESCO) industry has a well-established track record of delivering substantial energy and dollar savings in the public and institutional facilities sector, typically through the use of energy savings performance contracts (ESPC) (Larsen et al. 2012; Goldman et al. 2005; Hopper et al. 2005, Stuart et al. 2013). This ~$6.4 billion industry, which is expected to grow significantly over the next five years, may play an important role in achieving demand-side energy efficiency under local/state/federal environmental policy goals. To date, there has been little or no research in the public domain to estimate electricity savings formore » the entire U.S. ESCO industry. Estimating these savings levels is a foundational step in order to determine total avoided greenhouse gas (GHG) emissions from demand-side energy efficiency measures installed by U.S. ESCOs. We introduce a method to estimate the total amount of electricity saved by projects implemented by the U.S. ESCO industry using the Lawrence Berkeley National Laboratory (LBNL) /National Association of Energy Service Companies (NAESCO) database of projects and LBNL’s biennial industry survey. We report two metrics: incremental electricity savings and savings from ESCO projects that are active in a given year (e.g., 2012). Overall, we estimate that in 2012 active U.S. ESCO industry projects generated about 34 TWh of electricity savings—15 TWh of these electricity savings were for MUSH market customers who did not rely on utility customer-funded energy efficiency programs (see Figure 1). This analysis shows that almost two-thirds of 2012 electricity savings in municipal, local and state government facilities, universities/colleges, K-12 schools, and healthcare facilities (i.e., the so-called “MUSH” market) were not supported by a utility customer-funded energy efficiency program.« less

Avoiding 100 new power plants by increasing efficiency of room air conditioners in India: opportunities and challenges

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

Phadke, Amol; Abhyankar, Nikit; Shah, Nihar

Electricity demand for room ACs is growing very rapidly in emerging economies such as India. We estimate the electricity demand from room ACs in 2030 in India considering factors such as weather and income growth using market data on penetration of ACs in different income classes and climatic regions. We discuss the status of the current standards, labels, and incentive programs to improve the efficiency of room ACs in these markets and assess the potential for further large improvements in efficiency and find that efficiency can be improved by over 40% cost effectively. The total potential energy savings from Roommore » AC efficiency improvement in India using the best available technology will reach over 118 TWh in 2030; potential peak demand saving is found to be 60 GW by 2030. This is equivalent to avoiding 120 new coal fired power plants of 500 MW each. We discuss policy options to complement, expand and improve the ongoing programs to capture this large potential.« less

Time-driven activity-based costing to estimate cost of care at multidisciplinary aerodigestive centers.

PubMed

Garcia, Jordan A; Mistry, Bipin; Hardy, Stephen; Fracchia, Mary Shannon; Hersh, Cheryl; Wentland, Carissa; Vadakekalam, Joseph; Kaplan, Robert; Hartnick, Christopher J

2017-09-01

Providing high-value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care units consolidate care for complex patients. However, their potential impact on decreasing healthcare costs is less clear. The goal of this study was to estimate the potential cost savings of treating patients with laryngeal clefts at multidisciplinary aerodigestive centers. Retrospective chart review. Time-driven activity-based costing was used to estimate the cost of care for patients with laryngeal cleft seen between 2008 and 2013 at the Massachusetts Eye and Ear Infirmary Pediatric Aerodigestive Center. Retrospective chart review was performed to identify clinic utilization by patients as well as patient diet outcomes after treatment. Patients were stratified into neurologically complex and neurologically noncomplex groups. The cost of care for patients requiring surgical intervention was five and three times as expensive of the cost of care for patients not requiring surgery for neurologically noncomplex and complex patients, respectively. Following treatment, 50% and 55% of complex and noncomplex patients returned to normal diet, whereas 83% and 87% of patients experienced improved diets, respectively. Additionally, multidisciplinary team-based care for children with laryngeal clefts potentially achieves 20% to 40% cost savings. These findings demonstrate how time-driven activity-based costing can be used to estimate and compare patient costs in multidisciplinary aerodigestive centers. 2c. Laryngoscope, 127:2152-2158, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Chapter 21: Estimating Net Savings - Common Practices. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Violette, Daniel M.; Rathbun, Pamela

This chapter focuses on the methods used to estimate net energy savings in evaluation, measurement, and verification (EM and V) studies for energy efficiency (EE) programs. The chapter provides a definition of net savings, which remains an unsettled topic both within the EE evaluation community and across the broader public policy evaluation community, particularly in the context of attribution of savings to a program. The chapter differs from the measure-specific Uniform Methods Project (UMP) chapters in both its approach and work product. Unlike other UMP resources that provide recommended protocols for determining gross energy savings, this chapter describes and comparesmore » the current industry practices for determining net energy savings but does not prescribe methods.« less

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.

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.

PubMed

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-02-01

This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Annual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20-29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. Copyright © 2013 Elsevier Inc. All rights reserved.

Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception

PubMed Central

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-01-01

Background This study evaluated the total costs of unintended pregnancy (UP) in the United States from a third -party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study Design An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all US women requiring reversible contraception: the pattern of contraceptive use and rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Results Annual medical costs of UP in the United States were estimated to be $4.5 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Conclusions Imperfect contraceptive adherence leads to substantial unintended pregnancy and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. PMID:22959904

A simple tool for estimating city-wide annual electrical energy savings from cooler surfaces

DOE PAGES

Pomerantz, Melvin; Rosado, Pablo J.; Levinson, Ronnen

2015-07-26

We present a simple method to estimate the maximum possible energy saving that might be achieved by increasing the albedo of surfaces in a large city. We restrict this to the "indirect effect", the cooling of outside air that lessens the demand for air conditioning (AC). Given the power demand of the electric utilities and data about the city, we can use a single linear equation to estimate the maximum saving. For example, the result for an albedo change of 0.2 of pavements in a typical warm city in California, such as Sacramento, is that the saving is less thanmore » about 2 kWh per m 2 per year. This may help decision makers choose which heat island mitigation techniques are economical from an energy-saving perspective.« less

Technology Prioritization: Transforming the U.S. Building Stock to Embrace Energy Efficiency

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

Abdelaziz, Omar; Farese, Philip; Abramson, Alexis

2013-01-01

The U.S. Buildings sector is responsible for about 40% of the national energy expenditures. This is due in part to wasteful use of resources and limited considerations made for energy efficiency during the design and retrofit phases. Recent studies have indicated the potential for up to 30-50% energy savings in the U.S. buildings sector using currently available technologies. This paper discusses efforts to accelerate the transformation in the U.S. building energy efficiency sector using a new technology prioritization framework. The underlying analysis examines building energy use micro segments using the Energy Information Administration Annual Energy Outlook and other publically availablemore » information. The tool includes a stock-and-flow model to track stock vintage and efficiency levels with time. The tool can be used to investigate energy efficiency measures under a variety of scenarios and has a built-in energy accounting framework to prevent double counting of energy savings within any given portfolio. This tool is developed to inform decision making and estimate long term potential energy savings for different market adoption scenarios.« less

Civil Uses of Remotely Piloted Aircraft

NASA Technical Reports Server (NTRS)

Aderhold, J. R.; Gordon, G.; Scott, G. W.

1976-01-01

The economic, technical, and environmental implications of remotely piloted vehicles (RVP) are examined. The time frame is 1980-85. Representative uses are selected; detailed functional and performance requirements are derived for RPV systems; and conceptual system designs are devised. Total system cost comparisons are made with non-RPV alternatives. The potential market demand for RPV systems is estimated. Environmental and safety requirements are examined, and legal and regulatory concerns are identified. A potential demand for 2,000-11,000 RVP systems is estimated. Typical cost savings of 25 to 35% compared to non-RPV alternatives are determined. There appear to be no environmental problems, and the safety issue appears manageable.

Assessing potential prescription reimbursement changes: Estimated acquisition costs in Wisconsin

PubMed Central

Kreling, David H.

1989-01-01

Potential impacts from two methods of changing prescription drug ingredient reimbursement in the Wisconsin Medicaid program were estimated. Current reimbursement amounts were compared with those resulting from either direct prices for eight manufacturers' products and average wholesale price less 10.5 percent for other products or wholesaler cost plus 5.01 percent for all products. The resulting overall average ingredient cost reimbursement reductions were 6.64 percent ($0.56 per prescription) and 6.94 percent ($0.59 per prescription) for the two methods, respectively. The results should be viewed from the perspective of both program savings and reduced pharmacists' revenues. PMID:10313098

Washington State CARE Project: downstream cost changes associated with the provision of cognitive services by pharmacists.

PubMed

Smith, D H; Fassett, W E; Christensen, D B

1999-01-01

To determine the changes in drug costs associated with drug therapy changes resulting from pharmacists' cognitive services (CS) provided to Medicaid recipients during a 1-year period following the documented CS. A study-control group analysis of documented pharmacists' CS interventions linked to Medicaid prescription claims. Each CS resulting in a drug therapy change was linked to an index prescription claim and all refills for the same drug within 365 days. The drug cost change associated with the CS was calculated as the difference between the estimated cost of the prescription as originally written less the actual cost to Medicaid for the stream of refills dispensed. Pharmacies serving ambulatory Medicaid patients in the state of Washington, excluding staff-model health maintenance organization pharmacies and pharmacies predominantly serving long-term care residents. Approximately 200 community pharmacies participating in the Washington State Cognitive Activities and Reimbursement Effectiveness (CARE) Project. Pharmacies were randomly assigned to a group that was paid a fee for each CS provided or a group that was not paid. Payment for CS. Downstream drug costs associated with CS resulting in a drug therapy change. CS resulting in drug therapy changes accounted for 5,417 out of 20,240 (27%) documented CS in the CARE Project. Of the 2,002 CS records analyzed in this study, 76% indicated a change in the prescribed drug or drug regimen, 9% indicated that a drug was added, 5% indicated that a current drug was discontinued, and 10% indicated that an originally prescribed drug was never dispensed. Only 9% involved generic substitution; all other changes would have necessitated prior prescriber approval. Overall, CS resulting in a drug therapy change generated a mean drug cost savings of $13.05 per CS intervention. There were no significant differences in average savings per intervention between the paid and nonpaid groups. For all result categories except "add drug therapy," the extrapolated cost savings in the paid group exceeded the savings estimated from the nonpaid group, sometimes by a considerable amount. At the payment rate used in this study, paying for CS that result in a drug therapy change (except add drug therapy) is estimated to save an additional $10 per 1,000 prescriptions dispensed. Those CS that result in addition of drug therapy are estimated to add an incremental cost of about $13 per 1,000 prescriptions. A sensitivity analysis revealed that a higher intervention rate would lead to a higher potential savings. This finding suggests that efforts to encourage CS interventions may lead to greater savings.

Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study

PubMed Central

2011-01-01

Background The development of a successful new tuberculosis (TB) vaccine would circumvent many limitations of current diagnostic and treatment practices. However, vaccine development is complex and costly. We aimed to assess the potential cost effectiveness of novel vaccines for TB control in a sub-Saharan African country - Zambia - relative to the existing strategy of directly observed treatment, short course (DOTS) and current level of bacille Calmette-Guérin (BCG) vaccination coverage. Methods We conducted a decision analysis model-based simulation from the societal perspective, with a 3% discount rate and all costs expressed in 2007 US dollars. Health outcomes and costs were projected over a 30-year period, for persons born in Zambia (population 11,478,000 in 2005) in year 1. Initial development costs for single vaccination and prime-boost strategies were prorated to the Zambian share (0.398%) of global BCG vaccine coverage for newborns. Main outcome measures were TB-related morbidity, mortality, and costs over a range of potential scenarios for vaccine efficacy. Results Relative to the status quo strategy, a BCG replacement vaccine administered at birth, with 70% efficacy in preventing rapid progression to TB disease after initial infection, is estimated to avert 932 TB cases and 422 TB-related deaths (prevention of 199 cases/100,000 vaccinated, and 90 deaths/100,000 vaccinated). This would result in estimated net savings of $3.6 million over 30 years for 468,073 Zambians born in year 1 of the simulation. The addition of a booster at age 10 results in estimated savings of $5.6 million compared to the status quo, averting 1,863 TB cases and 1,011 TB-related deaths (prevention of 398 cases/100,000 vaccinated, and of 216 deaths/100,000 vaccinated). With vaccination at birth alone, net savings would be realized within 1 year, whereas the prime-boost strategy would require an additional 5 years to realize savings, reflecting a greater initial development cost. Conclusions Investment in an improved TB vaccine is predicted to result in considerable cost savings, as well as a reduction in TB morbidity and TB-related mortality, when added to existing control strategies. For a vaccine with waning efficacy, a prime-boost strategy is more cost-effective in the long term. PMID:21269503

Cost-effective control of nitrogen loadings in Long Island Sound

NASA Astrophysics Data System (ADS)

Bennett, Lynne L.; Thorpe, Steven G.; Guse, A. Joseph

2000-12-01

Long Island Sound is plagued by conditions of severe hypoxia (low levels of dissolved oxygen) during the summer months because of the existence of excessive amounts of nitrogen. A new proposal that would allow sewage treatment plants to buy or sell nitrogen discharge credits is currently being evaluated by the states of Connecticut and New York. Existing theory suggests that a trading program for nitrogen emissions would be a cost-effective means of addressing the problem. We estimate the costs associated with several trading scenarios and find that the potential for cost savings is substantial and that cost savings rise as the scope of trading expands.

State-dependent metabolic partitioning and energy conservation: A theoretical framework for understanding the function of sleep.

PubMed

Schmidt, Markus H; Swang, Theodore W; Hamilton, Ian M; Best, Janet A

2017-01-01

Metabolic rate reduction has been considered the mechanism by which sleep conserves energy, similar to torpor or hibernation. This mechanism of energy savings is in conflict with the known upregulation (compared to wake) of diverse functions during sleep and neglects a potential role in energy conservation for partitioning of biological operations by behavioral state. Indeed, energy savings as derived from state-dependent resource allocations have yet to be examined. A mathematical model is presented based on relative rates of energy deployment for biological processes upregulated during either wake or sleep. Using this model, energy savings from sleep-wake cycling over constant wakefulness is computed by comparing stable limit cycles for systems of differential equations. A primary objective is to compare potential energy savings derived from state-dependent metabolic partitioning versus metabolic rate reduction. Additionally, energy conservation from sleep quota and the circadian system are also quantified in relation to a continuous wake condition. As a function of metabolic partitioning, our calculations show that coupling of metabolic operations with behavioral state may provide comparatively greater energy savings than the measured decrease in metabolic rate, suggesting that actual energy savings derived from sleep may be more than 4-fold greater than previous estimates. A combination of state-dependent metabolic partitioning and modest metabolic rate reduction during sleep may enhance energy savings beyond what is achievable through metabolic partitioning alone; however, the relative contribution from metabolic partitioning diminishes as metabolic rate is decreased during the rest phase. Sleep quota and the circadian system further augment energy savings in the model. Finally, we propose that state-dependent resource allocation underpins both sleep homeostasis and the optimization of daily energy conservation across species. This new paradigm identifies an evolutionary selective advantage for the upregulation of central and peripheral biological processes during sleep, presenting a unifying construct to understand sleep function.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study.

PubMed

Brennan, Alan; Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-09-30

To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Modelling study using the Sheffield Alcohol Policy Model version 2.5. England 2014-15. Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45 p, and 50 p per unit (7.9 g/10 mL) of pure alcohol. Changes in mean consumption in terms of units of alcohol, drinkers' expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45 p minimum unit price. Below cost selling is estimated to reduce harmful drinkers' mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45 p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health-saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45 p minimum unit price is estimated to save 624 deaths and 23,700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40 p and 50 p per unit, is estimated to have an approximately 40-50 times greater effect. © Brennan et al 2014.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study

PubMed Central

Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-01-01

Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40p and 50p per unit, is estimated to have an approximately 40-50 times greater effect. PMID:25270743

ePrescribing: Reducing Costs through In-Class Therapeutic Interchange.

PubMed

Stenner, Shane P; Chakravarthy, Rohini; Johnson, Kevin B; Miller, William L; Olson, Julie; Wickizer, Marleen; Johnson, Nate N; Ohmer, Rick; Uskavitch, David R; Bernard, Gordon R; Neal, Erin B; Lehmann, Christoph U

2016-12-14

Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative. Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members. For all medication classes, significant improvements were demonstrated - the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member. A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan - $17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.

Consumers’ perceptions of energy use and energy savings: A literature review

NASA Astrophysics Data System (ADS)

Lesic, Vedran; Bruine de Bruin, Wändi; Davis, Matthew C.; Krishnamurti, Tamar; Azevedo, Inês M. L.

2018-03-01

Background. Policy makers and program managers need to better understand consumers’ perceptions of their energy use and savings to design effective strategies for promoting energy savings. Methods. We reviewed 14 studies from the emerging interdisciplinary literature examining consumers’ perceptions electricity use by specific appliances, and potential savings. Results. We find that: (1) electricity use is often overestimated for low-energy consuming appliances, and underestimated for high-energy consuming appliances; (2) curtailment strategies are typically preferred over energy efficiency strategies; (3) consumers lack information about how much electricity can be saved through specific strategies; (4) consumers use heuristics for assessing the electricity use of specific appliances, with some indication that more accurate judgments are made among consumers with higher numeracy and stronger pro-environmental attitudes. However, design differences between studies, such as variations in reference points, reporting units and assessed time periods, may affect consumers’ reported perceptions. Moreover, studies differ with regard to whether accuracy of perceptions was evaluated through comparisons with general estimates of actual use, self-reported use, household-level meter readings, or real-time smart meter readings. Conclusion. Although emerging findings are promising, systematic variations in the measurement of perceived and actual electricity use are potential cause for concern. We propose avenues for future research, so as to better understand, and possibly inform, consumers’ perceptions of their electricity use. Ultimately, this literature will have implications for the design of effective electricity feedback for consumers, and related policies.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

PubMed

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Estimated saving of antibiotics in pharyngitis and lower respiratory tract infections if general practitioners used rapid tests and followed guidelines.

PubMed

Llor, Carles; Moragas, Ana; Cots, Josep M; López-Valcárcel, Beatriz González

General practitioners (GP) in Spain do not have access to rapid tests and adherence to guidelines is usually suboptimal. The aim of the study is to evaluate the estimated number of antibiotics that could have been saved if GPs had appropriately used these tests and had followed the guidelines. Observational study. Primary care centres from eight Autonomous Communities in Spain. GPs who had not participated in previous studies on rational use of antibiotics. GPs registered all the cases of pharyngitis and lower respiratory tract infections (LRTI) during 15 working days in 2015, by means of a 47-item audit. Actual GPs' antibiotic prescription and estimated number of antibiotics that could have been saved according to recent guidelines. A total of 126 GPs registered 1012 episodes of pharyngitis and 1928 LRTIs. Antibiotics were given or patients were referred in 497 patients with pharyngitis (49.1%) and 963 patients with LRTI (49.9%). If GPs had appropriately used rapid antigen detection tests and C-reactive protein tests and had strictly followed current guidelines, antibiotics would have been given to 7.6% and 15.1%, respectively, with an estimated saving of 420 antibiotics in patients with sore throat (estimated saving of 84.5%; 95% CI: 81.1-87.4%) and 672 antibiotics in LRTIs (estimated saving of 69.8%,95% CI: 67.1-72.5%). GP adherence to guidelines and a correct introduction of rapid tests in clinical practice in Spain could result in a considerable saving of unnecessary prescription of antibiotics in pharyngitis and LRTIs. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Application of a design-build-team approach to low cost and weight composite fuselage structure

NASA Technical Reports Server (NTRS)

Ilcewicz, L. B.; Walker, T. H.; Willden, K. S.; Swanson, G. D.; Truslove, G.; Metschan, S. L.; Pfahl, C. L.

1991-01-01

Relationships between manufacturing costs and design details must be understood to promote the application of advanced composite technologies to transport fuselage structures. A team approach, integrating the disciplines responsible for aircraft structural design and manufacturing, was developed to perform cost and weight trade studies for a twenty-foot diameter aft fuselage section. Baseline composite design and manufacturing concepts were selected for large quadrant panels in crown, side, and keel areas of the fuselage section. The associated technical issues were also identified. Detailed evaluation of crown panels indicated the potential for large weight savings and costs competitive with aluminum technology in the 1995 timeframe. Different processes and material forms were selected for the various elements that comprise the fuselage structure. Additional cost and weight savings potential was estimated for future advancements.

Use of chromium picolinate and biotin in the management of type 2 diabetes: an economic analysis.

PubMed

Fuhr, Joseph P; He, Hope; Goldfarb, Neil; Nash, David B

2005-08-01

This paper addresses the potential economic benefits of chromium picolinate plus biotin (Diachrome) use in people with Type 2 diabetes (T2DM). The economic model was developed to estimate the impact on health care systems' costs by improved HbA1C levels with chromium picolinate plus biotin (Diachrome). Lifetimes cost savings were estimated by adjusting a benchmark from the literature, using a price index to adjust for inflation. The cost of diabetes is highly dependent on the HbA1C level with higher initial levels and higher annual increments increasing the cost. Improvement in glycemic control has proven to be cost-effective in delaying the onset and progression of T2DM, reducing the risk for diabetes-associated complications and lowering utilization and cost of care. Chromium picolinate plus biotin (Diachrome) showed greater improvement of glycemic control in poorly controlled T2DM patients (HbA(1C) > or = 10%) compared to their better controlled counterparts (HbA(1C) < 10%). This improvement was additive to that achieved by oral hypoglycemic medications and correlates to calculated levels of cost savings. Average 3-year cost savings for chromium picolinate plus biotin (Diachrome) use could range from 1,636 dollars for a poorly controlled patient with diabetes without heart diseases or hypertension, to 5,435 dollars for a poorly controlled patient with diabetes, heart disease, and hypertension. Average 3-year cost savings was estimated to be between 3.9 billion dollars and 52.9 billion dollars for the 16.3 million existing patients with diabetes. Chromium picolinate plus biotin (Diachrome) use among the 1.17 million newly diagnosed patients with T2DM each year could deliver lifetime cost savings of 42 billion dollars, or 36,000 dollars per T2DM patient. Affordable, safe, and convenient, chromium picolinate plus biotin (Diachrome) could prove to be a cost-effective complement to existing pharmacological therapies for controlling T2DM.

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

PubMed

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

2017-03-01

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

Potentials for Platooning in U.S. Highway Freight Transport: Preprint

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

Muratori, Matteo; Holden, Jacob; Lammert, Michael

2017-03-15

Smart technologies enabling connection among vehicles and between vehicles and infrastructure as well as vehicle automation to assist human operators are receiving significant attention as means for improving road transportation systems by reducing fuel consumption - and related emissions - while also providing additional benefits through improving overall traffic safety and efficiency. For truck applications, currently responsible for nearly three-quarters of the total U.S. freight energy use and greenhouse gas (GHG) emissions, platooning has been identified as an early feature for connected and automated vehicles (CAVs) that could provide significant fuel savings and improved traffic safety and efficiency without radicalmore » design or technology changes compared to existing vehicles. A statistical analysis was performed based on a large collection of real-world U.S. truck usage data to estimate the fraction of total miles that are technically suitable for platooning. In particular, our analysis focuses on estimating 'platoonable' mileage based on overall highway vehicle use and prolonged high-velocity traveling, establishing that about 65% of the total miles driven by combination trucks could be driven in platoon formation, leading to a 4% reduction in total truck fuel consumption. This technical potential for 'platoonable' miles in the U.S. provides an upper bound for scenario analysis considering fleet willingness to platoon as an estimate of overall benefits of early adoption of CAV technologies. A benefit analysis is proposed to assess the overall potential for energy savings and emissions mitigation by widespread implementation of highway platooning for trucks.« less

Hidden Efficiencies: Making Completion of the Pediatric Vaccine Schedule More Efficient for Physicians

PubMed Central

Ciarametaro, Mike; Bradshaw, Steven E.; Guiglotto, Jillian; Hahn, Beth; Meier, Genevieve

2015-01-01

Abstract The objective of this work is to demonstrate the potential time and labor savings that may result from increased use of combination vaccinations. The study (GSK study identifier: HO-12-4735) was a model developed to evaluate the efficiency of the pediatric vaccine schedule, using time and motion studies. The model considered vaccination time and the associated labor costs, but vaccination acquisition costs were not considered. We also did not consider any efficacy or safety differences between formulations. The model inputs were supported by a targeted literature review. The reference year for the model was 2012. The most efficient vaccination program using currently available vaccines was predicted to reduce costs through a combination of fewer injections (62%) and less time per vaccination (38%). The most versus the least efficient vaccine program was predicted to result in a 47% reduction in vaccination time and a 42% reduction in labor and supply costs. The estimated administration cost saving with the most versus the least efficient program was estimated to be nearly US $45 million. If hypothetical 6- or 7-valent vaccines are developed using the already most efficient schedule by adding additional antigens (pneumococcal conjugate vaccine and Haemophilus influenzae type b) to the most efficient 5-valent vaccine, the savings are predicted to be even greater. Combination vaccinations reduce the time burden of the childhood immunization schedule and could create the potential to improve vaccination uptake and compliance as a result of fewer required injections. PMID:25634165

Estimating the effects of light rail transit on health care costs.

PubMed

Stokes, Robert J; MacDonald, John; Ridgeway, Greg

2008-03-01

In recent years, there has been a proliferation of research on the effects of the built environment, including mass transit systems, on health-related outcomes. While there is general agreement that the built environment affects travel choices and physical activity, it remains unclear how much of a public health benefit (in dollars) can be derived from land use policies that support walking, biking, and transit. In the present study, we develop a model to assess the potential cost savings in public health that will be realized from the investment in a new light rail transit system in Charlotte, NC. Relying on estimates of future riders, area obesity rates, and the effects of public transit on physical activity (daily walking to and from the transit stations), we simulated the potential yearly public health cost savings associated with this infrastructure investment. Our results indicate that investing in light rail is associated with a 9-year cumulative public health cost savings of dollars 12.6 million. While these results suggest that there is a sizable public health benefit associated with the adoption of light rail, they also indicate that the effects are relatively small compared to the costs associated with constructing and operating such systems. These findings suggest that planning efforts that focus solely on the health impact of modifications in the built environment are likely to overstate the economic benefits. Public health benefits should be considered along with broader environmental health benefits.

[Urinary tract infections: Economical impact of water intake].

PubMed

Bruyère, F; Buendia-Jiménez, I; Cosnefroy, A; Lenoir-Wijnkoop, I; Tack, I; Molinier, L; Daudon, M; Nuijten, M J C

2015-09-01

This study aims to estimate the impact of preventing urinary tract infections (UTI), using a strategy of increased water intake, from the payer's perspective in the French health care system. A Markov model enables a comparison of health care costs and outcomes for a virtual cohort of subjects with different levels of daily water intake. The analysis of the budgetary impact was based on a period of 5years. The analysis was based on a 25-year follow-up period to assess the effects of adequate water supply on long-term complications. The authors estimate annual primary incidence of UTI and annual risk of recurrence at 5.3% and 30%, respectively. Risk reduction associated with greater water intake reached 45% and 33% for the general and recurrent populations, respectively. The average total health care cost of a single UTI episode is €1074; for a population of 65 millions, UTI management represents a cost of €3.700 millions for payers. With adequate water intake, the model indicates a potential cost savings of €2.288 millions annually, by preventing 27 million UTI episodes. At the individual level, the potential cost savings is approximately €2915. Preventing urinary tract infections using a strategy of adequate water intake could lead to significant cost savings for a public health care system. Further studies are needed to assess the effectiveness of such an approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Effective interventions for unintentional injuries: a systematic review and mortality impact assessment among the poorest billion.

PubMed

Vecino-Ortiz, Andres I; Jafri, Aisha; Hyder, Adnan A

2018-05-01

Between 1990 and 2015, the global injury mortality declined, but in countries where the poorest billion live, injuries are becoming an increasingly prevalent cause of death. The vulnerability of this population requires immediate attention from policy makers to implement effective interventions that lessen the burden of injuries in these countries. Our aim was two-fold; first, to review all the evidence on effective interventions for the five main types of unintentional injury; and second, to estimate the potential number of lives saved by effective injury interventions among the poorest billion. For our systematic review we used references in the Disability Control Priorities third edition, and searched PubMed and the Cochrane database for papers published until Sept 10, 2016, using a comprehensive search strategy to find interventions for the five major causes of unintentional injuries: road traffic crashes, falls, drowning, burns, and poisoning. Studies were included if they presented evidence with significant effects sizes for any outcome; no inclusions or exclusions made on the basis of where the study was carried out (ie, low-income, middle-income, or high-income country). Then we used data from the Global Burden of Disease 2015 study and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved among the poorest billion by these evidence-based injury interventions. We estimated results for 84 countries where the poorest billion live. From the 513 papers identified, 47 were eligible for inclusion. We identified 11 interventions that had an effect on injury mortality. For road traffic deaths, the most successful interventions in preventing deaths are speed enforcement (>80 000 lives saved per year) and drink-driving enforcement (>60 000 lives saved per year). Interventions potentially most effective in preventing deaths from drowning are formal swimming lessons for children younger than 14 years (>25 000 lives saved per year) and the use of crèches to supervise younger children (younger than 5 years; >10 000 lives saved per year). We did not find sufficient evidence on interventions for other causes of unintentional injuries (poisoning, burns, and falls) to run similar simulations. Based on the little available evidence, key interventions have been identified to prevent lives lost from unintentional injuries among the poorest billion. This Article provides guidance to national authorities on evidence-based priority interventions that can reduce the burden of injuries among the most vulnerable members of the population. We also identify an important gap in knowledge on the effectiveness and the mortality impacts of injury interventions. Partly supported by the Fogarty International Center of the US National Institutes of Health (Chronic Consequences of Trauma, Injuries, Disability Across the Lifespan: Uganda; #D43TW009284). Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. 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.

2011-06-01

The U.S. Department of Energy (DOE) is evaluating the Baker-Barry Tunnel as a potential GATEWAY Demonstrations project for deployment of solid-state lighting (SSL) technology. The National Park Service (NPS) views this project as a possible proving ground and template for implementation of light-emitting diode (LED) luminaires in other NPS tunnels, thereby expanding the estimated 40% energy savings from 132 MWh/yr for this tunnel to a much larger figure national

Methodology for National Water Savings Model and Spreadsheet Tool—Outdoor Water Use

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

Williams, Alison, A; Chen, Yuting; Dunham, Camilla

This report describes the method Lawrence Berkeley National Laboratory (LBNL) developed to estimate national impacts of the U.S. Environmental Protection Agency’s (EPA’s) WaterSense labeling program for weather-based irrigation controllers (WBIC). Estimated impacts include the national water savings attributable to the program and the net present value of the lifetime water savings for consumers of irrigation controllers.

Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis

PubMed Central

Huang, Yue; Bandosz, Piotr; Capewell, Simon; Wilde, Parke

2018-01-01

Background Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. Methods and findings We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect estimates in the model are based on interventional and prospective observational studies. They are therefore subject to biases and confounding that may have influenced also our model estimates. Conclusions Implementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings. PMID:29634725

Nonprice incentives and energy conservation

PubMed Central

Asensio, Omar I.; Delmas, Magali A.

2015-01-01

In the electricity sector, energy conservation through technological and behavioral change is estimated to have a savings potential of 123 million metric tons of carbon per year, which represents 20% of US household direct emissions in the United States. In this article, we investigate the effectiveness of nonprice information strategies to motivate conservation behavior. We introduce environment and health-based messaging as a behavioral strategy to reduce energy use in the home and promote energy conservation. In a randomized controlled trial with real-time appliance-level energy metering, we find that environment and health-based information strategies, which communicate the environmental and public health externalities of electricity production, such as pounds of pollutants, childhood asthma, and cancer, outperform monetary savings information to drive behavioral change in the home. Environment and health-based information treatments motivated 8% energy savings versus control and were particularly effective on families with children, who achieved up to 19% energy savings. Our results are based on a panel of 3.4 million hourly appliance-level kilowatt–hour observations for 118 residences over 8 mo. We discuss the relative impacts of both cost-savings information and environmental health messaging strategies with residential consumers. PMID:25583494

Nonprice incentives and energy conservation.

PubMed

Asensio, Omar I; Delmas, Magali A

2015-02-10

In the electricity sector, energy conservation through technological and behavioral change is estimated to have a savings potential of 123 million metric tons of carbon per year, which represents 20% of US household direct emissions in the United States. In this article, we investigate the effectiveness of nonprice information strategies to motivate conservation behavior. We introduce environment and health-based messaging as a behavioral strategy to reduce energy use in the home and promote energy conservation. In a randomized controlled trial with real-time appliance-level energy metering, we find that environment and health-based information strategies, which communicate the environmental and public health externalities of electricity production, such as pounds of pollutants, childhood asthma, and cancer, outperform monetary savings information to drive behavioral change in the home. Environment and health-based information treatments motivated 8% energy savings versus control and were particularly effective on families with children, who achieved up to 19% energy savings. Our results are based on a panel of 3.4 million hourly appliance-level kilowatt-hour observations for 118 residences over 8 mo. We discuss the relative impacts of both cost-savings information and environmental health messaging strategies with residential consumers.

Energy and Economic Impacts of U.S. Federal Energy and Water Conservation Standards Adopted From 1987 Through 2010

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

Meyers, Stephen; Williams, Alison; Chan, Peter

This paper presents estimates of the key impacts of the energy and water conservation standards that have been adopted from 1987 through 2010. The standards covered include those set by legislation as well as standards adopted by DOE through rulemaking. We estimate that energy efficiency standards for consumer products and certain commercial and industrial equipment that have been adopted from 1987 through 2010 saved 3.0 quads in 2010, have had a cumulative energy savings of 25.9 quads through 2010 and will achieve cumulative energy savings of 158 quads over the period 1990-2070. Thus, the majority of the savings are stillmore » to come as products subject to standards enter the stock. Furthermore, the standards will have a cumulative net present value (NPV) of consumer benefit of between $851 billion and $1,103 billion, using 7 percent and 3 percent discount rates, respectively. In addition, we estimate the water conservation standards, together with those energy conservation standards that also save water, saved residential consumers 1.5 trillion gallons of water in 2010, have had cumulative water savings of 11.7 trillion gallons through 2010, and will achieve cumulative water savings by 2040 of 51.4 trillion gallons.« less

Productivity Savings from Colorectal Cancer Prevention and Control Strategies

PubMed Central

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

2011-01-01

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

Productivity savings from colorectal cancer prevention and control strategies.

PubMed

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

2011-08-01

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

Cost 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.

The potential health and economic effects of plant-based food patterns in Belgium and the United Kingdom.

PubMed

Schepers, Janne; Annemans, Lieven

2018-04-01

Policymakers increasingly require scientific evidence on both health and economic consequences of different nutritional patterns. The aim of this study was to assess health and economic effects of Mediterranean and soy-containing diets. Selected countries were Belgium and the United Kingdom. Cost-effectiveness of these plant-based food patterns was assessed in comparison with a "conventional" diet using an age- and sex-dependent prediction model. The model allowed the prediction of health outcomes and related health care costs for the food patterns over 20 y. A societal perspective was applied for cost calculation and health outcomes were expressed in quality-adjusted life-years (QALYs). For Belgium, a soy-containing diet is estimated to lead to 202 QALYs and 107 QALYs per 1000 women and men, respectively, whereas societal savings of €2 146 000 and €1 653 000 are predicted. For the United Kingdom, a gain of 159 QALYs and 100 QALYs per 1000 women and men, respectively, is estimated, as are a prediction of savings of £1 580 000 and £1 606 000. For the Mediterranean diet in the corresponding estimates for Belgium are 184 QALYs and 148 QALYs per 1000 women and men, respectively, and savings of €1 618 000 and €1 595 000. For the United Kingdom, these are 122 QALYs and 110 QALYs per 1000 women and men, respectively, and savings of £1 155 000 and £1 046 000, respectively. A wider implementation of plant-based eating would lead to large net economic gains for society and improved health outcomes for the population. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-world resource use and costs of haemophilia A-related bleeding.

PubMed

Shrestha, A; Eldar-Lissai, A; Hou, N; Lakdawalla, D N; Batt, K

2017-07-01

Prophylaxis treatment is recommended for haemophilia patients, but associated real-world economic costs and potential cost-savings associated with improved disease management are not fully known. This study aimed to assess haemophilia A-related resource use and cost by treatment type (prophylaxis versus non-prophylaxis) and any associated cost-savings. Truven MarketScan Commercial claims data (2004-2012) were used to identify haemophilia A-related healthcare utilization, healthcare costs and patterns of prophylaxis and non-prophylaxis treatment among 6- to 64-year-old males. We estimated bleeding-related resource utilization and costs in three age groups (6-18, 19-44, 45-64) by treatment types and assessed the extent to which early initiation of prophylactic treatment can mitigate them. T-tests and ordinary least squares regressions were used to compare unadjusted and demographics-adjusted cost estimates. Among children, overall haemophilia- and bleeding-related non-pharmacy costs were substantially lower for patients receiving prophylaxis (haemophilia-related: $15,864 vs. $53,408; P < 0.001; bleeding-related: $696 vs. $2013, respectively; P = 0.04). Among younger adults (19-44), haemophilia-related non-pharmacy costs were lower for patients receiving prophylaxis ($22,028 vs. $56,311, respectively; P = 0.001). Among children, these savings fully offset the incremental pharmacy cost due to prophylaxis. Among younger adults, the savings offset approximately 34% of the incremental pharmacy cost. No differences were found for older adults (45-64). These results suggest that initiating prophylaxis earlier in life may reduce the healthcare costs of bleeding events and their long-term complications. Future studies should strive to collect more detailed information on disease severity and treatment protocols to improve estimates of disease burden. © 2017 John Wiley & Sons Ltd.

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project.

PubMed

Özmen, Vahit; Gürdal, Sibel Ö; Cabioğlu, Neslihan; Özcinar, Beyza; Özaydın, A Nilüfer; Kayhan, Arda; Arıbal, Erkin; Sahin, Cennet; Saip, Pınar; Alagöz, Oğuzhan

2017-07-01

We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

An economic analysis of conservative management versus active treatment for men with localized prostate cancer.

PubMed

Perlroth, Daniella J; Bhattacharya, Jay; Goldman, Dana P; Garber, Alan M

2012-12-01

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.

Performance of a large building rainwater harvesting system.

PubMed

Ward, S; Memon, F A; Butler, D

2012-10-15

Rainwater harvesting is increasingly becoming an integral part of the sustainable water management toolkit. Despite a plethora of studies modelling the feasibility of the utilisation of rainwater harvesting (RWH) systems in particular contexts, there remains a significant gap in knowledge in relation to detailed empirical assessments of performance. Domestic systems have been investigated to a limited degree in the literature, including in the UK, but there are few recent longitudinal studies of larger non-domestic systems. Additionally, there are few studies comparing estimated and actual performance. This paper presents the results of a longitudinal empirical performance assessment of a non-domestic RWH system located in an office building in the UK. Furthermore, it compares actual performance with the estimated performance based on two methods recommended by the British Standards Institute - the Intermediate (simple calculations) and Detailed (simulation-based) Approaches. Results highlight that the average measured water saving efficiency (amount of mains water saved) of the office-based RWH system was 87% across an 8-month period, due to the system being over-sized for the actual occupancy level. Consequently, a similar level of performance could have been achieved using a smaller-sized tank. Estimated cost savings resulted in capital payback periods of 11 and 6 years for the actual over-sized tank and the smaller optimised tank, respectively. However, more detailed cost data on maintenance and operation is required to perform whole life cost analyses. These findings indicate that office-scale RWH systems potentially offer significant water and cost savings. They also emphasise the importance of monitoring data and that a transition to the use of Detailed Approaches (particularly in the UK) is required to (a) minimise over-sizing of storage tanks and (b) build confidence in RWH system performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

How much drinking water can be saved by using rainwater harvesting on a large urban area? application to Paris agglomeration.

PubMed

Belmeziti, Ali; Coutard, Olivier; de Gouvello, Bernard

2014-01-01

This paper is based on a prospective scenario of development of rainwater harvesting (RWH) on a given large urban area (such as metropolitan area or region). In such a perspective, a new method is proposed to quantify the related potential of potable water savings (PPWS) indicator on this type of area by adapting the reference model usually used on the building level. The method is based on four setting-up principles: gathering (definition of buildings-types and municipalities-types), progressing (use of an intermediate level), increasing (choice of an upper estimation) and prioritizing (ranking the stakes of RWH). Its application to the Paris agglomeration shows that is possible to save up to 11% of the total current potable water through the use of RWH. It also shows that the residential sector offers the most important part because it holds two-thirds of the agglomeration PPWS.

Performance evaluation of radiant cooling system application on a university building in Indonesia

NASA Astrophysics Data System (ADS)

Satrio, Pujo; Sholahudin, S.; Nasruddin

2017-03-01

The paper describes a study developed to estimate the energy savings potential of a radiant cooling system installed in an institutional building in Indonesia. The simulations were carried out using IESVE to evaluate thermal performance and energy consumption The building model was calibrated using the measured data for the installed radiant system. Then this calibrated model was used to simulate the energy consumption and temperature distribution to determine the proportional energy savings and occupant comfort under different systems. The result was radiant cooling which integrated with a Dedicated Outside Air System (DOAS) could make 41,84% energy savings compared to the installed cooling system. The Computational Fluid Dynamics (CFD) simulation showed that a radiant system integrated with DOAS provides superior human comfort than a radiant system integrated with Variable Air Volume (VAV). Percentage People Dissatisfied was kept below 10% using the proposed system.

Energy savings by reduced mixing in aeration tanks: results from a full scale investigation and long term implementation at Avedoere wastewater treatment plant.

PubMed

Sharma, A K; Guildal, T; Thomsen, H R; Jacobsen, B N

2011-01-01

The aim of this project was to investigate the potential of reducing number of mixers in the biological treatment process and thereby achieve energy and economical savings and contribute to cleaner environment. The project was carried out at Avedoere wastewater treatment plant and a full scale investigation was conducted to study the effect of reduced mixing on flow velocity, suspended solid sedimentation, concentration gradients of oxygen and SS with depth and treatment efficiency. The only negative effect observed was on flow velocity; however the velocity was above the critical velocity. The plant has been operating with 50% of its designed number of mixers since September 2007 and long term results also confirm that reduced mixing did not have any negative effect on treatment efficiency. The estimated yearly electricity saving is 0.75 GWh/year.

Supermarket refrigeration assessment for the Commonwealth Electric Company

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

Tsaros, T.L.; Walker, D.H.

The Commonwealth Electric Company (COM/Electric) has initiated an incentive program to promote electric energy conservation within its service territory. The Electric Power Research Institute (EPRI) has assisted COM/Electric in assessing the impact on the utility and its customers of implementing energy efficient supermarket refrigeration in retrofit applications. The primary task of this assessment was to contact the supermarket chains and refrigeration contractors and suppliers in the COM/Electric service territory to determine the type of refrigeration employed and standard or novel retrofit equipment implemented in supermarkets. With this information, estimates were made of the potential energy savings that COM/Electric and themore » supermarkets could realize if supermarkets were retrofitted with energy efficient refrigeration equipment. It was determined that the refrigerated display case features offering the greatest potential for savings through retrofit installations include doors for medium temperature multideck cases, high-efficiency fan motors, anti-sweat heater controls, and vinyl strip curtains for walk-in coolers. The retrofit components associated with the compressor machine room that offer the greatest potential for savings include the use of low heat pressure control, hot gas defrost, and external liquid-suction heat exchangers and remote evaporative subcoolers for low temperature refrigeration. 6 refs., 14 figs., 26 tabs.« less

Efficient Data-Worth Analysis Using a Multilevel Monte Carlo Method Applied in Oil Reservoir Simulations

NASA Astrophysics Data System (ADS)

Lu, D.; Ricciuto, D. M.; Evans, K. J.

2017-12-01

Data-worth analysis plays an essential role in improving the understanding of the subsurface system, in developing and refining subsurface models, and in supporting rational water resources management. However, data-worth analysis is computationally expensive as it requires quantifying parameter uncertainty, prediction uncertainty, and both current and potential data uncertainties. Assessment of these uncertainties in large-scale stochastic subsurface simulations using standard Monte Carlo (MC) sampling or advanced surrogate modeling is extremely computationally intensive, sometimes even infeasible. In this work, we propose efficient Bayesian analysis of data-worth using a multilevel Monte Carlo (MLMC) method. Compared to the standard MC that requires a significantly large number of high-fidelity model executions to achieve a prescribed accuracy in estimating expectations, the MLMC can substantially reduce the computational cost with the use of multifidelity approximations. As the data-worth analysis involves a great deal of expectation estimations, the cost savings from MLMC in the assessment can be very outstanding. While the proposed MLMC-based data-worth analysis is broadly applicable, we use it to a highly heterogeneous oil reservoir simulation to select an optimal candidate data set that gives the largest uncertainty reduction in predicting mass flow rates at four production wells. The choices made by the MLMC estimation are validated by the actual measurements of the potential data, and consistent with the estimation obtained from the standard MC. But compared to the standard MC, the MLMC greatly reduces the computational costs in the uncertainty reduction estimation, with up to 600 days cost savings when one processor is used.

Estimating Medicare and patient savings from the use of bevacizumab for the treatment of exudative age-related macular degeneration.

PubMed

Rosenfeld, Philip J; Windsor, Matthew A; Feuer, William J; Sun, Sissi J J; Frick, Kevin D; Swanson, Eric A; Huang, David

2018-04-12

The Medicare cost savings from the use of bevacizumab in the United States for the treatment of exudative age-related macular degeneration (AMD) were estimated by replacing the use of bevacizumab with ranibizumab and aflibercept. Retrospective trend study. Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology (CPT) codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490 and J3590) for inhibitors of vascular endothelial growth factor. These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 - 2015. The 2008 claims were acquired from the 100% fee-for-service (FFS) Part B Medicare Claims File. The use of bevacizumab from 2008 to 2015 resulted in an estimated savings of $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion savings to patients. This amount underestimated the actual cost-savings to Medicare providers since approximately 30% of Medicare-eligible recipients received care within Medicare Advantage plans and were not included in this analysis. The cost savings from the use of bevacizumab from 2008-2015 for Medicare fee-for-service patients undergoing treatment for exudative AMD was estimated at $17.3 billion. Additional savings over the $17.3 billion would have accrued from the use of bevacizumab if diagnostic categories such as diabetic macular edema and retinal vein occlusion were included in this study. Copyright © 2018. Published by Elsevier Inc.

Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis.

PubMed

Watkins, David A; Olson, Zachary D; Verguet, Stéphane; Nugent, Rachel A; Jamison, Dean T

2016-02-01

The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

[Research on carbon reduction potential of electric vehicles for low-carbon transportation and its influencing factors].

PubMed

Shi, Xiao-Qing; Li, Xiao-Nuo; Yang, Jian-Xin

2013-01-01

Transportation is the key industry of urban energy consumption and carbon emissions. The transformation of conventional gasoline vehicles to new energy vehicles is an important initiative to realize the goal of developing low-carbon city through energy saving and emissions reduction, while electric vehicles (EV) will play an important role in this transition due to their advantage in energy saving and lower carbon emissions. After reviewing the existing researches on energy saving and emissions reduction of electric vehicles, this paper analyzed the factors affecting carbon emissions reduction. Combining with electric vehicles promotion program in Beijing, the paper analyzed carbon emissions and reduction potential of electric vehicles in six scenarios using the optimized energy consumption related carbon emissions model from the perspective of fuel life cycle. The scenarios included power energy structure, fuel type (energy consumption per 100 km), car type (CO2 emission factor of fuel), urban traffic conditions (speed), coal-power technologies and battery type (weight, energy efficiency). The results showed that the optimized model was able to estimate carbon emissions caused by fuel consumption more reasonably; electric vehicles had an obvious restrictive carbon reduction potential with the fluctuation of 57%-81.2% in the analysis of six influencing factors, while power energy structure and coal-power technologies play decisive roles in life-cycle carbon emissions of electric vehicles with the reduction potential of 78.1% and 81.2%, respectively. Finally, some optimized measures were proposed to reduce transport energy consumption and carbon emissions during electric vehicles promotion including improving energy structure and coal technology, popularizing energy saving technologies and electric vehicles, accelerating the battery R&D and so on. The research provides scientific basis and methods for the policy development for the transition of new energy vehicles in low-carbon transport.

Application of automated measurement and verification to utility energy efficiency program data

DOE PAGES

Granderson, Jessica; Touzani, Samir; Fernandes, Samuel; ...

2017-02-17

Trustworthy savings calculations are critical to convincing regulators of both the cost-effectiveness of energy efficiency program investments and their ability to defer supply-side capital investments. Today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of energy efficiency programs. They also require time-consuming data acquisition. A spectrum of savings calculation approaches is used, with some relying more heavily on measured data and others relying more heavily on estimated, modeled, or stipulated data. The increasing availability of “smart” meters and devices that report near-real time data, combined with new analytical approaches to quantifymore » savings, offers the potential to conduct M&V more quickly and at lower cost, with comparable or improved accuracy. Commercial energy management and information systems (EMIS) technologies are beginning to offer these ‘M&V 2.0’ capabilities, and program administrators want to understand how they might assist programs in quickly and accurately measuring energy savings. This paper presents the results of recent testing of the ability to use automation to streamline the M&V process. In this paper, we apply an automated whole-building M&V tool to historic data sets from energy efficiency programs to begin to explore the accuracy, cost, and time trade-offs between more traditional M&V, and these emerging streamlined methods that use high-resolution energy data and automated computational intelligence. For the data sets studied we evaluate the fraction of buildings that are well suited to automated baseline characterization, the uncertainty in gross savings that is due to M&V 2.0 tools’ model error, and indications of labor time savings, and how the automated savings results compare to prior, traditionally determined savings results. The results show that 70% of the buildings were well suited to the automated approach. In a majority of the cases (80%) savings and uncertainties for each individual building were quantified to levels above the criteria in ASHRAE Guideline 14. In addition the findings suggest that M&V 2.0 methods may also offer time-savings relative to traditional approaches. Lastly, we discuss the implications of these findings relative to the potential evolution of M&V, and pilots currently being launched to test how M&V automation can be integrated into ratepayer-funded programs and professional implementation and evaluation practice.« less

Application of automated measurement and verification to utility energy efficiency program data

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

Granderson, Jessica; Touzani, Samir; Fernandes, Samuel

Trustworthy savings calculations are critical to convincing regulators of both the cost-effectiveness of energy efficiency program investments and their ability to defer supply-side capital investments. Today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of energy efficiency programs. They also require time-consuming data acquisition. A spectrum of savings calculation approaches is used, with some relying more heavily on measured data and others relying more heavily on estimated, modeled, or stipulated data. The increasing availability of “smart” meters and devices that report near-real time data, combined with new analytical approaches to quantifymore » savings, offers the potential to conduct M&V more quickly and at lower cost, with comparable or improved accuracy. Commercial energy management and information systems (EMIS) technologies are beginning to offer these ‘M&V 2.0’ capabilities, and program administrators want to understand how they might assist programs in quickly and accurately measuring energy savings. This paper presents the results of recent testing of the ability to use automation to streamline the M&V process. In this paper, we apply an automated whole-building M&V tool to historic data sets from energy efficiency programs to begin to explore the accuracy, cost, and time trade-offs between more traditional M&V, and these emerging streamlined methods that use high-resolution energy data and automated computational intelligence. For the data sets studied we evaluate the fraction of buildings that are well suited to automated baseline characterization, the uncertainty in gross savings that is due to M&V 2.0 tools’ model error, and indications of labor time savings, and how the automated savings results compare to prior, traditionally determined savings results. The results show that 70% of the buildings were well suited to the automated approach. In a majority of the cases (80%) savings and uncertainties for each individual building were quantified to levels above the criteria in ASHRAE Guideline 14. In addition the findings suggest that M&V 2.0 methods may also offer time-savings relative to traditional approaches. Lastly, we discuss the implications of these findings relative to the potential evolution of M&V, and pilots currently being launched to test how M&V automation can be integrated into ratepayer-funded programs and professional implementation and evaluation practice.« less

[Economic impact of overactive bladder symptoms in Japan].

PubMed

Inoue, Sachie; Kobayashi, Makoto; Sugaya, Kimio

2008-11-01

Overactive bladder (OAB) is characterized by involuntary contractions of the detrusor muscles of the bladder. The primary symptoms of OAB include urinary urgency and frequency, with or without urge incontinence. Despite the growing awareness of OAB as a chronic medical condition, little is known about the disease's economic burden. Therefore, in the present study, the costs associated with the management of OAB symptoms in Japan were estimated, and the potential cost saving by increasing the rate of physician visits in OAB population was analyzed. To estimate the costs of OAB symptoms in Japan, we collected a variety of epidemiologic and economic literatures about OAB or urinary incontinence published by June, 2007. Three types of costs were considered in this estimation: 1. OAB treatment cost (pharmacological treatment cost, diagnostic cost and cost for physician visits), 2. direct cost (OAB-related cost [urinary tract infections, skin infections and fractures] and incontinence care cost [costs of pads, diapers and cleaning]), and 3. indirect cost (work loss due to absence from work and decrease in productivity). The analysis was conducted on community dwelling Japanese persons aged > or = 40 years, and assumed that OAB patients visited a hospital or a clinic once every four weeks. For the estimation of pharmacological treatment cost, four anticholinergic drugs (immediate-release oxybutynin (Pollakisu), propiverine (BUP-4), extended-release tolterodine (Detrusitol) and solifenacin (Vesicare)) were referred. Potential cost saving was estimated on the assumption that the hospital visit rate would increase from the current 22.7% to 35% and 50%, respectively. The number of persons with OAB symptoms and OAB patients was estimated at 8.6 million (4.6 million men, 4.0 million women) and 2.0 million (1.7 million men, 0.3 million women), respectively. The annual cost for OAB was estimated to be 956.2 billion yen (112,000 yen per one person with OAB symptoms). This cost included 180.9 billion yen (19%) for OAB treatment cost (including medication of 159.1 billion yen), 62 billion yen (6%) for OAB-related cost, 28.7 billion yen (3%) for incontinence care cost and 684.6 billion yen (72%) for work loss. Therefore, the cost for work loss accounted for the majority of OAB cost. The potential annual cost saving was estimated at 92.7 billion yen and 205.8 billion yen for the assumed hospital visit rate of 35% and 50%, respectively, and 88,000 yen per newly visiting OAB patient. It was revealed that the economic impact imposed by OAB was enormous. It might be possible to reduce the cost for OAB by appropriate treatment for OAB population.

The Energy Implications of Air-Side Fouling in Constant Air Volume HVAC Systems

NASA Astrophysics Data System (ADS)

Wilson, Eric J. H.

2011-12-01

This thesis examines the effect of air-side fouling on the energy consumption of constant air volume (CAV) heating, ventilating, and air conditioning (HVAC) systems in residential and small commercial buildings. There is a particular focus on evaluating the potential energy savings that may result from the remediation of such fouling from coils, filters, and other air system components. A computer model was constructed to simulate the behavior of a building and its duct system under various levels of fouling. The model was verified through laboratory and field testing and then used to run parametric simulations to examine the range of energy impacts for various climates and duct system characteristics. A sensitivity analysis was conducted to determine the impact of parameters like duct insulation, duct leakage, duct location, and duct design on savings potential. Duct system pressures, temperatures, and energy consumption for two houses were monitored for one month. The houses' duct systems, which were both in conditioned space, were given a full cleaning, and were then monitored for another month. The flow rates at the houses improved by 10% and 6%. The improvements were primarily due to installing a new filter, as both houses had only light coil fouling. The results indicate that there was negligible change in heating energy efficiency due to the system cleaning. The parametric simulation results are in agreement with the field experiment: for systems in all eight climates, with flowrates degraded by 20% or less, if ducts are located within the thermal zone, HVAC source energy savings from cleaning are negligible or even slightly negative. However, if ducts are outside the thermal zone, savings are in the 1 to 5% range. For systems with flowrates degraded by 40%, if ducts are within the thermal zone, savings from cleaning occurs only for air conditioning energy, up to 8% in climates like Miami, FL. If ducts are outside the thermal zone, savings occurs with both heating and cooling energy, and ranges from 7% in Los Angeles, CA to 13% in Fairbanks, AK. These results assume a leaky and uninsulated duct system. The potential for savings from cleaning decreases if duct insulation is in place or sealing has been performed. The potential for energy savings is directly related to the distribution system's thermal efficiency, with air conditioner performance also playing a minor role. Results for small commercial buildings with constant air volume HVAC systems and leaky and uninsulated duct systems span a wider range: from -12% in Miami, FL to 30% in Minneapolis, MN. However, for improved ducts or ducts in the conditioned space, small commercial HVAC source energy savings is always negative (down to -17%) for flowrates degradation in the 0--40% range. The sensitivity of these results to duct characteristics (location, leakage, and insulation) and the after-cleaning flowrate, as it varies from an ideal flowrate, was also evaluated. Energy savings can reach up to 80% for some scenarios where clean airflow is severely restricted down to 20% of ideal by poor duct layout or other obstructions not removable by cleaning. In addition, a simplified spreadsheet tool was developed for technicians to use in the field to estimate potential savings resulting from a system cleaning. Measuring the temperature rise across the furnace was found to give less uncertainty than measuring the pressure rise and assuming a fan curve. Despite the uncertainty, the tool can give a general idea of the range of savings possible under various conditions.

Estimating the Energy, Demand and Cost Savings from a Geothermal Heat Pump ESPC Project at Fort Polk, LA Through Utility Bill Analysis.

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

Shonder, John A; Hughes, Patrick

2006-01-01

Energy savings performance contracts (ESPCs) are a method of financing energy conservation projects using the energy cost savings generated by the conservation measures themselves. Ideally, reduced energy costs are visible as reduced utility bills, but in fact this is not always the case. On large military bases, for example, a single electric meter typically covers hundreds of individual buildings. Savings from an ESPC involving only a small number of these buildings will have little effect on the overall utility bill. In fact, changes in mission, occupancy, and energy prices could cause substantial increases in utility bills. For this reason, other,more » more practical, methods have been developed to measure and verify savings in ESPC projects. Nevertheless, increasing utility bills--when ESPCs are expected to be reducing them--are problematic and can lead some observers to question whether savings are actually being achieved. In this paper, the authors use utility bill analysis to determine energy, demand, and cost savings from an ESPC project that installed geothermal heat pumps in the family housing areas of the military base at Fort Polk, Louisiana. The savings estimates for the first year after the retrofits were found to be in substantial agreement with previous estimates that were based on submetered data. However, the utility bills also show that electrical use tended to increase as time went on. Since other data show that the energy use in family housing has remained about the same over the period, the authors conclude that the savings from the ESPC have persisted, and increases in electrical use must be due to loads unassociated with family housing. This shows that under certain circumstances, and with the proper analysis, utility bills can be used to estimate savings from ESPC projects. However, these circumstances are rare and over time the comparison may be invalidated by increases in energy use in areas unaffected by the ESPC.« less

CLIMATE CHANGE: Information on Limitations and Assumptions of DOE’s Five-Lab Study

DTIC Science & Technology

1998-09-01

the potential consequences of climate change , the United States and other countries have entered into international negotiations and agreements. In...energy savings estimated to roughly equal or exceed costs. In view of the study’s potential influence on U.S. climate change policy, as requested, we...the study’s results, (3) the study’s role in the formulation of the Oct. 󈨥 climate change proposal and the Kyoto Conference’s emission-reduction goals for the U.S.

The Guaranteed Student Loan Program: Options for Controlling Federal Costs While Preserving Needed Credit for College. A Discussion Paper.

ERIC Educational Resources Information Center

College Entrance Examination Board, Washington, DC.

The Reagan Administration's proposals concerning the Guaranteed Student Loan (GSL) Program and possible alternatives are examined. A variety of proposals are analyzed in terms of the estimated cost savings and potential effects on the supply of and demand for student loans. Background is also included on the history of legislative changes and…

Performance and operational economics estimates for a coal gasification combined-cycle cogeneration powerplant

NASA Technical Reports Server (NTRS)

Nainiger, J. J.; Burns, R. K.; Easley, A. J.

1982-01-01

A performance and operational economics analysis is presented for an integrated-gasifier, combined-cycle (IGCC) system to meet the steam and baseload electrical requirements. The effect of time variations in steam and electrial requirements is included. The amount and timing of electricity purchases from sales to the electric utility are determined. The resulting expenses for purchased electricity and revenues from electricity sales are estimated by using an assumed utility rate structure model. Cogeneration results for a range of potential IGCC cogeneration system sizes are compared with the fuel consumption and costs of natural gas and electricity to meet requirements without cogeneration. The results indicate that an IGCC cogeneration system could save about 10 percent of the total fuel energy presently required to supply steam and electrical requirements without cogeneration. Also for the assumed future fuel and electricity prices, an annual operating cost savings of 21 percent to 26 percent could be achieved with such a cogeneration system. An analysis of the effects of electricity price, fuel price, and system availability indicates that the IGCC cogeneration system has a good potential for economical operation over a wide range in these assumptions.

The health and economic benefits of the global programme to eliminate lymphatic filariasis (2000-2014).

PubMed

Turner, Hugo C; Bettis, Alison A; Chu, Brian K; McFarland, Deborah A; Hooper, Pamela J; Ottesen, Eric A; Bradley, Mark H

2016-05-24

Lymphatic filariasis (LF), also known as elephantiasis, is a neglected tropical disease (NTD) targeted for elimination through a Global Programme to Eliminate LF (GPELF). Between 2000 and 2014, the GPELF has delivered 5.6 billion treatments to over 763 million people. Updating the estimated health and economic benefits of this significant achievement is important in justifying the resources and investment needed for eliminating LF. We combined previously established models to estimate the number of clinical manifestations and disability-adjusted life years (DALYs) averted from three benefit cohorts (those protected from acquiring infection, those with subclinical morbidity prevented from progressing and those with clinical disease alleviated). The economic savings associated with this disease prevention was then analysed in the context of prevented medical expenses incurred by LF clinical patients, potential income loss through lost-labour, and prevented costs to the health system to care for affected individuals. The indirect cost estimates were calculated using the human capital approach. A combination of four wage sources was used to estimate the fair market value of time for an agricultural worker with LF infection (to ensure a conservative estimate, the lowest wage value was used). We projected that due to the first 15 years of the GPELF 36 million clinical cases and 175 (116-250) million DALYs will potentially be averted. It was estimated that due to this notable health impact, US$100.5 billion will potentially be saved over the lifetimes of the benefit cohorts. This total amount results from summing the medical expenses incurred by LF patients (US$3 billion), potential income loss (US$94 billion), and costs to the health system (US$3.5 billion) that were projected to be prevented. The results were subjected to sensitivity analysis and were most sensitive to the assumed percentage of work hours lost for those suffering from chronic disease (changing the total economic benefit between US$69.30-150.7 billion). Despite the limitations of any such analysis, this study identifies substantial health and economic benefits that have resulted from the first 15 years of the GPELF, and it highlights the value and importance of continued investment in the GPELF.

Improving value of travel time savings estimation for more effective transportation project evaluation.

DOT National Transportation Integrated Search

2012-12-01

Estimates of value of time (VOT) and value of travel time savings (VTTS) are critical elements in benefitcost : analyses of transportation projects and in developing congestion pricing policies. In addition, : differences in VTTS among various modes ...

Cost-effectiveness of a ROPS social marketing campaign.

PubMed

Sorensen, J A; Jenkins, P; Bayes, B; Clark, S; May, J J

2010-01-01

Tractor rollovers are the most frequent cause of death in the farm community. Rollover protection structures (ROPS) can prevent the injuries and fatalities associated with these events; however, almost half of U.S. farms lack these essential devices. One promising strategy for increasing ROPS use is social marketing. The purpose of this study was to assess the costs associated with the New York ROPS Social Marketing Campaign in relation to the cost of fatalities and injuries averted as a result of the campaign to determine whether cost savings could be demonstrated in the initial years of program implementation. A total of 524 farmers who had retrofitted a tractor through the program were mailed a survey to assess the number of rollovers or close calls that occurred since ROPS installation. Responses were obtained from 382 farmers, two of whom indicated that they had a potential fatality/injury scenario since retrofitting their tractor through the program. The cost savings associated with the intervention was estimated using a decision-tree analysis adapted from Myers and Pana-Cryan with appropriate consumer price index adjustments. The data were compared to the cost of the New York ROPS Social Marketing Campaign to arrive at an associated cost-savings estimate relative to the intervention. This study indicates that a net savings will likely be demonstrated within the third year of the New York ROPS Social Marketing initiative. These data may provide evidence for researchers hoping to generate support from state and private agencies for similar initiatives.

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

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

ePrescribing: Reducing Costs Through In-Class Therapeutic Interchange

PubMed Central

Stenner, Shane P.; Chakravarthy, Rohini; Johnson, Kevin B.; Miller, William L.; Olson, Julie; Wickizer, Marleen; Johnson, Nate N.; Ohmer, Rick; Uskavitch, David R.; Bernard, Gordon R.; Neal, Erin B.

2016-01-01

Summary Introduction Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative. Methods Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members. Results For all medication classes, significant improvements were demonstrated – the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member. Conclusion A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan – $17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates. PMID:27966005

Avoiding 100 New Power Plants by Increasing Efficiency of Room Air Conditioners in India: Opportunities and Challenges

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

Phadke, Amol; Abhyankar, Nikit; Shah, Nihar

Electricity demand for room ACs is growing very rapidly in emerging economies such as India. We estimate the electricity demand from room ACs in 2030 in India considering factors such as weather and income growth using market data on penetration of ACs in different income classes and climatic regions. We discuss the status of the current standards, labels, and incentive programs to improve the efficiency of room ACs in these markets and assess the potential for further large improvements in efficiency and find that efficiency can be improved by over 40percent cost effectively. The total potential energy savings from Roommore » AC efficiency improvement in India using the best available technology will reach over 118 TWh in 2030; potential peak demand saving is found to be 60 GW by 2030. This is equivalent to avoiding 120 new coal fired power plants of 500 MW each. We discuss policy options to complement, expand and improve the ongoing programs to capture this large potential.« less

Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme

PubMed Central

Anopa, Yulia; McMahon, Alex D.; Conway, David I.; Ball, Graham E.; McIntosh, Emma; Macpherson, Lorna M. D.

2015-01-01

Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay. Methods Estimated costs of the nursery toothbrushing programme in 2011/12 were requested from all Scottish Health Boards. Unit costs of a filled, extracted and decayed primary tooth were calculated using verifiable sources of information. Total costs associated with dental treatments were estimated for the period from 1999/00 to 2009/10. These costs were based on the unit costs above and using the data of the National Dental Inspection Programme and then extrapolated to the population level. Expected cost savings were calculated for each of the subsequent years in comparison with the 2001/02 dental treatment costs. Population standardised analysis of hypothetical cohorts of 1000 children per deprivation category was performed. Results The estimated cost of the nursery toothbrushing programme in Scotland was £1,762,621 per year. The estimated cost of dental treatments in the baseline year 2001/02 was £8,766,297, while in 2009/10 it was £4,035,200. In 2002/03 the costs of dental treatments increased by £213,380 (2.4%). In the following years the costs decreased dramatically with the estimated annual savings ranging from £1,217,255 in 2003/04 (13.9% of costs in 2001/02) to £4,731,097 in 2009/10 (54.0%). Population standardised analysis by deprivation groups showed that the largest decrease in modelled costs was for the most deprived cohort of children. Conclusions The NHS costs associated with the dental treatments for five-year-old children decreased over time. In the eighth year of the toothbrushing programme the expected savings were more than two and a half times the costs of the programme implementation. PMID:26305577

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.

Navigation API Route Fuel Saving Opportunity Assessment on Large-Scale Real-World Travel Data for Conventional Vehicles and Hybrid Electric Vehicles: Preprint

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

Zhu, Lei; Holden, Jacob; Gonder, Jeffrey D

The green routing strategy instructing a vehicle to select a fuel-efficient route benefits the current transportation system with fuel-saving opportunities. This paper introduces a navigation API route fuel-saving evaluation framework for estimating fuel advantages of alternative API routes based on large-scale, real-world travel data for conventional vehicles (CVs) and hybrid electric vehicles (HEVs). The navigation APIs, such Google Directions API, integrate traffic conditions and provide feasible alternative routes for origin-destination pairs. This paper develops two link-based fuel-consumption models stratified by link-level speed, road grade, and functional class (local/non-local), one for CVs and the other for HEVs. The link-based fuel-consumption modelsmore » are built by assigning travel from a large number of GPS driving traces to the links in TomTom MultiNet as the underlying road network layer and road grade data from a U.S. Geological Survey elevation data set. Fuel consumption on a link is calculated by the proposed fuel consumption model. This paper envisions two kinds of applications: 1) identifying alternate routes that save fuel, and 2) quantifying the potential fuel savings for large amounts of travel. An experiment based on a large-scale California Household Travel Survey GPS trajectory data set is conducted. The fuel consumption and savings of CVs and HEVs are investigated. At the same time, the trade-off between fuel saving and time saving for choosing different routes is also examined for both powertrains.« less

Report: EPA’s Voluntary WaterSense Program Demonstrated Success

EPA Pesticide Factsheets

Report #17-P-0352, August 1, 2017. The EPA estimated that consumers saved over 1.5 trillion gallons of water through use of WaterSense-labeled products. Consumers saved an estimated $1,100 for every federal dollar spent on the program.

Continuous high-solids corn liquefaction and fermentation with stripping of ethanol.

PubMed

Taylor, Frank; Marquez, Marco A; Johnston, David B; Goldberg, Neil M; Hicks, Kevin B

2010-06-01

Removal of ethanol from the fermentor during fermentation can increase productivity and reduce the costs for dewatering the product and coproduct. One approach is to recycle the fermentor contents through a stripping column, where a non-condensable gas removes ethanol to a condenser. Previous research showed that this approach is feasible. Savings of $0.03 per gallon were predicted at 34% corn dry solids. Greater savings were predicted at higher concentration. Now the feasibility has been demonstrated at over 40% corn dry solids, using a continuous corn liquefaction system. A pilot plant, that continuously fed corn meal at more than one bushel (25 kg) per day, was operated for 60 consecutive days, continuously converting 95% of starch and producing 88% of the maximum theoretical yield of ethanol. A computer simulation was used to analyze the results. The fermentation and stripping systems were not significantly affected when the CO(2) stripping gas was partially replaced by nitrogen or air, potentially lowering costs associated with the gas recycle loop. It was concluded that previous estimates of potential cost savings are still valid. (c) 2010. Published by Elsevier Ltd. All rights reserved.

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.

Estimating the Effects of the Terminal Area Productivity Program

NASA Technical Reports Server (NTRS)

Lee, David A.; Kostiuk, Peter F.; Hemm, Robert V., Jr.; Wingrove, Earl R., III; Shapiro, Gerald

1997-01-01

The report describes methods and results of an analysis of the technical and economic benefits of the systems to be developed in the NASA Terminal Area Productivity (TAP) program. A runway capacity model using parameters that reflect the potential impact of the TAP technologies is described. The runway capacity model feeds airport specific models which are also described. The capacity estimates are used with a queuing model to calculate aircraft delays, and TAP benefits are determined by calculating the savings due to reduced delays. The report includes benefit estimates for Boston Logan and Detroit Wayne County airports. An appendix includes a description and listing of the runway capacity model.

NREL Screens Universities for Solar and Battery Storage Potential

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

In support of the U.S. Department of Energy's SunShot initiative, NREL provided solar photovoltaic (PV) screenings in 2016 for eight universities seeking to go solar. NREL conducted an initial technoeconomic assessment of PV and storage feasibility at the selected universities using the REopt model, an energy planning platform that can be used to evaluate RE options, estimate costs, and suggest a mix of RE technologies to meet defined assumptions and constraints. NREL provided each university with customized results, including the cost-effectiveness of PV and storage, recommended system size, estimated capital cost to implement the technology, and estimated life cycle costmore » savings.« less

Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care.

PubMed

2008-07-01

Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention. Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18-75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the 'top ten' drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline. The minimum annual cost of all drug prescriptions at BMI 20 kg/m(2) was pound 50.71 for men and pound 62.59 for women. Costs were greater by pound 5.27 (men) and pound 4.20 (women) for each unit increase in BMI, to a BMI of 25 (men pound 77.04, women pound 78.91), then by pound 7.78 and pound 5.53, respectively, to BMI 30 (men pound 115.93 women pound 111.23), then by pound 8.27 and pound 4.95 to BMI 40 (men pound 198.66, women pound 160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men pound 8.45, women pound 7.80), substantially greater at BMI 30 (men pound 23.98, women pound 16.72) and highest at BMI 40 (men pound 63.59, women pound 27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately pound 60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by pound 6.35 (men) and pound 3.75 (women) or around 8% of programme costs at one year, and by pound 12.58 and pound 8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up. Drug prescriptions rise from a minimum at BMI of 20 kg/m(2) and steeply above BMI 30 kg/m(2). An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Estimating the Value of Life, Injury, and Travel Time Saved Using a Stated Preference Framework.

PubMed

Niroomand, Naghmeh; Jenkins, Glenn P

2016-06-01

The incidence of fatality over the period 2010-2014 from automobile accidents in North Cyprus is 2.75 times greater than the average for the EU. With the prospect of North Cyprus entering the EU, many investments will need to be undertaken to improve road safety in order to reach EU benchmarks. The objective of this study is to provide local estimates of the value of a statistical life and injury along with the value of time savings. These are among the parameter values needed for the evaluation of the change in the expected incidence of automotive accidents and time savings brought about by such projects. In this study we conducted a stated choice experiment to identify the preferences and tradeoffs of automobile drivers in North Cyprus for improved travel times, travel costs, and safety. The choice of route was examined using mixed logit models to obtain the marginal utilities associated with each attribute of the routes that consumers choose. These estimates were used to assess the individuals' willingness to pay (WTP) to avoid fatalities and injuries and to save travel time. We then used the results to obtain community-wide estimates of the value of a statistical life (VSL) saved, the value of injury (VI) prevented, and the value per hour of travel time saved. The estimates for the VSL range from €315,293 to €1,117,856 and the estimates of VI from € 5,603 to € 28,186. These values are consistent, after adjusting for differences in incomes, with the median results of similar studies done for EU countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Investigating the Gap Between Estimated and Actual Energy Efficiency and Conservation Savings for Public Buildings Projects & Programs in United States

NASA Astrophysics Data System (ADS)

Qaddus, Muhammad Kamil

The gap between estimated and actual savings in energy efficiency and conservation (EE&C) projects or programs forms the problem statement for the scope of public and government buildings. This gap has been analyzed first on impact and then on process-level. On the impact-level, the methodology leads to categorization of the gap as 'Realization Gap'. It then views the categorization of gap within the context of past and current narratives linked to realization gap. On process-level, the methodology leads to further analysis of realization gap on process evaluation basis. The process evaluation criterion, a product of this basis is then applied to two different programs (DESEU and NYC ACE) linked to the scope of this thesis. Utilizing the synergies of impact and process level analysis, it offers proposals on program development and its structure using our process evaluation criterion. Innovative financing and benefits distribution structure is thus developed and will remain part of the proposal. Restricted Stakeholder Crowd Financing and Risk-Free Incentivized return are the products of proposed financing and benefit distribution structure respectively. These products are then complimented by proposing an alternative approach in estimating EE&C savings. The approach advocates estimation based on range-allocation rather than currently utilized unique estimated savings approach. The Way Ahead section thus explores synergy between financial and engineering ranges of energy savings as a multi-discipline approach for future research. Moreover, it provides the proposed program structure with risk aversion and incentive allocation while dealing with uncertainty. This set of new approaches are believed to better fill the realization gap between estimated and actual energy efficiency savings.

A method for estimating cost savings for population health management programs.

PubMed

Murphy, Shannon M E; McGready, John; Griswold, Michael E; Sylvia, Martha L

2013-04-01

To develop a quasi-experimental method for estimating Population Health Management (PHM) program savings that mitigates common sources of confounding, supports regular updates for continued program monitoring, and estimates model precision. Administrative, program, and claims records from January 2005 through June 2009. Data are aggregated by member and month. Study participants include chronically ill adult commercial health plan members. The intervention group consists of members currently enrolled in PHM, stratified by intensity level. Comparison groups include (1) members never enrolled, and (2) PHM participants not currently enrolled. Mixed model smoothing is employed to regress monthly medical costs on time (in months), a history of PHM enrollment, and monthly program enrollment by intensity level. Comparison group trends are used to estimate expected costs for intervention members. Savings are realized when PHM participants' costs are lower than expected. This method mitigates many of the limitations faced using traditional pre-post models for estimating PHM savings in an observational setting, supports replication for ongoing monitoring, and performs basic statistical inference. This method provides payers with a confident basis for making investment decisions. © Health Research and Educational Trust.

Potentials for Platooning in U.S. Highway Freight Transport

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

Muratori, Matteo; Holden, Jacob; Lammert, Michael

2017-03-28

Smart technologies enabling connection among vehicles and between vehicles and infrastructure as well as vehicle automation to assist human operators are receiving significant attention as a means for improving road transportation systems by reducing fuel consumption - and related emissions - while also providing additional benefits through improving overall traffic safety and efficiency. For truck applications, which are currently responsible for nearly three-quarters of the total U.S. freight energy use and greenhouse gas (GHG) emissions, platooning has been identified as an early feature for connected and automated vehicles (CAVs) that could provide significant fuel savings and improved traffic safety andmore » efficiency without radical design or technology changes compared to existing vehicles. A statistical analysis was performed based on a large collection of real-world U.S. truck usage data to estimate the fraction of total miles that are technically suitable for platooning. In particular, our analysis focuses on estimating 'platoonable' mileage based on overall highway vehicle use and prolonged high-velocity traveling, and established that about 65% of the total miles driven by combination trucks from this data sample could be driven in platoon formation, leading to a 4% reduction in total truck fuel consumption. This technical potential for 'platoonable' miles in the United States provides an upper bound for scenario analysis considering fleet willingness and convenience to platoon as an estimate of overall benefits of early adoption of connected and automated vehicle technologies. A benefit analysis is proposed to assess the overall potential for energy savings and emissions mitigation by widespread implementation of highway platooning for trucks.« less

Bay Ridge Gardens - Mixed-Humid Affordable Multifamily Housing Deep Energy Retrofit

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

Lyons, J.; Moore, M.; Thompson, M.

2013-08-01

Under this project, Newport Partners (as part of the BA-PIRC research team) evaluated the installation, measured performance, and cost-effectiveness of efficiency upgrade measures for a tenant-in-place DER at the Bay Ridge multifamily (MF) development in Annapolis, Maryland. The design and construction phase of the Bay Ridge project was completed in August 2012. This report summarizes system commissioning, short-term test results, utility bill data analysis, and analysis of real-time data collected over a one-year period after the retrofit was complete. The Bay Ridge project is comprised of a 'base scope' retrofit which was estimated to achieve a 30%+ savings (relative tomore » pre-retrofit) on 186 apartments, and a 'DER scope' which was estimated to achieve 50% savings (relative to pre-retrofit) on a 12-unit building. The base scope was applied to the entire apartment complex, except for one 12-unit building which underwent the DER scope. A wide range of efficiency measures was applied to pursue this savings target for the DER building, including improvements/replacements of mechanical equipment and distribution systems, appliances, lighting and lighting controls, the building envelope, hot water conservation measures, and resident education. The results of this research build upon the current body of knowledge of multifamily retrofits. Towards this end, the research team has collected and generated data on the selection of measures, their estimated performance, their measured performance, and risk factors and their impact on potential measures.« less

Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program

PubMed Central

Frost, Jennifer J; Sonfield, Adam; Zolna, Mia R; Finer, Lawrence B

2014-01-01

Context Each year the United States’ publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Methods Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. Findings In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion—$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion. Conclusions Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This investment saved the government billions of public dollars, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent. PMID:25314928

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

Economic Analysis of the Return-on-Investment of a Worksite Wellness Program for a Large Multistate Retail Grocery Organization.

PubMed

Light, Emily M W; Kline, Allison S; Drosky, Megan A; Chapman, Larry S

2015-08-01

The objective of this study is to measure the return on investment (ROI) of the Price Chopper/Golub Corporation employee population who participate in wellness programs available to them. Medical claims data, risk level, and presence of comorbidities such as diabetes and heart disease were compared in a matched retrospective cohort of participants and nonparticipants, with 2008, 2009, and 2010 serving as measurement years. Program costs and estimated savings were used to calculate an ROI of $4.33 for every dollar invested in wellness programs. Reductions in medical costs were observed at several risk and participation levels, with an average savings of $133 per participant and a 3-year savings estimate of $285,706. The positive ROI and savings estimate indicate that wellness interventions added economic value to Price Chopper/Golub Corporation.

Cost-Value Analysis and the SAVE: A Work in Progress, But an Option for Localised Decision Making?

PubMed

Karnon, Jonathan; Partington, Andrew

2015-12-01

Cost-value analysis aims to address the limitations of the quality-adjusted life-year (QALY) by incorporating the strength of public concerns for fairness in the allocation of scarce health care resources. To date, the measurement of value has focused on equity weights to reflect societal preferences for the allocation of QALY gains. Another approach is to use a non-QALY-based measure of value, such as an outcome 'equivalent to saving the life of a young person' (a SAVE). This paper assesses the feasibility and validity of using the SAVE as a measure of value for the economic evaluation of health care technologies. A web-based person trade-off (PTO) survey was designed and implemented to estimate equivalent SAVEs for outcome events associated with the progression and treatment of early-stage breast cancer. The estimated equivalent SAVEs were applied to the outputs of an existing decision analytic model for early breast cancer. The web-based PTO survey was undertaken by 1094 respondents. Validation tests showed that 68 % of eligible responses revealed consistent ordering of responses and 32 % displayed ordinal transitivity, while 37 % of respondents showing consistency and ordinal transitivity approached cardinal transitivity. Using consistent and ordinally transitive responses, the mean incremental cost per SAVE gained was £ 3.72 million. Further research is required to improve the validity of the SAVE, which may include a simpler web-based survey format or a face-to-face format to facilitate more informed responses. A validated method for estimating equivalent SAVEs is unlikely to replace the QALY as the globally preferred measure of outcome, but the SAVE may provide a useful alternative for localized decision makers with relatively small, constrained budgets-for example, in programme budgeting and marginal analysis.

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

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.

Cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system. Volume 2: Market and economic analyses

NASA Technical Reports Server (NTRS)

Vanabkoude, J. C.

1976-01-01

The impact of the most promising fuel conserving options on fuel consumption, passenger demand, operating costs, and airline profits when implemented into the U.S. domestic and international airline fleets is assessed. The potential fuel savings achievable in the U.S. scheduled air transportation system over the forecast period, 1973-1990, are estimated.

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova.

PubMed

Kempers, Jari; Ketting, Evert; Lesco, Galina

2014-07-21

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies.

A shift from motorised travel to active transport: What are the potential health gains for an Australian city?

PubMed

Zapata-Diomedi, Belen; Knibbs, Luke D; Ware, Robert S; Heesch, Kristiann C; Tainio, Marko; Woodcock, James; Veerman, J Lennert

2017-01-01

An alarmingly high proportion of the Australian adult population does not meet national physical activity guidelines (57%). This is concerning because physical inactivity is a risk factor for several chronic diseases. In recent years, an increasing emphasis has been placed on the potential for transport and urban planning to contribute to increased physical activity via greater uptake of active transport (walking, cycling and public transport). In this study, we aimed to estimate the potential health gains and savings in health care costs of an Australian city achieving its stated travel targets for the use of active transport. Additional active transport time was estimated for the hypothetical scenario of Brisbane (1.1 million population 2013) in Australia achieving specified travel targets. A multi-state life table model was used to estimate the number of health-adjusted life years, life-years, changes in the burden of diseases and injuries, and the health care costs associated with changes in physical activity, fine particle (<2.5 μm; PM2.5) exposure, and road trauma attributable to a shift from motorised travel to active transport. Sensitivity analyses were conducted to test alternative modelling assumptions. Over the life course of the Brisbane adult population in 2013 (860,000 persons), 33,000 health-adjusted life years could be gained if the travel targets were achieved by 2026. This was mainly due to lower risks of physical inactivity-related diseases, with life course reductions in prevalence and mortality risk in the range of 1.5%-6.0%. Prevalence and mortality of respiratory diseases increased slightly (≥0.27%) due to increased exposure of larger numbers of cyclists and pedestrians to fine particles. The burden of road trauma increased by 30% for mortality and 7% for years lived with disability. We calculated substantial net savings ($AU183 million, 2013 values) in health care costs. In cities, such as Brisbane, where over 80% of trips are made by private cars, shifts towards walking, cycling and public transport would cause substantial net health benefits and savings in health care costs. However, for such shifts to occur, investments are needed to ensure safe and convenient travel.

Balancing the benefits and detriments among women targeted by the Norwegian Breast Cancer Screening Program.

PubMed

Hofvind, Solveig; Román, Marta; Sebuødegård, Sofie; Falk, Ragnhild S

2016-12-01

To compute a ratio between the estimated numbers of lives saved from breast cancer death and the number of women diagnosed with a breast cancer that never would have been diagnosed during the woman's lifetime had she not attended screening (epidemiologic over-diagnosis) in the Norwegian Breast Cancer Screening Program. The Norwegian Breast Cancer Screening Program invites women aged 50-69 to biennial mammographic screening. Results from published studies using individual level data from the programme for estimating breast cancer mortality and epidemiologic over-diagnosis comprised the basis for the ratio. The mortality reduction varied from 36.8% to 43% among screened women, while estimates on epidemiologic over-diagnosis ranged from 7% to 19.6%. We computed the average estimates for both values. The benefit-detriment ratio, number of lives saved, and number of women over-diagnosed were computed for different scenarios of reduction in breast cancer mortality and epidemiologic over-diagnosis. For every 10,000 biennially screened women, followed until age 79, we estimated that 53-61 (average 57) women were saved from breast cancer death, and 45-126 (average 82) were over-diagnosed. The benefit-detriment ratio using average estimates was 1:1.4, indicating that the programme saved about one life per 1-2 women with epidemiologic over-diagnosis. The benefit-detriment ratio estimates of the Norwegian Breast Cancer Screening Program, expressed as lives saved from breast cancer death and epidemiologic over-diagnosis, should be interpreted with care due to substantial uncertainties in the estimates, and the differences in the scale of values of the events compared. © The Author(s) 2016.

Estimated medical cost savings in Massachusetts by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2008-12-01

This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Massachusetts if a primary seat belt law is implemented. The savi...

Home Performance with ENERGY STAR: Utility Bill Analysis on Homes Participating in Austin Energy's Program

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

Belzer, D.; Mosey, G.; Dagher, L.

2008-01-01

Home Performance with ENERGY STAR (HPwES) is a jointly managed program of the U.S. Department of Energy (DOE) and the U.S. Environmental Protection Agency (EPA). This program focuses on improving energy efficiency in existing homes via a whole-house approach to assessing and improving a home's energy performance, and helping to protect the environment. As a local sponsor for HPwES, Austin Energy's HPwES program offers a complete home energy assessment and a list of recommendations for efficiency improvements, along with cost estimates. The owner can choose to implement only one or the complete set of energy conservation measures. Austin Energy facilitatesmore » the process by providing economic incentives to the homeowner through its HPwES Loan program and its HPwES Rebate program. In 2005, the total number of participants in both programs was approximately 1,400. Both programs are only available for improvements made by a participating HPwES contractor. The individual household billing data - encompassing more than 7,000 households - provided by Austin Energy provides a rich data set to estimate the impacts of its HPwES program. The length of the billing histories is sufficient to develop PRISM-type models of electricity use based on several years of monthly bills before and after the installation of the conservation measures. Individual household savings were estimated from a restricted version of a PRISM-type regression model where the reference temperature to define cooling (or heating degree days) was estimated along with other parameters. Because the statistical quality of the regression models varies across individual households, three separate samples were used to measure the aggregate results. The samples were distinguished on the basis of the statistical significance of the estimated (normalized) cooling consumption. A normalized measure of cooling consumption was based on average temperatures observed over the most recent nine-year period ending in 2006. This study provided a statistically rigorous approach to incorporating the variability of expected savings across the households in the sample together with the uncertainty inherent in the regression models used to estimate those savings. While the impact of the regression errors was found to be relatively small in these particular samples, this approach may be useful in future studies using individual household billing data. The median percentage savings for the largest sample of 6,000 households in the analysis was 32%, while the mean savings was 28%. Because the number of households in the sample is very large, the standard error associated with the mean percentage savings are very small, less than 1%. A conservative statement of the average savings is that is falls in the range of 25% to 30% with a high level of certainty. This preliminary analysis provides robust estimates of average program savings, but offers no insight into how savings may vary by type of conservation measure or whether savings vary by the amount of cooling electricity used prior to undertaking the measure. Follow-up researchers may want to analyze the impacts of specific ECMs. Households that use electricity for heating might also be separately analyzed. In potential future work several methodological improvements could also be explored. As mentioned in Section 2, there was no formal attempt to clean the data set of outliers and other abnormal patterns of billing data prior to the statistical analysis. The restriction of a constant reference temperature might also be relaxed. This approach may provide evidence as to whether any 'take-back' efforts are present, whereby thermostat settings are lowered during the summer months after the measures are undertaken (reflected in lower reference temperatures in the post-ECM period). A more extended analysis may also justify the investment in and use of the PRISM software package, which may provide more diagnostic measures with respect to the reference temperature. PRISM also appears to contain some built-in capability to detect outliers and other anomalous data points.« less

Investigating energy-saving potentials in the cloud.

PubMed

Lee, Da-Sheng

2014-02-20

Collecting webpage messages can serve as a sensor for investigating the energy-saving potential of buildings. Focusing on stores, a cloud sensor system is developed to collect data and determine their energy-saving potential. The owner of a store under investigation must register online, report the store address, area, and the customer ID number on the electric meter. The cloud sensor system automatically surveys the energy usage records by connecting to the power company website and calculating the energy use index (EUI) of the store. Other data includes the chain store check, company capital, location price, and the influence of weather conditions on the store; even the exposure frequency of store under investigation may impact the energy usage collected online. After collecting data from numerous stores, a multi-dimensional data array is constructed to determine energy-saving potential by identifying stores with similarity conditions. Similarity conditions refer to analyzed results that indicate that two stores have similar capital, business scale, weather conditions, and exposure frequency on web. Calculating the EUI difference or pure technical efficiency of stores, the energy-saving potential is determined. In this study, a real case study is performed. An 8-dimensional (8D) data array is constructed by surveying web data related to 67 stores. Then, this study investigated the savings potential of the 33 stores, using a site visit, and employed the cloud sensor system to determine the saving potential. The case study results show good agreement between the data obtained by the site visit and the cloud investigation, with errors within 4.17%. Among 33 the samples, eight stores have low saving potentials of less than 5%. The developed sensor on the cloud successfully identifies them as having low saving potential and avoids wasting money on the site visit.

Investigating Energy-Saving Potentials in the Cloud

PubMed Central

Lee, Da-Sheng

2014-01-01

Collecting webpage messages can serve as a sensor for investigating the energy-saving potential of buildings. Focusing on stores, a cloud sensor system is developed to collect data and determine their energy-saving potential. The owner of a store under investigation must register online, report the store address, area, and the customer ID number on the electric meter. The cloud sensor system automatically surveys the energy usage records by connecting to the power company website and calculating the energy use index (EUI) of the store. Other data includes the chain store check, company capital, location price, and the influence of weather conditions on the store; even the exposure frequency of store under investigation may impact the energy usage collected online. After collecting data from numerous stores, a multi-dimensional data array is constructed to determine energy-saving potential by identifying stores with similarity conditions. Similarity conditions refer to analyzed results that indicate that two stores have similar capital, business scale, weather conditions, and exposure frequency on web. Calculating the EUI difference or pure technical efficiency of stores, the energy-saving potential is determined. In this study, a real case study is performed. An 8-dimensional (8D) data array is constructed by surveying web data related to 67 stores. Then, this study investigated the savings potential of the 33 stores, using a site visit, and employed the cloud sensor system to determine the saving potential. The case study results show good agreement between the data obtained by the site visit and the cloud investigation, with errors within 4.17%. Among 33 the samples, eight stores have low saving potentials of less than 5%. The developed sensor on the cloud successfully identifies them as having low saving potential and avoids wasting money on the site visit. PMID:24561405

An economic model of the benefits of professional doula labor support in Wisconsin births.

PubMed

Chapple, Will; Gilliland, Amy; Li, Dongmei; Shier, Emily; Wright, Emily

2013-04-01

The purpose of this study is to estimate the immediate cost savings per delivery with in-hospital professional doula labor support in Wisconsin. This is the first study that calculates the estimated cost savings of professional doula labor support specific to Wisconsin. This analysis used results presented in and derived from the Cochrane Review of continuous labor support to estimate procedure reduction and cost savings in Wisconsin using birth statistics from 2010. The delivery outcomes included were cesarean deliveries, instrumental deliveries, and regional analgesia use. To accurately reflect published studies on labor support, only low-risk deliveries were used for intervention reduction calculations. For 2010 data, estimated savings of 28,997,754.80 dollars could have been achieved if every low-risk birth were attended in-hospital by a professional doula. A professional doula providing only in-hospital labor support would yield an estimated cost savings of 424.14 dollars per delivery or 530.89 dollars per low-risk delivery. A system-based change in how laboring mothers are supported would be an innovative step that would put Wisconsin at the forefront of cost-effective health care, reducing interventions while improving outcomes. It is recommended that Wisconsin insurers consider reimbursing for professional doula labor support. It is also recommended that pilot programs be implemented in Wisconsin that can better assess the implementation of professional doula labor support services.

Cost-effectiveness analysis of revised WHO guidelines for management of childhood pneumonia in 74 Countdown countries.

PubMed

Zhang, Shanshan; Incardona, Beatrice; Qazi, Shamim A; Stenberg, Karin; Campbell, Harry; Nair, Harish

2017-06-01

Treatment of childhood pneumonia is a key priority in low-income countries, with substantial resource implications. WHO revised their guidelines for the management of childhood pneumonia in 2013. We estimated and compared the resource requirements, total direct medical cost and cost-effectiveness of childhood pneumonia management in 74 countries with high burden of child mortality (Countdown countries) using the 2005 and 2013 revised WHO guidelines. We constructed a cost model using a bottom up approach to estimate the cost of childhood pneumonia management using the 2005 and 2013 WHO guidelines from a public provider perspective in 74 Countdown countries. The cost of pneumonia treatment was estimated, by country, for year 2013, including costs of medicines and service delivery at three different management levels. We also assessed country-specific lives saved and disability adjusted life years (DALYs) averted due to pneumonia treated in children aged below five years. The cost-effectiveness of pneumonia treatment was estimated in terms of cost per DALY averted by fully implementing WHO treatment guidelines relative to no treatment intervention for pneumonia. Achieving full treatment coverage with the 2005 WHO guidelines was estimated to cost US$ 2.9 (1.9-4.2) billion compared to an estimated US$ 1.8 (0.8-3.0) billion for the revised 2013 WHO guidelines in these countries. Pneumonia management in young children following WHO treatment guidelines could save up to 39.8 million DALYs compared to a zero coverage scenario in the year 2013 in the 74 Countdown countries. The median cost-effectiveness ratio per DALY averted in 74 countries was substantially lower for the 2013 guidelines: US$ 26.6 (interquartile range IQR: 17.7-45.9) vs US$ 38.3 (IQR: US$ 26.2-86.9) per DALY averted for the 2005 guideline respectively. Child pneumonia management as detailed in standard WHO guidelines is a very cost-effective intervention. Implementation of the 2013 WHO guidelines is expected to result in a 39.5% reduction in treatment costs compared to the 2005 guidelines which could save up to US$ 1.16 (0.68-1.23) billion in the 74 Countdown countries, with potential savings greatest in low HIV burden countries which can implement effective community case management of pneumonia.

Cost–effectiveness analysis of revised WHO guidelines for management of childhood pneumonia in 74 Countdown countries

PubMed Central

Zhang, Shanshan; Incardona, Beatrice; Qazi, Shamim A; Stenberg, Karin; Campbell, Harry; Nair, Harish

2017-01-01

Background Treatment of childhood pneumonia is a key priority in low–income countries, with substantial resource implications. WHO revised their guidelines for the management of childhood pneumonia in 2013. We estimated and compared the resource requirements, total direct medical cost and cost-effectiveness of childhood pneumonia management in 74 countries with high burden of child mortality (Countdown countries) using the 2005 and 2013 revised WHO guidelines. Methods We constructed a cost model using a bottom up approach to estimate the cost of childhood pneumonia management using the 2005 and 2013 WHO guidelines from a public provider perspective in 74 Countdown countries. The cost of pneumonia treatment was estimated, by country, for year 2013, including costs of medicines and service delivery at three different management levels. We also assessed country–specific lives saved and disability adjusted life years (DALYs) averted due to pneumonia treated in children aged below five years. The cost-effectiveness of pneumonia treatment was estimated in terms of cost per DALY averted by fully implementing WHO treatment guidelines relative to no treatment intervention for pneumonia. Results Achieving full treatment coverage with the 2005 WHO guidelines was estimated to cost US$ 2.9 (1.9–4.2) billion compared to an estimated US$ 1.8 (0.8–3.0) billion for the revised 2013 WHO guidelines in these countries. Pneumonia management in young children following WHO treatment guidelines could save up to 39.8 million DALYs compared to a zero coverage scenario in the year 2013 in the 74 Countdown countries. The median cost-effectiveness ratio per DALY averted in 74 countries was substantially lower for the 2013 guidelines: US$ 26.6 (interquartile range IQR: 17.7–45.9) vs US$ 38.3 (IQR: US$ 26.2–86.9) per DALY averted for the 2005 guideline respectively. Conclusions Child pneumonia management as detailed in standard WHO guidelines is a very cost–effective intervention. Implementation of the 2013 WHO guidelines is expected to result in a 39.5% reduction in treatment costs compared to the 2005 guidelines which could save up to US$ 1.16 (0.68–1.23) billion in the 74 Countdown countries, with potential savings greatest in low HIV burden countries which can implement effective community case management of pneumonia. PMID:28400955

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

PubMed Central

2014-01-01

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

Economic benefits of the Mediterranean-style diet consumption in Canada and the United States

PubMed Central

Abdullah, Mohammad M.H.; Jones, Jason P.H.; Jones, Peter J.H.

2015-01-01

Background The Mediterranean-style diet (MedDiet) is an established healthy-eating behavior that has consistently been shown to favorably impact cardiovascular health, thus likely improving quality of life and reducing costs associated with cardiovascular disease (CVD). Data on the economic benefits of MedDiet intakes are, however, scarce. Objective The objective of this study was to estimate the annual healthcare and societal cost savings that would accrue to the Canadian and American public, independently, as a result of a reduction in the incidence of CVD following adherence to a MedDiet. Design A variation in cost-of-illness analysis entailing three stages of estimations was developed to 1) identify the proportion of individuals who are likely to adopt a MedDiet in North America, 2) assess the impact of the MedDiet intake on CVD incidence reduction, and 3) impute the potential savings in costs associated with healthcare and productivity following the estimated CVD reduction. To account for the uncertainty factor, a sensitivity analysis of four scenarios, including ideal, optimistic, pessimistic, and very-pessimistic assumptions, was implemented within each of these stages. Results Significant improvements in CVD-related costs were evident with varying MedDiet adoption and CVD reduction rates. Specifically, CAD $41.9 million to 2.5 billion in Canada and US $1.0–62.8 billion in the United States were estimated to accrue as total annual savings in economic costs, given the ‘very-pessimistic’ through ‘ideal’ scenarios. Conclusions Closer adherence to dietary behaviors that are consistent with the principles of the MedDiet is expected to contribute to a reduction in the monetary burdens of CVD in Canada, the United States, and possibly other parts of the world. PMID:26111965

Estimated cost of universal public coverage of prescription drugs in Canada

PubMed Central

Morgan, Steven G.; Law, Michael; Daw, Jamie R.; Abraham, Liza; Martin, Danielle

2015-01-01

Background: With the exception of Canada, all countries with universal health insurance systems provide universal coverage of prescription drugs. Progress toward universal public drug coverage in Canada has been slow, in part because of concerns about the potential costs. We sought to estimate the cost of implementing universal public coverage of prescription drugs in Canada. Methods: We used published data on prescribing patterns and costs by drug type, as well as source of funding (i.e., private drug plans, public drug plans and out-of-pocket expenses), in each province to estimate the cost of universal public coverage of prescription drugs from the perspectives of government, private payers and society as a whole. We estimated the cost of universal public drug coverage based on its anticipated effects on the volume of prescriptions filled, products selected and prices paid. We selected these parameters based on current policies and practices seen either in a Canadian province or in an international comparator. Results: Universal public drug coverage would reduce total spending on prescription drugs in Canada by $7.3 billion (worst-case scenario $4.2 billion, best-case scenario $9.4 billion). The private sector would save $8.2 billion (worst-case scenario $6.6 billion, best-case scenario $9.6 billion), whereas costs to government would increase by about $1.0 billion (worst-case scenario $5.4 billion net increase, best-case scenario $2.9 billion net savings). Most of the projected increase in government costs would arise from a small number of drug classes. Interpretation: The long-term barrier to the implementation of universal pharmacare owing to its perceived costs appears to be unjustified. Universal public drug coverage would likely yield substantial savings to the private sector with comparatively little increase in costs to government. PMID:25780047

Estimated cost of universal public coverage of prescription drugs in Canada.

PubMed

Morgan, Steven G; Law, Michael; Daw, Jamie R; Abraham, Liza; Martin, Danielle

2015-04-21

With the exception of Canada, all countries with universal health insurance systems provide universal coverage of prescription drugs. Progress toward universal public drug coverage in Canada has been slow, in part because of concerns about the potential costs. We sought to estimate the cost of implementing universal public coverage of prescription drugs in Canada. We used published data on prescribing patterns and costs by drug type, as well as source of funding (i.e., private drug plans, public drug plans and out-of-pocket expenses), in each province to estimate the cost of universal public coverage of prescription drugs from the perspectives of government, private payers and society as a whole. We estimated the cost of universal public drug coverage based on its anticipated effects on the volume of prescriptions filled, products selected and prices paid. We selected these parameters based on current policies and practices seen either in a Canadian province or in an international comparator. Universal public drug coverage would reduce total spending on prescription drugs in Canada by $7.3 billion (worst-case scenario $4.2 billion, best-case scenario $9.4 billion). The private sector would save $8.2 billion (worst-case scenario $6.6 billion, best-case scenario $9.6 billion), whereas costs to government would increase by about $1.0 billion (worst-case scenario $5.4 billion net increase, best-case scenario $2.9 billion net savings). Most of the projected increase in government costs would arise from a small number of drug classes. The long-term barrier to the implementation of universal pharmacare owing to its perceived costs appears to be unjustified. Universal public drug coverage would likely yield substantial savings to the private sector with comparatively little increase in costs to government. © 2015 Canadian Medical Association or its licensors.

Potential for Water Savings by Defoliation of Saltcedar (Tamarix spp.) by Saltcedar Beetles (Diorhabda carinulata) in the Upper Colorado River Basin

NASA Astrophysics Data System (ADS)

Nagler, P. L.; Nguyen, U.; Bateman, H. L.; Jarchow, C.; van Riper, C., III; Waugh, W.; Glenn, E.

2016-12-01

Northern saltcedar beetles (Diorhabda carinata) have spread widely in riparian zones on the Colorado Plateau since their initial release in 2002. One goal of the releases was to reduce water consumption by saltcedar in order to conserve water through reduction of evapotranspiration (ET). The beetle moved south on the Virgin River and reached Big Bend State Park in Nevada in 2014, an expansion rate of 60 km/year. This is important because the beetle's photoperiod requirement for diapause was expected to prevent them from moving south of 37°N latitude, where endangered southwest willow flycatcher habitat occurs. In addition to focusing on the rate of dispersal of the beetles, we used remote sensing estimates of ET at 13 sites on the Colorado, San Juan, Virgin and Dolores rivers and their tributaries to estimate riparian zone ET before and after beetle releases. We estimate that water savings from 2007-2015 was 31.5 million m3/yr (25,547 acre-ft/yr), amounting to 0.258 % of annual river flow from the Upper Colorado River Basin to the Lower Basin. Reasons for the relatively low potential water savings are: 1) baseline ET before beetle release was modest (0.472 m/yr); 2) reduction in ET was low (0.061 m/yr) because saltcedar stands tended to recover after defoliation; 3) riparian ET even in the absence of beetles was only 1.8 % of river flows, calculated as the before beetle average annual ET (472 mm/yr) times the total area of saltcedar (51,588 ha) divided by the combined total average annual flows (1964-2015) from the upper to lower catchment areas of the Colorado River Basin at the USGS gages (12,215 million m3/yr or 9.90 million acre-ft). Further research is suggested to concentrate on the ecological impacts (both positive and negative) of beetles on riparian zones and on identifying management options to maximize riparian health.

From Policy to Compliance: Federal Energy Efficient Product Procurement

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

DeMates, Laurèn; Scodel, Anna

Federal buyers are required to purchase energy-efficient products in an effort to minimize energy use in the federal sector, save the federal government money, and spur market development of efficient products. The Federal Energy Management Program (FEMP)’s Energy Efficient Product Procurement (EEPP) Program helps federal agencies comply with the requirement to purchase energy-efficient products by providing technical assistance and guidance and setting efficiency requirements for certain product categories. Past studies have estimated the savings potential of purchasing energy-efficient products at over $500 million per year in energy costs across federal agencies.1 Despite the strong policy support for EEPP and resourcesmore » available, energy-efficient product purchasing operates within complex decision-making processes and operational structures; implementation challenges exist that may hinder agencies’ ability to comply with purchasing requirements. The shift to purchasing green products, including energy-efficient products, relies on “buy in” from a variety of potential actors throughout different purchasing pathways. Challenges may be especially high for EEPP relative to other sustainable acquisition programs given that efficient products frequently have a higher first cost than non-efficient ones, which may be perceived as a conflict with fiscal responsibility, or more simply problematic for agency personnel trying to stretch limited budgets. Federal buyers may also face challenges in determining whether a given product is subject to EEPP requirements. Previous analysis on agency compliance with EEPP, conducted by the Alliance to Save Energy (ASE), shows that federal agencies are getting better at purchasing energy-efficient products. ASE conducted two reviews of relevant solicitations for product and service contracts listed on Federal Business Opportunities (FBO), the centralized website where federal agencies are required to post procurements greater than $25,000. In 2010, ASE estimated a compliance rate of 46% in 2010, up from an estimate of 12% in 2008. Our work updates and expands on ASE’s 2010 analysis to gauge agency compliance with EEPP requirements.« less

Estimated medical cost savings in New Hampshire by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2008-03-01

This report examines 2005 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to the State of New Hampshire if a primary seat belt law is implemen...

Estimated medical cost savings in Rhode Island by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2008-09-01

This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Rhode Island if a primary seat belt law is implemented. The savin...

Estimated medical cost savings in Vermont by implementation of a primary seat belt law

DOT National Transportation Integrated Search

2008-09-01

This report examines 2005 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to the State of Vermont if a primary seat belt law is implemented. T...

A method for the analysis of the benefits and costs for aeronautical research and technology

NASA Technical Reports Server (NTRS)

Williams, L. J.; Hoy, H. H.; Anderson, J. L.

1978-01-01

A relatively simple, consistent, and reasonable methodology for performing cost-benefit analyses which can be used to guide, justify, and explain investments in aeronautical research and technology is presented. The elements of this methodology (labeled ABC-ART for the Analysis of the Benefits and Costs of Aeronautical Research and Technology) include estimation of aircraft markets; manufacturer costs and return on investment versus aircraft price; airline costs and return on investment versus aircraft price and passenger yield; and potential system benefits--fuel savings, cost savings, and noise reduction. The application of this methodology is explained using the introduction of an advanced turboprop powered transport aircraft in the medium range market in 1978 as an example.

Historical declines and disparities in cigarette coupon saving among adolescents in the United States, 1997-2013.

PubMed

Owotomo, Olusegun; Maslowsky, Julie; Pasch, Keryn E

2017-07-01

Exposure to cigarette coupons is associated with smoking initiation and likelihood of cigarette purchase among adolescents. Some adolescents who are exposed to cigarette coupons take a step further by choosing to save or collect these coupons, a further risk factor for cigarette smoking. This study examines historical trends and disparities in cigarette coupon saving among adolescents in the United States from 1997 to 2013. National samples of 10th and 12th grade students (n=129,111) were obtained from Monitoring the Future surveys in 1997-2013. Prevalence of lifetime and current cigarette coupon saving was estimated in each year in the overall adolescent population, and in race/ethnicity, parent education level, sex, and urban/rural subgroups. Prevalence of lifetime and current cigarette coupon saving was then estimated in each year based on smoking status. Prevalence of cigarette coupon saving has decreased dramatically among adolescents; only 1.2% reported currently saving coupons in 2013. However, disparities in cigarette coupon saving remain with prevalence higher among rural, White, and low parental education level students. Adolescent smokers continue to save coupons at high rates; 21.2% had ever saved coupons and 6.9% currently saved coupons as of 2013. Despite overall declines in adolescent cigarette coupon saving, existing sociodemographic disparities and the considerably high prevalence of coupon saving among adolescent smokers suggest that cigarette coupons remain a threat to smoking prevention among youth. Additional research is needed to further elucidate longitudinal associations between cigarette coupon saving and smoking initiation and maintenance among adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

Modelling the Spatial-temporal Variation of Urban/peri-urban Forests and Their Ecosystem Services: a Case Study of North-West Sydney

NASA Astrophysics Data System (ADS)

Odeh, I. A.; Zou, X. L.

2015-12-01

In terms of total terrestrial sequestered carbon, the global soils and forests are recognized as the predominant C sinks. Even though urban forests stored a relatively small proportion of the total terrestrial C, they also provide other important ecosystem services such as improving air quality, cooling effect in buildings and aesthetics. Thus in view of these environmental services the quantification of urban tree is increasingly viewed as essential to the understanding of how these ecosystem services can be optimized. The aims of this paper are to: i) quantify the spatial-temporal distribution of urban forests in Northwest Sydney using remote sensing techniques; ii) determine the total urban C-storage over many decades; iii) apply UFORE model to estimate air pollutant removal ability of urban forest. The results revealed the estimated total trees in Northwest Sydney in 2011was approximately 2.3 million. These urban forests potentially store an estimated 1.3 million tons of carbon in various forms such as biomass, soil carbon, etc. The relative carbon sequestration rate of these trees was estimated to be about 20,500 tC/yr (equivalent to AUD 467,000/year). Furthermore, the results show that trees near buildings can potentially avoid AUD 12.9 million of energy cost every year and 70000 tons of carbon emission, the latter which is equivalent to additional savings of nearly AUD 1.6 million per year. We also estimated that urban forests in the study area could potentially remove about 44,600 tons of pollutants (mainly greenhouse gases) annually equivalent to a saving of about AUD 409 million per year. Thus the results reveal the spatial-temporal variation of urban vegetation in the last twenty year between 1991 and 2011. The study has showcased the importance and potential role of urban forests in preserving carbon and thus reducing GHG emissions into atmosphere. Furthermore, these results highlight the significant value of urban forests in term of pollutant removal. The significance of these outcomes, if extrapolated to other cities of Australia and the world, is huge.

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

PubMed

Fiedler, John L; Macdonald, Barbara

2009-12-01

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

Saving in cycles: how to get people to save more money.

PubMed

Tam, Leona; Dholakia, Utpal

2014-02-01

Low personal savings rates are an important social issue in the United States. We propose and test one particular method to get people to save more money that is based on the cyclical time orientation. In contrast to conventional, popular methods that encourage individuals to ignore past mistakes, focus on the future, and set goals to save money, our proposed method frames the savings task in cyclical terms, emphasizing the present. Across the studies, individuals who used our proposed cyclical savings method, compared with individuals who used a linear savings method, provided an average of 74% higher savings estimates and saved an average of 78% more money. We also found that the cyclical savings method was more efficacious because it increased implementation planning and lowered future optimism regarding saving money.

Comparison of Lives Saved Tool model child mortality estimates against measured data from vector control studies in sub-Saharan Africa

PubMed Central

2011-01-01

Background Insecticide-treated mosquito nets (ITNs) and indoor-residual spraying have been scaled-up across sub-Saharan Africa as part of international efforts to control malaria. These interventions have the potential to significantly impact child survival. The Lives Saved Tool (LiST) was developed to provide national and regional estimates of cause-specific mortality based on the extent of intervention coverage scale-up. We compared the percent reduction in all-cause child mortality estimated by LiST against measured reductions in all-cause child mortality from studies assessing the impact of vector control interventions in Africa. Methods We performed a literature search for appropriate studies and compared reductions in all-cause child mortality estimated by LiST to 4 studies that estimated changes in all-cause child mortality following the scale-up of vector control interventions. The following key parameters measured by each study were applied to available country projections: baseline all-cause child mortality rate, proportion of mortality due to malaria, and population coverage of vector control interventions at baseline and follow-up years. Results The percent reduction in all-cause child mortality estimated by the LiST model fell within the confidence intervals around the measured mortality reductions for all 4 studies. Two of the LiST estimates overestimated the mortality reductions by 6.1 and 4.2 percentage points (33% and 35% relative to the measured estimates), while two underestimated the mortality reductions by 4.7 and 6.2 percentage points (22% and 25% relative to the measured estimates). Conclusions The LiST model did not systematically under- or overestimate the impact of ITNs on all-cause child mortality. These results show the LiST model to perform reasonably well at estimating the effect of vector control scale-up on child mortality when compared against measured data from studies across a range of malaria transmission settings. The LiST model appears to be a useful tool in estimating the potential mortality reduction achieved from scaling-up malaria control interventions. PMID:21501453

Will the Measurement Robots Take Our Jobs? An Update on the State of Automated M&V for Energy Efficiency Programs

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

Granderson, Jessica; Touzani, Samir; Taylor, Cody

Trustworthy savings calculations are critical to convincing regulators of both the cost-effectiveness of energy efficiency program investments and their ability to defer supply-side capital investments. Today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of energy efficiency programs. They also require time-consuming data acquisition. A spectrum of savings calculation approaches is used, with some relying more heavily on measured data and others relying more heavily on estimated, modeled, or stipulated data. The rising availability of “smart” meters and devices that report near-real time data, combined with new analytical approaches to quantifyingmore » savings, offers potential to conduct M&V more quickly and at lower cost, with comparable or improved accuracy. Commercial energy management and information systems (EMIS) technologies are beginning to offer M&V capabilities, and program administrators want to understand how they might assist programs in quickly and accurately measuring energy savings. This paper presents the results of recent testing of the ability to use automation to streamline some parts of M&V. Here in this paper, we detail metrics to assess the performance of these new M&V approaches, and a framework to compute the metrics. We also discuss the accuracy, cost, and time trade-offs between more traditional M&V, and these emerging streamlined methods that use high-resolution energy data and automated computational intelligence. Finally we discuss the potential evolution of M&V and early results of pilots currently underway to incorporate M&V automation into ratepayer-funded programs and professional implementation and evaluation practice.« less

More efficient irrigation may compensate for increases in irrigation water requirements due to climate change in the Mediterranean area

NASA Astrophysics Data System (ADS)

Fader, Marianela; Shi, Sinan; von Bloh, Werner; Bondeau, Alberte; Cramer, Wolfgang

2017-04-01

Irrigation in the Mediterranean is of vital importance for food security, employment and economic development. We will present a recently published study1 that estimates the current level of water demand for Mediterranean agriculture and simulates the potential impacts of climate change, population growth and transitions to water-saving irrigation and conveyance technologies. The results indicate that, at present, Mediterranean region could save 35% of water by implementing more efficient irrigation and conveyance systems, with large differences in the saving potentials across countries. Under climate change, more efficient irrigation is of vital importance for counteracting increases in irrigation water requirements. The Mediterranean area as a whole might face an increase in gross irrigation requirements between 4% and 18% from climate change alone by the end of the century if irrigation systems and conveyance are not improved. Population growth increases these numbers to 22% and 74%, respectively, affecting mainly the Southern and Eastern Mediterranean. However, improved irrigation technologies and conveyance systems have large water saving potentials, especially in the Eastern Mediterranean. Both the Eastern and the Southern Mediterranean would need around 35% more water than today if they could afford some degree of modernization of irrigation and conveyance systems and benefit from the CO2-fertilization effect. However, in some scenarios water scarcity may constrain the supply of the irrigation water needed in future in Algeria, Libya, Israel, Jordan, Lebanon, Syria, Serbia, Morocco, Tunisia and Spain. In this study, vegetation growth, phenology, agricultural production and irrigation water requirements and withdrawal were simulated with the process-based ecohydrological and agro-ecosystem model LPJmL ("Lund-Potsdam-Jena managed Land") after a large development2 that comprised the improved representation of Mediterranean crops.

Data analytics for simplifying thermal efficiency planning in cities

PubMed Central

Abdolhosseini Qomi, Mohammad Javad; Noshadravan, Arash; Sobstyl, Jake M.; Toole, Jameson; Ferreira, Joseph; Pellenq, Roland J.-M.; Ulm, Franz-Josef; Gonzalez, Marta C.

2016-01-01

More than 44% of building energy consumption in the USA is used for space heating and cooling, and this accounts for 20% of national CO2 emissions. This prompts the need to identify among the 130 million households in the USA those with the greatest energy-saving potential and the associated costs of the path to reach that goal. Whereas current solutions address this problem by analysing each building in detail, we herein reduce the dimensionality of the problem by simplifying the calculations of energy losses in buildings. We present a novel inference method that can be used via a ranking algorithm that allows us to estimate the potential energy saving for heating purposes. To that end, we only need consumption from records of gas bills integrated with a building's footprint. The method entails a statistical screening of the intricate interplay between weather, infrastructural and residents' choice variables to determine building gas consumption and potential savings at a city scale. We derive a general statistical pattern of consumption in an urban settlement, reducing it to a set of the most influential buildings' parameters that operate locally. By way of example, the implications are explored using records of a set of (N = 6200) buildings in Cambridge, MA, USA, which indicate that retrofitting only 16% of buildings entails a 40% reduction in gas consumption of the whole building stock. We find that the inferred heat loss rate of buildings exhibits a power-law data distribution akin to Zipf's law, which provides a means to map an optimum path for gas savings per retrofit at a city scale. These findings have implications for improving the thermal efficiency of cities' building stock, as outlined by current policy efforts seeking to reduce home heating and cooling energy consumption and lower associated greenhouse gas emissions. PMID:27097652

Self-Monitoring of Blood Glucose: Impact of Quantity Limits in Public Drug Formularies on Provincial Costs Across Canada.

PubMed

Knowles, Sandra R; Lee, Kathy; Paterson, J Michael; Shah, Baiju R; Mamdani, Muhammad M; Juurlink, David N; Gomes, Tara

2017-04-01

For most patients with diabetes, routine use of blood glucose test strips (BGTS) has not been shown to be beneficial, yet the economic implications of broad publicly funded reimbursement for BGTS are substantial. We assessed the potential impact of BGTS quantity limits on utilization and costs for 6 publicly funded drug plans across Canada. A cross-sectional analysis was conducted in 6 provinces (Alberta, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador and Prince Edward Island) for patients who received at least 1 prescription for BGTS in 2014 through the public drug program. We determined the number of BGTS that would have exceeded the quantity limits and the associated costs to the provincial drug program. A total of $38,051,026 was spent on BGTS reimbursed through public drug programs among the 6 provinces. In provinces where BGTS use is largely restricted to patients using insulin, the potential annual savings were minimal, ranging from 0.4% to 2.3%, whereas in provinces with more liberal listings, potential savings ranged from 12.4% to 19.8%. Combining these results with data from a previous analysis in Ontario and British Columbia, the cost savings associated with BGTS quantity limits for 8 provinces across Canada (capturing approximately three-quarters of the Canadian population) is estimated to be $30.3 million annually. The national implementation of a quantity limit policy for BGTS that aligns with evidence of efficacy, optimal prescribing and patient safety can lead to considerable savings for most public drug plans across Canada. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Northwest Energy Policy Project. Energy conservation policy evaluation: study module IA. Final report. Volume I. Summary report

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

Berney, R.E.; Butcher, W.R.; Carter, L.F.

1977-01-01

This summary report identifies potential energy conservation measures and evaluates measures and policy options not likely to be suitable for adoption in the Pacific Northwest. Potential and incentives for energy conservation are specifically identified in the residential, commercial, industrial, and transportation sectors and through urban design. Selection of preferable policies and estimation of response to policies are next discussed. Finally, a computer impact model for calculating energy savings and changes in the levels of residuals resulting from energy conservation activities is discussed. (MCW)

Economics of Malaria Prevention in US Travelers to West Africa

PubMed Central

Adachi, Kenji; Coleman, Margaret S.; Khan, Nomana; Jentes, Emily S.; Arguin, Paul; Rao, Sowmya R.; LaRocque, Regina C.; Sotir, Mark J.; Brunette, Gary; Ryan, Edward T.; Meltzer, Martin I.

2014-01-01

Background. Pretravel health consultations help international travelers manage travel-related illness risks through education, vaccination, and medication. This study evaluated costs and benefits of that portion of the health consultation associated with malaria prevention provided to US travelers bound for West Africa. Methods. The estimated change in disease risk and associated costs and benefits resulting from traveler adherence to malaria chemoprophylaxis were calculated from 2 perspectives: the healthcare payer's and the traveler's. We used data from the Global TravEpiNet network of US travel clinics that collect de-identified pretravel data for international travelers. Disease risk and chemoprophylaxis effectiveness were estimated from published medical reports. Direct medical costs were obtained from the Nationwide Inpatient Sample and published literature. Results. We analyzed 1029 records from January 2009 to January 2011. Assuming full adherence to chemoprophylaxis regimens, consultations saved healthcare payers a per-traveler average of $14 (9-day trip) to $372 (30-day trip). For travelers, consultations resulted in a range of net cost of $20 (9-day trip) to a net savings of $32 (30-day trip). Differences were mostly driven by risk of malaria in the destination country. Conclusions. Our model suggests that healthcare payers save money for short- and longer-term trips, and that travelers save money for longer trips when travelers adhere to malaria recommendations and prophylactic regimens in West Africa. This is a potential incentive to healthcare payers to offer consistent pretravel preventive care to travelers. This financial benefit complements the medical benefit of reducing the risk of malaria. PMID:24014735

Reducing CO2 Emissions through Lightweight Design and Manufacturing

NASA Astrophysics Data System (ADS)

Carruth, Mark A.; Allwood, Julian M.; Milford, Rachel L.

2011-05-01

To meet targeted 50% reductions in industrial CO2 emissions by 2050, demand for steel and aluminium must be cut. Many steel and aluminium products include redundant material, and the manufacturing routes to produce them use more material than is necessary. Lightweight design and optimized manufacturing processes offer a means of demand reduction, whilst creating products to perform the same service as existing ones. This paper examines two strategies for demand reduction: lightweight product design; and minimizing yield losses through the product supply chain. Possible mass savings are estimated for specific case-studies on metal-intensive products, such as I-beams and food cans. These estimates are then extrapolated to other sectors to produce a global estimate for possible demand reductions. Results show that lightweight product design may offer potential mass savings of up to 30% for some products, whilst yield in the production of others could be improved by over 20%. If these two strategies could be combined for all products, global demand for steel and aluminium would be reduced by nearly 50%. The impact of demand reduction on CO2 emissions is presented, and barriers to the adoption of new, lightweight technologies are discussed.

[Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

PubMed

Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

2012-01-01

DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

Camp Pendleton Saves 91% in Parking Lot Lighting

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

None

2016-01-01

Case study describes how Camp Pendleton Marine Corps Base replaced high-pressure sodium (HPS) fixtures in one parking lot with high-efficiency induction fixtures for 91% savings in energy use and $5,700 in cost savings annually. This parking lot is estimated to have a simple payback of 2.9 years. Sitewide up-grades yielded annual savings of 1 million kWh.

Cost-benefit analysis simulation of a hospital-based violence intervention program.

PubMed

Purtle, Jonathan; Rich, Linda J; Bloom, Sandra L; Rich, John A; Corbin, Theodore J

2015-02-01

Violent injury is a major cause of disability, premature mortality, and health disparities worldwide. Hospital-based violence intervention programs (HVIPs) show promise in preventing violent injury. Little is known, however, about how the impact of HVIPs may translate into monetary figures. To conduct a cost-benefit analysis simulation to estimate the savings an HVIP might produce in healthcare, criminal justice, and lost productivity costs over 5 years in a hypothetical population of 180 violently injured patients, 90 of whom received HVIP intervention and 90 of whom did not. Primary data from 2012, analyzed in 2013, on annual HVIP costs/number of clients served and secondary data sources were used to estimate the cost, number, and type of violent reinjury incidents (fatal/nonfatal, resulting in hospitalization/not resulting in hospitalization) and violent perpetration incidents (aggravated assault/homicide) that this population might experience over 5 years. Four different models were constructed and three different estimates of HVIP effect size (20%, 25%, and 30%) were used to calculate a range of estimates for HVIP net savings and cost-benefit ratios from different payer perspectives. All benefits were discounted at 5% to adjust for their net present value. Estimates of HVIP cost savings at the base effect estimate of 25% ranged from $82,765 (narrowest model) to $4,055,873 (broadest model). HVIPs are likely to produce cost savings. This study provides a systematic framework for the economic evaluation of HVIPs and estimates of HVIP cost savings and cost-benefit ratios that may be useful in informing public policy decisions. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

Garbesi, Karina; Vossos, Vagelis; Sanstad, Alan

An increasing number of energy efficient appliances operate on direct current (DC) internally, offering the potential to use DC from renewable energy systems directly and avoiding the losses inherent in converting power to alternating current (AC) and back. This paper investigates that potential for net-metered residences with on-site photovoltaics (PV) by modeling the net power draw of the ‘direct-DC house’ with respect to today’s typical configuration, assuming identical DC-internal loads. Power draws were modeled for houses in 14 U.S. cities, using hourly, simulated PV-system output and residential loads. The latter were adjusted to reflect a 33% load reduction, representative ofmore » the most efficient DC-internal technology, based on an analysis of 32 electricity end-uses. The model tested the effect of climate, electric vehicle (EV) loads, electricity storage, and load shifting on electricity savings; a sensitivity analysis was conducted to determine how future changes in the efficiencies of power system components might affect savings potential. Based on this work, we estimate that net-metered PV residences could save 5% of their total electricity load for houses without storage and 14% for houses with storage. Based on residential PV penetration projections for year 2035 obtained from the National Energy Modeling System (2.7% for the reference case and 11.2% for the extended policy case), direct-DC could save the nation 10 trillion Btu (without storage) or 40 trillion Btu (with storage). Shifting the cooling load by two hours earlier in the day (pre-cooling) has negligible benefits for energy savings. Direct-DC provides no energy savings benefits for EV charging, to the extent that charging occurs at night. However, if charging occurred during the day, for example with employees charging while at work, the benefits would be large. Direct-DC energy savings are sensitive to power system and appliance conversion efficiencies but are not significantly influenced by climate. While direct-DC for residential applications will most likely arise as a spin-off of developments in the commercial sector—because of lower barriers to market entry and larger energy benefits resulting from the higher coincidence between load and insolation—this paper demonstrates that there are substantial benefits in the residential sector as well. Among residential applications, space cooling derives the largest energy savings from being delivered by a direct-DC system. It is the largest load for the average residence on a national basis and is particularly so in high-load regions. It is also the load with highest solar coincidence.« less

Preliminary Weight Savings Estimate for a Commercial Transport Wing Using Rod-Stiffened Stitched Composite Technology

NASA Technical Reports Server (NTRS)

Lovejoy, Andrew E.

2015-01-01

A structural concept called pultruded rod stitched efficient unitized structure (PRSEUS) was developed by the Boeing Company to address the complex structural design aspects associated with a pressurized hybrid wing body (HWB) aircraft configuration. While PRSEUS was an enabling technology for the pressurized HWB structure, limited investigation of PRSEUS for other aircraft structures, such as circular fuselages and wings, has been done. Therefore, a study was undertaken to investigate the potential weight savings afforded by using the PRSEUS concept for a commercial transport wing. The study applied PRSEUS to the Advanced Subsonic Technology (AST) Program composite semi-span test article, which was sized using three load cases. The initial PRSEUS design was developed by matching cross-sectional stiffnesses for each stringer/skin combination within the wing covers, then the design was modified to ensure that the PRSEUS design satisfied the design criteria. It was found that the PRSEUS wing design exhibited weight savings over the blade-stiffened composite AST Program wing of nearly 9%, and a weight savings of 49% and 29% for the lower and upper covers, respectively, compared to an equivalent metallic wing.

Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020.

PubMed

Ozawa, Sachiko; Clark, Samantha; Portnoy, Allison; Grewal, Simrun; Stack, Meghan L; Sinha, Anushua; Mirelman, Andrew; Franklin, Heather; Friberg, Ingrid K; Tam, Yvonne; Walker, Neff; Clark, Andrew; Ferrari, Matthew; Suraratdecha, Chutima; Sweet, Steven; Goldie, Sue J; Garske, Tini; Li, Michelle; Hansen, Peter M; Johnson, Hope L; Walker, Damian

2017-09-01

To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs - expressed in 2010 United States dollars (US$) - of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. By preventing significant costs and potentially increasing economic productivity among some of the world's poorest countries, the impact of immunization goes well beyond health.

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.

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

Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP).

PubMed

Juneja, Sandeep; Gupta, Aastha; Moon, Suerie; Resch, Stephen

2017-01-01

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010-2028 and generate a cost-benefit ratio-based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator's tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today.

Water-saving interventions assessment framework: an application for the Urmia Lake Restoration Program

NASA Astrophysics Data System (ADS)

Shadkam, Somayeh; Oel, Pieter; Kabat, Pavel; Ludwig, Fulco

2017-04-01

Increasing water demand often results in unsustainable water use leaving insufficient amounts of water for sustaining natural environments. Therefore, to save natural resources water-saving interventions have been introduced to the environmental policy agenda in many (semi)-arid regions. Many policies, however, have failed reaching their objectives to increase water availability for the environment. This calls for a comprehensive tool to assess water-saving policies. Therefore, this study introduces a constructive framework to assess the policies by estimating five components: 1) Total water demand under socio-economic scenarios, 2) Water supply under climate change scenarios, 3) Water withdrawal for different sectors, 4) Water depletion and 5) Environmental flow. The framework, was applied to assess Urmia Lake Restoration Program (ULRP), which aims to restore the drying Urmia Lake in north-western Iran by increasing the lake inflow by 3.1×106m3yr-1. Results suggest that although the ULRP helps to increase inflow by up to 57% it is unlikely to fully reach its target. The analysis shows that there are three main reasons for the potential poor performance. The first reason is decreasing return flows due to increasing irrigation efficiency. This means that the expected increase in lake inflow volume is smaller than the volume saved by increasing irrigation efficiency. The second reason is increased depletion which is due to neglecting the fact that agricultural water demand is currently higher than available water for agriculture. As a result, increasing water use efficiency may result in increased water depletion. The third reason is ignoring the potential impact of climate change, which might decrease future water availability by 3% to 15%. Our analysis suggests that to reach the intervention target, measures need to focus on reducing Water demand and Water depletion rather than on reducing Water withdrawals. The assessment framework can be used to comprehensively assess water-saving intervention plans, particularly in water-stressed basins.

Does the Institution of a Statewide Trauma System Reduce Preventable Mortality and Yield a Positive Return on Investment for Taxpayers?

PubMed

Maxson, Todd; Mabry, Charles D; Sutherland, Michael J; Robertson, Ronald D; Booker, James O; Collins, Terry; Spencer, Horace J; Rinker, Charles F; Sanddal, Teri L; Sanddal, Nels D

2017-04-01

In July 2009, Arkansas began to annually fund $20 million for a statewide trauma system (TS). We studied injury deaths both pre-TS (2009) and post-TS (2013 to 2014), with attention to causes of preventive mortality, societal cost of those preventable mortality deaths, and benefit to tax payers of the lives saved. A multi-specialty trauma-expert panel met and reviewed records of 672 decedents (290 pre-TS and 382 post-TS) who met standardized inclusion criteria, were judged potentially salvageable, and were selected by a proportional sampling of the roughly 2,500 annual trauma deaths. Deaths were adjudicated into sub-categories of nonpreventable and preventable causes. The value of lives lost was calculated for those lives potentially saved in the post-TS period. Total preventable mortality was reduced from 30% of cases pre-TS to 16% of cases studied post-TS, a reduction of 14%. Extrapolating a 14% reduction of preventable mortality to the post-TS study period, using the same inclusion criteria of the post-TS, we calculate that 79 lives were saved in 2013 to 2014 due to the institution of a TS. Using a minimal standard estimate of $100,000 value for a life-year, a lifetime value of $2,365,000 per person was saved. This equates to an economic impact of the lives saved of almost $186 million annually, representing a 9-fold return on investment from the $20 million of annual state funding invested in the TS. The implementation of a TS in Arkansas during a 5-year period resulted in a reduction of the preventable death rate to 16% post-TS, and a 9-fold return on investment by the tax payer. Additional life-saving gains can be expected with ongoing financial support and additional system performance-improvement efforts. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of Data-Logging Transducer to Passively Collect Pressure Vessel p/T History

NASA Technical Reports Server (NTRS)

Wnuk, Stephen P.; Le, Son; Loew, Raymond A.

2013-01-01

Pressure vessels owned and operated by NASA are required to be regularly certified per agency policy. Certification requires an assessment of damage mechanisms and an estimation of vessel remaining life. Since detail service histories are not typically available for most pressure vessels, a conservative estimate of vessel pressure/temperature excursions is typically used in assessing fatigue life. This paper details trial use of a data-logging transducer to passively obtain actual pressure and temperature service histories of pressure vessels. The approach was found to have some potential for cost savings and other benefits in certain cases.

Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.

PubMed

Frost, Jennifer J; Sonfield, Adam; Zolna, Mia R; Finer, Lawrence B

2014-12-01

Policy Points: The US publicly supported family planning effort serves millions of women and men each year, and this analysis provides new estimates of its positive impact on a wide range of health outcomes and its net savings to the government. The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births. This investment resulted in net government savings of $13.6 billion in 2010, or $7.09 for every public dollar spent. Each year the United States' publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion-$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion. Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This investment saved the government billions of public dollars, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent. © 2014 The Authors The Milbank Quarterly published by Wiley Periodicals, Inc. on behalf of The Milbank Memorial Fund.

Scientific Inquiry into Home Electronic Technology Usage

ERIC Educational Resources Information Center

Lazaros, Edward J.; Spotts, Thomas H.; Verdon, Jessica E.

2010-01-01

This activity promotes ways to save electricity in the home. Students identify electronic devices in the home and examine wattage, hours of use per month, estimated wattage per month, kilowatt hours per month, average retail price per kilowatt hour in each state, and the estimated cost per month. Students gain an appreciation for how saving power…

Estimated minimum savings to the medicaid budget in Florida by implementing a primary seat belt law

DOT National Transportation Integrated Search

2007-03-01

A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a States budget for Medicaid and other State medical expenditures...

Estimated minimum savings to the Medicaid budget in Arkansas by implementing a primary seat belt law

DOT National Transportation Integrated Search

2007-03-01

A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a States budget for Medicaid and other State medical expenditures...

Estimated minimum savings to the Medicaid budget in Missouri by implementing a primary seat belt law

DOT National Transportation Integrated Search

2007-03-01

A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a States budget for Medicaid and other State medical expenditures...

Traffic Safety Facts, 2001: Occupant Protection.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This document provides statistical information on the benefits of occupant restraint systems in U.S. motor vehicle accidents. Data tables include: (1) estimated number of lives saved by restraint systems (seat belts, air bags, child restraints), 1975-2001; (2) cumulative estimated number of lives saved by safety belt use, 1975-2001; and (3)…

Occupant Protection. Traffic Safety Facts, 2000.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This document provides statistical information on the benefits of occupant restraint systems in U.S. motor vehicle accidents. Data tables include: (1) estimated number of lives saved by restraint systems (seat belts, air bags, child restraints), 1975-2000; (2) cumulative estimated number of lives saved by safety belt use, 1975-2000; and (3)…

Status and Opportunities for Improving the Consistency of Technical Reference Manuals

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

Jayaweera, Tina; Velonis, Aquila; Haeri, Hossein

Across the United States, energy-efficiency program administrators rely on Technical Reference Manuals (TRMs) as sources for calculations and deemed savings values for specific, well-defined efficiency measures. TRMs play an important part in energy efficiency program planning by providing a common and consistent source for calculation of ex ante and often ex post savings. They thus help reduce energy-efficiency resource acquisition costs by obviating the need for extensive measurement and verification and lower performance risk for program administrators and implementation contractors. This paper considers the benefits of establishing region-wide or national TRMs and considers the challenges of such undertaking due tomore » the difficulties in comparing energy savings across jurisdictions. We argue that greater consistency across TRMs in the approaches used to determine deemed savings values, with more transparency about assumptions, would allow better comparisons in savings estimates across jurisdictions as well as improve confidence in reported efficiency measure savings. To support this thesis, we review approaches for the calculation of savings for select measures in TRMs currently in use in 17 jurisdictions. The review reveals differences in the saving methodologies, technical assumptions, and input variables used for estimating deemed savings values. These differences are described and their implications are summarized, using four, common energy-efficiency measures as examples. Recommendations are then offered for establishing a uniform approach for determining deemed savings values.« less

Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis.

PubMed

Lal, Anita; Mantilla-Herrera, Ana Maria; Veerman, Lennert; Backholer, Kathryn; Sacks, Gary; Moodie, Marjory; Siahpush, Mohammad; Carter, Rob; Peeters, Anna

2017-06-01

A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011-12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged quintiles in Australia. Whilst those in more disadvantaged areas would pay more SSB tax, the difference between areas is small. The equity of the tax could be further improved if the tax revenue were used to fund initiatives benefiting those with greater disadvantage.

Can differentiated care models solve the crisis in HIV treatment financing? Analysis of prospects for 38 countries in sub-Saharan Africa.

PubMed

Barker, Catherine; Dutta, Arin; Klein, Kate

2017-07-21

Rapid scale-up of antiretroviral therapy (ART) in the context of financial and health system constraints has resulted in calls to maximize efficiency in ART service delivery. Adopting differentiated care models (DCMs) for ART could potentially be more cost-efficient and improve outcomes. However, no study comprehensively projects the cost savings across countries. We model the potential reduction in facility-level costs and number of health workers needed when implementing two types of DCMs while attempting to reach 90-90-90 targets in 38 sub-Saharan African countries from 2016 to 2020. We estimated the costs of three service delivery models: (1) undifferentiated care, (2) differentiated care by patient age and stability, and (3) differentiated care by patient age, stability, key vs. general population status, and urban vs. rural location. Frequency of facility visits, type and frequency of laboratory testing, and coverage of community ART support vary by patient subgroup. For each model, we estimated the total costs of antiretroviral drugs, laboratory commodities, and facility-level personnel and overhead. Certain groups under four-criteria differentiation require more intensive inputs. Community-based ART costs were included in the DCMs. We take into account underlying uncertainty in the projected numbers on ART and unit costs. Total five-year facility-based ART costs for undifferentiated care are estimated to be US$23.33 billion (95% confidence interval [CI]: $23.3-$23.5 billion). An estimated 17.5% (95% CI: 17.4%-17.7%) and 16.8% (95% CI: 16.7%-17.0%) could be saved from 2016 to 2020 from implementing the age and stability DCM and four-criteria DCM, respectively, with annual cost savings increasing over time. DCMs decrease the full-time equivalent (FTE) health workforce requirements for ART. An estimated 46.4% (95% CI: 46.1%-46.7%) fewer FTE health workers are needed in 2020 for the age and stability DCM compared with undifferentiated care. Adopting DCMs can result in significant efficiency gains in terms of reduced costs and health workforce needs, even with the costs of scaling up community-based ART support under DCMs. Efficiency gains remained flat with increased differentiation. More evidence is needed on how to translate analyzed efficiency gains into implemented cost reductions at the facility level.

Bay Ridge Gardens - Mixed Humid Affordable Multifamily Housing Deep Energy Retrofit: Annapolis, Maryland. Building America Case Study: Whole-House Solutions for Existing Homes (Fact Sheet)

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

Not Available

2013-10-01

Under this project, Newport Partners (as part of the BA-PIRC research team) evaluated the installation, measured performance, and cost-effectiveness of efficiency upgrade measures for a tenant-in-place DER at the Bay Ridge multifamily (MF) development in Annapolis, Maryland. The design and construction phase of the Bay Ridge project was completed in August 2012. This report summarizes system commissioning, short-term test results, utility bill data analysis, and analysis of real-time data collected over a one-year period after the retrofit was complete. The Bay Ridge project is comprised of a "base scope" retrofit which was estimated to achieve a 30%+ savings (relative tomore » pre-retrofit) on 186 apartments, and a "DER scope" which was estimated to achieve 50% savings (relative to pre-retrofit) on a 12-unit building. The base scope was applied to the entire apartment complex, except for one 12-unit building which underwent the DER scope. A wide range of efficiency measures was applied to pursue this savings target for the DER building, including improvements/replacements of mechanical equipment and distribution systems, appliances, lighting and lighting controls, the building envelope, hot water conservation measures, and resident education. The results of this research build upon the current body of knowledge of multifamily retrofits. Towards this end, the research team has collected and generated data on the selection of measures, their estimated performance, their measured performance, and risk factors and their impact on potential measures.« less

Preliminary Estimates of the Potential for Carbon Mitigation in European Soils Through No-Till Farming

DOE Data Explorer

Smith, P. [University of Aberdeen, Aberdeen, UK; Powlson, D. [University of Aberdeen, Aberdeen, UK; Glendining, M. [University of Aberdeen, Aberdeen, UK; Smith, J. [University of Aberdeen, Aberdeen, UK

2003-01-01

in this paper we estimate the European potential for carbon mitigation of no-till farming using results from European tillage experiments. Our calculations suggest some potential in terms of (a) reduced agricultural fossil fuel emissions, and (b) increased soil carbon sequestration. We estimate that 100% conversion to no-till farming would be likely to sequester about 23 Tg C y^–11 in the European Union or about 43 Tg C y^–1 in the wider Europe (excluding the former Soviet Union). In addition, up to 3.2 Tg C y^–1 could be saved in agricultural fossil fuel emissions. Compared to estimates of the potential for carbon sequestration of other carbon mitigation options, no-till agriculture shows nearly twice the potential of scenarios whereby soils are amended with organic materials. Our calculations suggest that 100% conversion to no-till agriculture in Europe could mitigate all fossil fuel-carbon emissions from agriculture in Europe. However, this is equivalent to only about 4.1% of total anthropogenic CO2-carbon produced annually in Europe (excluding the former Soviet Union) which in turn is equivalent to about 0.8% of global annual anthropogenic CO2-carbon emissions.

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-12-31

Technology based standards such as RACT, which require the installation of a Reasonably Available Control Technology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, the authors have used a combinatorial optimization approach tomore » identify boiler retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement. In the formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. The authors constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. The authors estimate the magnitude of these effects for two Eastern electric utilities making intra and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-10-01

Technology based standards such as RACT, which require the installation of a (R)easonably (A)vailable (C)ontrol (T)echnology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, they use a combinatorial optimization approach to identify boilermore » retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement strategies. In their formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. They constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. They estimate the magnitude of these effects for two Eastern electric utilities making intra- and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

Rotavirus diarrhea disease burden in Peru: the need for a rotavirus vaccine and its potential cost savings.

PubMed

Ehrenkranz, P; Lanata, C F; Penny, M E; Salazar-Lindo, E; Glass, R I

2001-10-01

To assess the disease burden of rotavirus diarrhea in Peru as well the need for and the potential cost savings with a rotavirus vaccine in that country. To assess the burden of rotavirus diarrhea in Peru, we reviewed published and unpublished reports where rotavirus was sought as the etiologic agent of diarrhea in children. Rotavirus detection rates obtained from these studies were combined with diarrhea incidence rates from a number of national surveys in order to estimate both the burden of rotavirus diarrhea in the country and its associated medical costs. Rotavirus is a significant cause of morbidity and mortality in Peruvian children. In their first 5 years of life, an estimated 1 in 1.6 children will experience an episode of rotavirus diarrhea, 1 in 9.4 will seek medical care, 1 in 19.7 will require hospitalization, and 1 in 375 will die of the disease. Per year, this represents approximately 384,000 cases, 64,000 clinic visits, 30,000 hospitalizations, and 1,600 deaths. The annual cost of medical care alone for these children is approximately US$ 2.6 million--and that does not take into account the indirect or societal costs of the illness and the deaths. Rotavirus immunization provides the prospect of decreasing the morbidity and mortality from diarrhea in Peru, but a vaccine regimen would have to be relatively inexpensive, a few dollars or less per child. Future cost-effectiveness analyses should explore the total costs (medical as well as indirect or societal) associated with rotavirus diarrhea. Newly licensed vaccines should be tested according to both their ability to avert deaths and their efficacy with fewer than three doses. All three of these factors could increase the cost savings associated with a rotavirus vaccine.

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

PubMed

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Ben Romdhane, Habiba; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

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

PubMed

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

2012-01-01

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

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

PubMed Central

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities.

PubMed

Di Novi, Cinzia; Rizzi, Dino; Zanette, Michele

2018-02-01

Consolidation is often considered by policymakers as a means to reduce service delivery costs and enhance accountability. The aim of this study was to estimate the potential cost savings that may be derived from consolidation of local health authorities (LHAs) with specific reference to the Italian setting. For our empirical analysis, we use data relating to the costs of the LHAs as reported in the 2012 LHAs' Income Statements published within the New Health Information System (NSIS) by the Ministry of Health. With respect to the previous literature on the consolidation of local health departments (LHDs), which is based on ex-post-assessments on what has been the impact of the consolidation of LHDs on health spending, we use an ex-ante-evaluation design and simulate the potential cost savings that may arise from the consolidation of LHAs. Our results show the existence of economies of scale with reference to a particular subset of the production costs of LHAs, i.e. administrative costs together with the purchasing costs of goods (such as drugs and medical devices) as well as non-healthcare-related services. The research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure.

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008–2012)

PubMed Central

Weir, Hannah K.; Li, Chunyu; Henley, S. Jane; Joseph, Djenaba

2018-01-01

Background Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer–related deaths among screen-eligible adults residing in lower EA counties in the United States. Methods Mortality and population data were used to examine colorectal cancer deaths (2008–2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed–expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars. Results County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss. Conclusions County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer–related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups. Impact These results estimate the large economic impact of potentially avoidable colorectal cancer–related deaths in economically disadvantaged communities, as measured by lower EA. PMID:28003180

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.

Outcomes of Cardiopulmonary Resuscitation and Estimation of Healthcare Costs in Potential ‘Do Not Resuscitate’ Cases

PubMed Central

Ahmad, Akhwand S.; Mudasser, Sayed; Khan, Muhammad N.; Abdoun, Hafiz N. H.

2016-01-01

Objectives: Cardiopulmonary resuscitation (CPR) is a life-saving procedure which may fail if applied unselectively. ‘Do not resuscitate’ (DNR) policies can help avoid futile life-saving attempts among terminally-ill patients. This study aimed to assess CPR outcomes and estimate healthcare costs in potential DNR cases. Methods: This retrospective study was carried out between March and June 2014 and included 50 adult cardiac arrest patients who had undergone CPR at Sultan Qaboos Hospital in Salalah, Oman. Medical records were reviewed and treating teams were consulted to determine DNR eligibility. The outcomes, clinical risk categories and associated healthcare costs of the DNR candidates were assessed. Results: Two-thirds of the potential DNR candidates were ≥60 years old. Eight patients (16%) were in a vegetative state, 39 (78%) had an irreversible terminal illness and 43 (86%) had a low likelihood of successful CPR. Most patients (72%) met multiple criteria for DNR eligibility. According to clinical risk categories, these patients had terminal malignancies (30%), recent massive strokes (16%), end-stage organ failure (30%) or were bed-bound (50%). Initial CPR was unsuccessful in 30 patients (60%); the remaining 20 patients (40%) were initially resuscitated but subsequently died, with 70% dying within 24 hours. These patients were ventilated for an average of 5.6 days, with four patients (20%) requiring >15 days of ventilation. The average healthcare cost per patient was USD $1,958.9. Conclusion: With careful assessment, potential DNR patients can be identified and futile CPR efforts avoided. Institutional DNR policies may help to reduce healthcare costs and improve services. PMID:26909209

The effectiveness of the 55 MPH national maximum speed limit as a life saving benefit

DOT National Transportation Integrated Search

1980-10-01

The report contains an analysis of the life saving benefits resulting from the 55 mph NMSL from 1974-1979. Monthly fatality data from 1970-1979 was used in a time series model to arrive at the estimated safety benefits (lives saved). The time series ...

Civil Uses of Remotely Piloted Aircraft

NASA Technical Reports Server (NTRS)

Aderhold, J. R.; Gordon, G.; Scott, G. W.

1976-01-01

The technology effort is identified and assessed that is required to bring the civil uses of RPVs to fruition and to determine whether or not the potential market is real and economically practical, the technologies are within reach, the operational problems are manageable, and the benefits are worth the cost. To do so, the economic, technical, and environmental implications are examined. The time frame is 1980-85. Representative uses are selected; detailed functional and performance requirements are derived for RPV systems; and conceptual system designs are devised. Total system cost comparisons are made with non-RPV alternatives. The potential market demand for RPV systems is estimated. Environmental and safety requirements are examined, and legal and regulatory concerns are identified. A potential demand for 2,000-11,000 RPV systems is estimated. Typical cost savings of 25-35% compared to non-RPV alternatives are determined. There appear to be no environmental problems, and the safety issue appears manageable.

Chapter 12: Survey Design and Implementation for Estimating Gross Savings Cross-Cutting Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Baumgartner, Robert

This chapter presents an overview of best practices for designing and executing survey research to estimate gross energy savings in energy efficiency evaluations. A detailed description of the specific techniques and strategies for designing questions, implementing a survey, and analyzing and reporting the survey procedures and results is beyond the scope of this chapter. So for each topic covered below, readers are encouraged to consult articles and books cited in References, as well as other sources that cover the specific topics in greater depth. This chapter focuses on the use of survey methods to collect data for estimating gross savingsmore » from energy efficiency programs.« less

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

Lantz, Eric; Mai, Trieu; Wiser, Ryan H.

This paper evaluates potential changes in the power system associated with sustained growth in wind generation in the United States to 35% of end-use demand by 2050; Wiser et al. (2016) evaluate societal benefits and other impacts for this same scenario. Under reference or central conditions, the analysis finds cumulative wind capacity of 404 gigawatts (GW) would be required to reach this level and drive 2050 incremental electricity rate and cumulative electric sector savings of 2% and 3% respectively, relative to a scenario with no new wind capacity additions. Greater savings are estimated under higher fossil fuel costs or withmore » greater advancements in wind technologies. Conversely, incremental costs are found when fossil fuel costs are lower than central assumptions or wind technology improvements are more-limited. Through 2030, the primary generation sources displaced by new wind capacity include natural gas and coal-fired generation. By 2050, wind could displace other renewables. Incremental new transmission infrastructure totaling 29 million megawatt-miles is estimated to be needed by 2050. In conjunction with related societal benefits, this work demonstrates that 35% wind energy by 2050 is plausible, could support enduring benefits, and could result in long-term consumer savings, if nearer-term (pre-2030) cost barriers are overcome; at the same time, these opportunities are not anticipated to be realized in their full form under 'business-as-usual' conditions.« less

School nurses' role in asthma management, school absenteeism, and cost savings: a demonstration project.

PubMed

Rodriguez, Eunice; Rivera, Diana Austria; Perlroth, Daniella; Becker, Edmund; Wang, Nancy Ewen; Landau, Melinda

2013-12-01

With increasing budget cuts to education and social services, rigorous evaluation needs to document school nurses' impact on student health, academic outcomes, and district funding. Utilizing a quasi-experimental design, we evaluated outcomes in 4 schools with added full-time nurses and 5 matched schools with part-time nurses in the San Jose Unified School District. Student data and logistic regression models were used to examine predictors of illness-related absenteeism for 2006-2007 and 2008-2009. We calculated average daily attendance (ADA) funding and parent wages associated with an improvement in illness-related absenteeism. Utilizing parent surveys, we also estimated the cost of services for asthma-related visits to the emergency room (ER; N = 2489). Children with asthma were more likely to be absent due to illness; however, mean absenteeism due to illness decreased when full-time nurses were added to demonstration schools but increased in comparison schools during 2008-2009, resulting in a potential savings of $48,518.62 in ADA funding (N = 6081). Parents in demonstration schools reported fewer ER visits, and the estimated savings in ER services and parent wages were significant. Full-time school nurses play an important role in improving asthma management among students in underserved schools, which can impact school absenteeism and attendance-related economic costs. © 2013, American School Health Association.

Public transit, obesity, and medical costs: assessing the magnitudes.

PubMed

Edwards, Ryan D

2008-01-01

This paper assesses the potential benefits of increased walking and reduced obesity associated with taking public transit in terms of dollars of medical costs saved and disability avoided. I conduct a new analysis of a nationally representative U.S. transportation survey to gauge the net increase in walking associated with public transit usage. I translate minutes spent walking into energy expenditures and reductions in obesity prevalence, estimating the present value of costs and disability that may be avoided. Taking public transit is associated with walking 8.3 more minutes per day on average, or an additional 25.7-39.0 kcal. Hill et al. [Hill, J.O., Wyatt, H.R., Reed, G.W., Peters, J.C., 2003. Obesity and the environment: Where do we go from here? Science 299 (5608), 853-855] estimate that an increase in net expenditure of 100 kcal/day can stop the increase in obesity in 90% of the population. Additional walking associated with public transit could save $5500 per person in present value by reducing obesity-related medical costs. Savings in quality-adjusted life years could be even higher. While no silver bullet, walking associated with public transit can have a substantial impact on obesity, costs, and well-being. Further research is warranted on the net impact of transit usage on all behaviors, including caloric intake and other types of exercise, and on whether policies can promote transit usage at acceptable cost.

Updated Estimates of the Remaining Market Potential of the U.S. ESCO Industry

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

Larsen, Peter H.; Carvallo Bodelon, Juan Pablo; Goldman, Charles A.

The energy service company (ESCO) industry has a well-established track record of delivering energy and economic savings in the public and institutional buildings sector, primarily through the use of performance-based contracts. The ESCO industry often provides (or helps arrange) private sector financing to complete public infrastructure projects with little or no up-front cost to taxpayers. In 2014, total U.S. ESCO industry revenue was estimated at $5.3 billion. ESCOs expect total industry revenue to grow to $7.6 billion in 2017—a 13% annual growth rate from 2015-2017. Researchers at Lawrence Berkeley National Laboratory (LBNL) were asked by the U.S. Department of Energymore » Federal Energy Management Program (FEMP) to update and expand our estimates of the remaining market potential of the U.S. ESCO industry. We define remaining market potential as the aggregate amount of project investment by ESCOs that is technically possible based on the types of projects that ESCOS have historically implemented in the institutional, commercial, and industrial sectors using ESCO estimates of current market penetration in those sectors. In this analysis, we report U.S. ESCO industry remaining market potential under two scenarios: (1) a base case and (2) a case “unfettered” by market, bureaucratic, and regulatory barriers. We find that there is significant remaining market potential for the U.S. ESCO industry under both the base and unfettered cases. For the base case, we estimate a remaining market potential of $92-$201 billion ($2016). We estimate a remaining market potential of $190-$333 billion for the unfettered case. It is important to note, however, that there is considerable uncertainty surrounding the estimates for both the base and unfettered cases.« less

Economic evaluation of a Child Health Days strategy to deliver multiple maternal and child health interventions in Somalia.

PubMed

Vijayaraghavan, Maya; Wallace, Aaron; Mirza, Imran Raza; Kamadjeu, Raoul; Nandy, Robin; Durry, Elias; Everard, Marthe

2012-03-01

Child Health Days (CHDs) are increasingly used by countries to periodically deliver multiple maternal and child health interventions as time-limited events, particularly to populations not reached by routine health services. In countries with a weak health infrastructure, this strategy could be used to reach many underserved populations with an integrated package of services. In this study, we estimate the incremental costs, impact, cost-effectiveness, and return on investment of 2 rounds of CHDs that were conducted in Somalia in 2009 and 2010. We use program costs and population estimates reported by the World Health Organization and United Nations Children's Fund to estimate the average cost per beneficiary for each of 9 interventions delivered during 2 rounds of CHDs implemented during the periods of December 2008 to May 2009 and August 2009 to April 2010. Because unstable areas were unreachable, we calculated costs for targeted and accessible beneficiaries. We model the impact of the CHDs on child mortality using the Lives Saved Tool, convert these estimates of mortality reduction to life years saved, and derive the cost-effectiveness ratio and the return on investment. The estimated average incremental cost per intervention for each targeted beneficiary was $0.63, with the cost increasing to $0.77 per accessible beneficiary. The CHDs were estimated to save the lives of at least 10,000, or 500,000 life years for both rounds combined. The CHDs were cost-effective at $34.00/life year saved. For every $1 million invested in the strategy, an estimated 615 children's lives, or 29,500 life years, were saved. If the pentavalent vaccine had been delivered during the CHDs instead of diphtheria-pertussis-tetanus vaccine, an additional 5000 children's lives could have been saved. Despite high operational costs, CHDs are a very cost-effective service delivery strategy for addressing the leading causes of child mortality in a conflict setting like Somalia and compare favorably with other interventions rated as health sector "best buys" in sub-Saharan Africa.

[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.

Exploring efficacy of residential energy efficiency programs in Florida

NASA Astrophysics Data System (ADS)

Taylor, Nicholas Wade

Electric utilities, government agencies, and private interests in the U.S. have committed and continue to invest substantial resources in the pursuit of energy efficiency and conservation through demand-side management (DSM) programs. Program investments, and the demand for impact evaluations that accompany them, are projected to grow in coming years due to increased pressure from state-level energy regulation, costs and challenges of building additional production capacity, fuel costs and potential carbon or renewable energy regulation. This dissertation provides detailed analyses of ex-post energy savings from energy efficiency programs in three key sectors of residential buildings: new, single-family, detached homes; retrofits to existing single-family, detached homes; and retrofits to existing multifamily housing units. Each of the energy efficiency programs analyzed resulted in statistically significant energy savings at the full program group level, yet savings for individual participants and participant subgroups were highly variable. Even though savings estimates were statistically greater than zero, those energy savings did not always meet expectations. Results also show that high variability in energy savings among participant groups or subgroups can negatively impact overall program performance and can undermine marketing efforts for future participation. Design, implementation, and continued support of conservation programs based solely on deemed or projected savings is inherently counter to the pursuit of meaningful energy conservation and reductions in greenhouse gas emissions. To fully understand and optimize program impacts, consistent and robust measurement and verification protocols must be instituted in the design phase and maintained over time. Furthermore, marketing for program participation must target those who have the greatest opportunity for savings. In most utility territories it is not possible to gain access to the type of large scale datasets that would facilitate robust program analysis. Along with measuring and optimizing energy conservation programs, utilities should provide public access to historical consumption data. Open access to data, program optimization, consistent measurement and verification and transparency in reported savings are essential to reducing energy use and its associated environmental impacts.

Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting.

PubMed

Wrona, Witold; Budka, Katarzyna; Filipiak, Krzysztof J; Niewada, Maciej; Wojtyniak, Bogdan; Zdrojewski, Tomasz

2016-01-01

Arterial hypertension (AH) represents a public health problem in Poland, firstly due to the huge, still growing population of patients (10.45 million patients based on NATPOL 2011 and PolSenior Surveys), and secondly because of the substantial cost of reimbursement from the National Health Fund (NHF). The most commonly used drugs in the treatment of AH include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the latter being associated with significantly higher unit reimbursement cost. Recent meta-analyses of randomised, controlled trials indicate that there is no medical reason to favour ARBs over ACEIs in AH treatment. To assess the clinical benefit of using ACEIs instead of ARBs and to calculate the potential savings for the payer and patients associated with changing the treatment paradigm to preferential use of ACEIs. The assessment of clinical consequences includes differences between ACEIs and ARBs in terms of average life expectancy and quality-adjusted life years (QALYs) gained. The impact of these drugs on general mortality was estimated based on the meta-analysis carried out by van Vark et al. in 2012. Patients' health-related quality of life was adjusted with Polish population utility norms derived for the EQ-5D-3L questionnaire and additionally for ACEI-induced cough-related utility decrease. Potential savings for the payer on a yearly basis were calculated for a hypothetical cohort of patients who are currently treated with ARBs and might be switched to ACEIs. The number of patients treated with ARBs and ACEIs was estimated based on NHF and IMS Health data. ACEIs were associated with a statistically significant 10% reduction in all-cause mortality, which results in extra life gained of 0.354 years (4.2 months) or an additional 0.201 QALY (2.4 months). Potential annual savings could amount to 112.0 million PLN (25.7 million EUR) and 10.5 million PLN (2.4 million EUR) for the public payer (NHF) and patients, respectively; and 1768 cardiovascular deaths per year could be prevented. Preferential use of ACEIs in comparison with ARBs in the treatment of AH is associated with substantial extension of life (including quality-adjusted life), reduction of cardiovascular deaths, and savings for the NHF and patients.

Annualized TASAR Benefit Estimate for Alaska Airlines Operations

NASA Technical Reports Server (NTRS)

Henderson, Jeffrey

2015-01-01

The Traffic Aware Strategic Aircrew Request (TASAR) concept offers onboard automation for the purpose of advising the pilot of traffic compatible trajectory changes that would be beneficial to the flight. A fast-time simulation study was conducted to assess the benefits of TASAR to Alaska Airlines. The simulation compares historical trajectories without TASAR to trajectories developed with TASAR and evaluated by controllers against their objectives. It was estimated that between 8,000 and 12,000 gallons of fuel and 900 to 1,300 minutes could be saved annually per aircraft. These savings were applied fleet-wide to produce an estimated annual cost savings to Alaska Airlines in excess of $5 million due to fuel, maintenance, and depreciation cost savings. Switching to a more wind-optimal trajectory was found to be the use case that generated the highest benefits out of the three TASAR use cases analyzed. Alaska TASAR requests peaked at four to eight requests per hour in high-altitude Seattle center sectors south of Seattle-Tacoma airport.

Annualized TASAR Benefit Estimate for Virgin America Operations

NASA Technical Reports Server (NTRS)

Henderson, Jeffrey

2015-01-01

The Traffic Aware Strategic Aircrew Request (TASAR) concept offers onboard automation for the purpose of advising the pilot of traffic compatible trajectory changes that would be beneficial to the flight. A fast-time simulation study was conducted to assess the benefits of TASAR to Virgin America. The simulation compares historical trajectories without TASAR to trajectories developed with TASAR and evaluated by controllers against their objectives. It was estimated that about 25,000 gallons of fuel and about 2,500 minutes could be saved annually per aircraft. These savings were applied fleet-wide to produce an estimated annual cost savings to Virgin America in excess of $5 million due to fuel, maintenance, and depreciation cost savings. Switching to a more wind-optimal trajectory was found to be the use case that generated the highest benefits out of the three TASAR use cases analyzed. Virgin America TASAR requests peaked at two to four requests per hour per sector in high-altitude Oakland and Salt Lake City center sectors east of San Francisco.

OTTER: An Optimized Transit Tool And Easy Reference

DTIC Science & Technology

2016-03-01

as stated in the CNO’s Position Report: 2014. While a number of fuel -saving measures have been implemented in recent years, the effects of...saving measures have been implemented in recent years, the effects of operational transit speed on fuel consumption have not been adequately...their estimated savings As clearly seen, operating configuration has the most effect by far on fuel savings. Source: Fonte S (2009). In 2015

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

PubMed

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

Overview of methods in economic analyses of behavioral interventions to promote oral health

PubMed Central

O’Connell, Joan M.; Griffin, Susan

2016-01-01

Background Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE. Objective To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health. Methods We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described. Discussion Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly. PMID:21656966

Overview of methods in economic analyses of behavioral interventions to promote oral health.

PubMed

O'Connell, Joan M; Griffin, Susan

2011-01-01

Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE. To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health. We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described. Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly.

Application of stormwater collected from porous asphalt pavements for non-potable uses in buildings.

PubMed

Hammes, Gabriela; Thives, Liseane Padilha; Ghisi, Enedir

2018-09-15

This study assessed the potential for potable water savings in a building by using stormwater filtered by a porous asphalt pavement located in a parking lot. Stormwater is meant to be used for non-potable purposes (flushing toilets and urinals). Two models of porous pavement systems were constructed, both with porous asphalt mixture over a different combination of porous granular layers. The models were assessed for their filtering capacity; samples of stormwater runoff were collected in a parking lot located near the building where filtered stormwater is meant to be used. The models showed to be capable of filtering some pollutants. However, additional water treatment would be necessary to obtain the quality required for non-potable uses. Then one model was selected for a theoretical analysis on using it in a parking lot. The potential for potable water savings was analysed considering four scenarios as a function of daily local rainfall data. The thickness of the temporary stormwater reservoir layer was calculated in order to meet the design rainfall adopted, and the stormwater tank capacity was estimated using the Netuno computer programme. As a result, using a 45,000-litre stormwater tank, potable water savings of at least 53% would be obtained if filtered stormwater were used to flush toilets and urinals. This indicates that porous pavements show a great potential for filtering stormwater runoff to be used in buildings. Copyright © 2018 Elsevier Ltd. All rights reserved.

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.

Adding interventions to mass measles vaccinations in India

PubMed Central

Verguet, Stéphane; Morris, Shaun K; Sharma, Jitendar K; Ram, Usha; Gauvreau, Cindy; Jones, Edward; Jha, Prabhat; Jit, Mark

2016-01-01

Abstract Objective To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India’s 2010–2013 measles supplementary immunization activity. Methods We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India’s Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). Findings The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200–79 300), preventing 73 700 child deaths (range: 70 000–79 000) and 300 maternal deaths (range: 200–400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions. Conclusion In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality. PMID:27843161

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

Freshwater savings from marine protein consumption

NASA Astrophysics Data System (ADS)

Gephart, Jessica A.; Pace, Michael L.; D'Odorico, Paolo

2014-01-01

Marine fisheries provide an essential source of protein for many people around the world. Unlike alternative terrestrial sources of protein, marine fish production requires little to no freshwater inputs. Consuming marine fish protein instead of terrestrial protein therefore represents freshwater savings (equivalent to an avoided water cost) and contributes to a low water footprint diet. These water savings are realized by the producers of alternative protein sources, rather than the consumers of marine protein. This study quantifies freshwater savings from marine fish consumption around the world by estimating the water footprint of replacing marine fish with terrestrial protein based on current consumption patterns. An estimated 7 600 km3 yr-1 of water is used for human food production. Replacing marine protein with terrestrial protein would require an additional 350 km3 yr-1 of water, meaning that marine protein provides current water savings of 4.6%. The importance of these freshwater savings is highly uneven around the globe, with savings ranging from as little as 0 to as much as 50%. The largest savings as a per cent of current water footprints occur in Asia, Oceania, and several coastal African nations. The greatest national water savings from marine fish protein occur in Southeast Asia and the United States. As the human population increases, future water savings from marine fish consumption will be increasingly important to food and water security and depend on sustainable harvest of capture fisheries and low water footprint growth of marine aquaculture.

Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP)

PubMed Central

Juneja, Sandeep; Gupta, Aastha; Moon, Suerie; Resch, Stephen

2017-01-01

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010–2028 and generate a cost-benefit ratio–based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator’s tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today. PMID:28542239

Biodiesel production potential from fat fraction of municipal waste in Makkah

PubMed Central

2017-01-01

In the Kingdom of Saudi Arabia (KSA), millions of Muslims come to perform Pilgrimage every year. Around one million ton of municipal solid waste (MSW) is generated in Makkah city annually. The collected MSW is disposed of in the landfills without any treatment or energy recovery. As a result, greenhouse gas (GHG) emissions and contamination of the soil and water bodies along with leachate and odors are occurring in waste disposal vicinities. The composition of MSW shows that food waste is the largest waste stream (up to 51%) of the total generated MSW. About 13% of the food waste consists of fat content that is equivalent to about 64 thousand tons per year. This study aims to estimate the production potential of biodiesel first time in Makkah city from fat/oil fractions of MSW and highlight its economic and environmental benefits. It has been estimated that 62.53, 117.15 and 6.38 thousand tons of biodiesel, meat and bone meal (MBM) and glycerol respectively could be produced in 2014. A total electricity potential of 852 Gigawatt hour (GWh) from all three sources based on their energy contents, Higher Heating Value (HHV) of 40.17, 18.33 and 19 MJ/kg, was estimated for 2014 that will increase up to 1777 GWh in 2050. The cumulative net savings from landfill waste diversion (256 to 533 million Saudi Riyal (SAR)), carbon credits (46 to 96 million SAR), fuel savings (146 to 303 million SAR) and electricity generation (273 to 569 million SAR) have a potential to add a total net revenue of 611 to 1274 million SAR every year to the Saudi economy, from 2014 to 2050 respectively. However, further studies including real-time data about annual slaughtering activities and the amount of waste generation and its management are critical to decide optimum waste management practices based on life cycle assessment (LCA) and life cycle costing (LCC) methodologies. PMID:28207856

State Approaches to Demand Reduction Induced Price Effects: Examining How Energy Efficiency Can Lower Prices for All

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

Taylor, Colin; Hedman, Bruce; Goldberg, Amelie

Effects (DRIPE) as a real, quantifiable benefit of energy efficiency and demand response programs. DRIPE is a measurement of the value of demand reductions in terms of the decrease in wholesale energy prices, resulting in lower total expenditures on electricity or natural gas across a given grid. Crucially for policymakers and consumer advocates, DRIPE savings accrue not only to the subset of customers who consume less, but to all consumers. Rate-paying customers realize DRIPE savings when price reductions across an electricity or natural gas system are passed on to all retail customers as lower rates (depending upon regulation and marketmore » structure, residual savings may be wholly or partially retained by utilities). DRIPE savings, though seemingly small in terms of percent price reductions or dollars per household, can amount to hundreds of millions of dollars per year across entire states or grids. Therefore, accurately assessing DRIPE benefits can help to ensure appropriate programs are designed and implemented for energy efficiency measures. This paper reviews the existing knowledge and experience from select U.S. states regarding DRIPE (including New York and Ohio), and the potential for expanded application of the concept of DRIPE by regulators. Policymakers and public utility commissions have a critical role to play in setting the methodology for determining DRIPE, encouraging its capture by utilities, and allocating DRIPE benefits among utilities, various groups of customers, and/or society at large. While the methodologies for estimating DRIPE benefits are still being perfected, policymakers can follow the examples of states such as Maryland and Vermont in including conservative DRIPE estimates in their resource planning.« less

[Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjugated vaccines].

PubMed

Muciño-Ortega, Emilio; Mould-Quevedo, Joaquín Federico; Farkouh, Raymond; Strutton, David

2011-01-01

Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV's) currently available in Mexico from a third payer perspective. A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children <2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV's. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY's) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed. Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY's and 332.006 QALY's and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV's prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY's, 282.969 and 114.972 QALY's and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine. In Mexico, immunization strategies based on 7, 10 and 13-valent PCV's would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV's. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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...

The effectiveness of the 55 MPH national maximum speed limit as a life saving benefit : executive summary

DOT National Transportation Integrated Search

1981-01-01

The following report contains an analysis of the life saving benefits resulting from the 55 mph NMSL from 1974-1979. Monthly fatality data from 1970-1979 was used in a time series model to arrive at the estimated safety benefits (lives saved). The ti...

Nutrition economic evaluation of a probiotic in the prevention of antibiotic-associated diarrhea.

PubMed

Lenoir-Wijnkoop, Irene; Nuijten, Mark J C; Craig, Joyce; Butler, Christopher C

2014-01-01

Antibiotic-associated diarrhea (AAD) is common and frequently more severe in hospitalized elderly adults. It can lead to increased use of healthcare resources. We estimated the cost-effectiveness of a fermented milk (FM) with probiotic in preventing AAD and in particular Clostridium difficile-associated diarrhea (CDAD). Clinical effectiveness data and cost information were incorporated in a model to estimate the cost impact of administering a FM containing the probiotic Lactobacillus paracasei ssp paracasei CNCM I-1518 in a hospital setting. Preventing AAD by the consumption of the probiotic was compared to no preventive strategy. The probiotic intervention to prevent AAD generated estimated mean cost savings of £339 per hospitalized patient over the age of 65 years and treated with antibiotics, compared to no preventive probiotic. Estimated cost savings were sensitive to variation in the incidence of AAD, and to the proportion of patients who develop non-severe/severe AAD. However, probiotics remained cost saving in all sensitivity analyses. Use of the fermented dairy drink containing the probiotic L. paracasei CNCM I-1518 to prevent AAD in older hospitalized patients treated with antibiotics could lead to substantial cost savings.

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

Advanced variable speed air source integrated heat pump (AS-IHP) development - CRADA final report

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

Baxter, Van D.; Rice, C. Keith; Munk, Jeffrey D.

2015-09-30

Between August 2011 and September 2015, Oak Ridge National Laboratory (ORNL) and Nordyne, LLC (now Nortek Global HVAC LLC, NGHVAC) engaged in a Cooperative Research and Development Agreement (CRADA) to develop an air-source integrated heat pump (AS-IHP) system for the US residential market. Two generations of laboratory prototype systems were designed, fabricated, and lab-tested during 2011-2013. Performance maps for the system were developed using the latest research version of the DOE/ORNL Heat Pump Design Model, or HPDM, (Rice 1991; Rice and Jackson 2005; Shen et al 2012) as calibrated against the lab test data. These maps were the input tomore » the TRNSYS (SOLAR Energy Laboratory, et al, 2010) system to predict annual performance relative to a baseline suite of equipment meeting minimum efficiency standards in effect in 2006 (combination of 13 SEER air-source heat pump (ASHP) and resistance water heater with Energy Factor (EF) of 0.9). Predicted total annual energy savings, while providing space conditioning and water heating for a tight, well insulated 2600 ft2 (242 m2) house at 5 U.S. locations, ranged from 46 to 61%, averaging 52%, relative to the baseline system (lowest savings at the cold-climate Chicago location). Predicted energy use for water heating was reduced 62 to 76% relative to resistance WH. Based on these lab prototype test and analyses results a field test prototype was designed and fabricated by NGHVAC. The unit was installed in a 2400 ft2 (223 m2) research house in Knoxville, TN and field tested from May 2014 to April 2015. Based on the demonstrated field performance of the AS-IHP prototype and estimated performance of a baseline system operating under the same loads and weather conditions, it was estimated that the prototype would achieve ~40% energy savings relative to the minimum efficiency suite. The estimated WH savings were >60% and SC mode savings were >50%. But estimated SH savings were only about 20%. It is believed that had the test house been better insulated (more like the house used for the savings predictions noted above) and the IHP system nominal capacity been a bit lower that the energy savings estimate would have been closer to 45% or more (similar to the analytical prediction for the cold climate location of Chicago).« less

Improving employee productivity through improved health.

PubMed

Mitchell, Rebecca J; Ozminkowski, Ronald J; Serxner, Seth

2013-10-01

The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Estimating the effect of hospital closure on areawide inpatient hospital costs: a preliminary model and application.

PubMed Central

Shepard, D S

1983-01-01

A preliminary model is developed for estimating the extent of savings, if any, likely to result from discontinuing a specific inpatient service. By examining the sources of referral to the discontinued service, the model estimates potential demand and how cases will be redistributed among remaining hospitals. This redistribution determines average cost per day in hospitals that receive these cases, relative to average cost per day of the discontinued service. The outflow rate, which measures the proportion of cases not absorbed in other acute care hospitals, is estimated as 30 percent for the average discontinuation. The marginal cost ratio, which relates marginal costs of cases absorbed in surrounding hospitals to the average costs in those hospitals, is estimated as 87 percent in the base case. The model was applied to the discontinuation of all inpatient services in the 75-bed Chelsea Memorial Hospital, near Boston, Massachusetts, using 1976 data. As the precise value of key parameters is uncertain, sensitivity analysis was used to explore a range of values. The most likely result is a small increase ($120,000) in the area's annual inpatient hospital costs, because many patients are referred to more costly teaching hospitals. A similar situation may arise with other urban closures. For service discontinuations to generate savings, recipient hospitals must be low in costs, the outflow rate must be large, and the marginal cost ratio must be low. PMID:6668181

[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products].

PubMed

Berreur, B; Guerin, F; Christophe, B; Limido, G; Paubel, P

2018-01-01

To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products. Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H 1 ); all initiations under biosimilars and continuation therapy with the princeps (H 2 ) or all patients are treated with biosimilars (H 3 ). The annual savings are estimated at 237,000 € with the H 1 hypothesis. In the case of H 2 , the expected savings would be 376,200 € per year. In the case of H 3 , savings for the community could reach almost 1,282,800 € per year. The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H 1 and H 2 hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020

PubMed Central

Clark, Samantha; Portnoy, Allison; Grewal, Simrun; Stack, Meghan L; Sinha, Anushua; Mirelman, Andrew; Franklin, Heather; Friberg, Ingrid K; Tam, Yvonne; Walker, Neff; Clark, Andrew; Ferrari, Matthew; Suraratdecha, Chutima; Sweet, Steven; Goldie, Sue J; Garske, Tini; Li, Michelle; Hansen, Peter M; Johnson, Hope L; Walker, Damian

2017-01-01

Abstract Objective To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. Methods We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs – expressed in 2010 United States dollars (US$) – of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. Findings We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. Conclusion By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health. PMID:28867843

Detecting structural heat losses with mobile infrared thermography. Part IV. Estimating quantitative heat loss at Dartmouth College, Hanover, New Hampshire

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

Munis, R.H.; Marshall, S.J.; Bush, M.A.

1976-09-01

During the winter of 1973-74 a mobile infrared thermography system was used to survey campus buildings at Dartmouth College, Hanover, New Hampshire. Both qualitative and quantitative data are presented regarding heat flow through a small area of a wall of one brick dormitory building before and after installation of aluminum reflectors between radiators and the wall. These data were used to estimate annual cost savings for 22 buildings of similar construction having aluminum reflectors installed behind 1100 radiators. The data were then compared with the actual savings which were calculated from condensate meter data. The discrepancy between estimated and actualmore » annual cost savings is explained in detail along with all assumptions required for these calculations.« less

Greenhouse gas emissions of an agro-biogas energy system: Estimation under the Renewable Energy Directive.

PubMed

Rana, Roberto; Ingrao, Carlo; Lombardi, Mariarosaria; Tricase, Caterina

2016-04-15

Agro-biogas from energy crops and by-products is a renewable energy carrier that can potentially contribute to climate change mitigation. In this context, application of the methodology defined by the Renewable Energy Directive 2009/28/EC (RED) was performed in order to estimate the 100-year Global Warming Potential (GWP100) associated with an agro-biogas supply chain (SC) in Southern Italy. Doing so enabled calculation of Greenhouse Gas (GHG) emission saving in order to verify if it is at least equal to 35% compared to the fossil fuel reference system, as specified by the RED. For the assessment, an attributional Life Cycle Assessment (LCA) approach (International Organization for Standardization (ISO), 2006a,b) was integrated with the RED methodology applied following the guidelines reported in COM(2010)11 and updated by SWD(2014)259 and Report EUR 27215 EN (2015). Moreover, primary data were collected with secondary data extrapolated from the Ecoinvent database system. Results showed that the GWP100 associated with electricity production through the biogas plant investigated was equal to 111.58gCO2eqMJe(-1) and so a 40.01% GHG-emission saving was recorded compared to the RED reference. The highest contribution comes from biomass production and, in particular, from crop cultivation due to production of ammonium nitrate in the overall amount used for crop cultivation. Based upon the findings of the study, the GHG saving calculated slightly exceeds the related minimum proposed by the RED: therefore, improvements are needed anyway. In particular, the authors documented that through replacement of ammonium nitrate with urea the GHG-emission saving would increase to almost 68%, thus largely satisfying the RED limit. In addition, the study highlighted that conservation practices, such as NT, can significantly enable reduction of the GHG-emissions coming from agricultural activities. Therefore, those practices should be increasingly adopted for cultivation of energy crops, because the latter significantly contribute to biogas production yield enhancement. Copyright © 2016 Elsevier B.V. All rights reserved.

Time-varying value of electric energy efficiency

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

Mims, Natalie A.; Eckman, Tom; Goldman, Charles

Electric energy efficiency resources save energy and may reduce peak demand. Historically, quantification of energy efficiency benefits has largely focused on the economic value of energy savings during the first year and lifetime of the installed measures. Due in part to the lack of publicly available research on end-use load shapes (i.e., the hourly or seasonal timing of electricity savings) and energy savings shapes, consideration of the impact of energy efficiency on peak demand reduction (i.e., capacity savings) has been more limited. End-use load research and the hourly valuation of efficiency savings are used for a variety of electricity planningmore » functions, including load forecasting, demand-side management and evaluation, capacity and demand response planning, long-term resource planning, renewable energy integration, assessing potential grid modernization investments, establishing rates and pricing, and customer service. This study reviews existing literature on the time-varying value of energy efficiency savings, provides examples in four geographically diverse locations of how consideration of the time-varying value of efficiency savings impacts the calculation of power system benefits, and identifies future research needs to enhance the consideration of the time-varying value of energy efficiency in cost-effectiveness screening analysis. Findings from this study include: -The time-varying value of individual energy efficiency measures varies across the locations studied because of the physical and operational characteristics of the individual utility system (e.g., summer or winter peaking, load factor, reserve margin) as well as the time periods during which savings from measures occur. -Across the four locations studied, some of the largest capacity benefits from energy efficiency are derived from the deferral of transmission and distribution system infrastructure upgrades. However, the deferred cost of such upgrades also exhibited the greatest range in value of all the components of avoided costs across the locations studied. -Of the five energy efficiency measures studied, those targeting residential air conditioning in summer-peaking electric systems have the most significant added value when the total time-varying value is considered. -The increased use of rooftop solar systems, storage, and demand response, and the addition of electric vehicles and other major new electricity-consuming end uses are anticipated to significantly alter the load shape of many utility systems in the future. Data used to estimate the impact of energy efficiency measures on electric system peak demands will need to be updated periodically to accurately reflect the value of savings as system load shapes change. -Publicly available components of electric system costs avoided through energy efficiency are not uniform across states and utilities. Inclusion or exclusion of these components and differences in their value affect estimates of the time-varying value of energy efficiency. -Publicly available data on end-use load and energy savings shapes are limited, are concentrated regionally, and should be expanded.« less

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.

Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

PubMed

Novignon, Jacob; Nonvignon, Justice

2017-06-12

Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private and public facilities. There is need for primary health facility managers to improve productivity via effective and efficient resource use. Efforts to improve efficiency should focus on training health workers and improving facility environment alongside effective monitoring and evaluation exercises.

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

PubMed Central

2014-01-01

Background Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies. PMID:25047074

A shift from motorised travel to active transport: What are the potential health gains for an Australian city?

PubMed Central

Knibbs, Luke D.; Ware, Robert S.; Heesch, Kristiann C.; Tainio, Marko; Woodcock, James; Veerman, J. Lennert

2017-01-01

Introduction An alarmingly high proportion of the Australian adult population does not meet national physical activity guidelines (57%). This is concerning because physical inactivity is a risk factor for several chronic diseases. In recent years, an increasing emphasis has been placed on the potential for transport and urban planning to contribute to increased physical activity via greater uptake of active transport (walking, cycling and public transport). In this study, we aimed to estimate the potential health gains and savings in health care costs of an Australian city achieving its stated travel targets for the use of active transport. Methods Additional active transport time was estimated for the hypothetical scenario of Brisbane (1.1 million population 2013) in Australia achieving specified travel targets. A multi-state life table model was used to estimate the number of health-adjusted life years, life-years, changes in the burden of diseases and injuries, and the health care costs associated with changes in physical activity, fine particle (<2.5 μm; PM2.5) exposure, and road trauma attributable to a shift from motorised travel to active transport. Sensitivity analyses were conducted to test alternative modelling assumptions. Results Over the life course of the Brisbane adult population in 2013 (860,000 persons), 33,000 health-adjusted life years could be gained if the travel targets were achieved by 2026. This was mainly due to lower risks of physical inactivity-related diseases, with life course reductions in prevalence and mortality risk in the range of 1.5%-6.0%. Prevalence and mortality of respiratory diseases increased slightly (≥0.27%) due to increased exposure of larger numbers of cyclists and pedestrians to fine particles. The burden of road trauma increased by 30% for mortality and 7% for years lived with disability. We calculated substantial net savings ($AU183 million, 2013 values) in health care costs. Conclusion In cities, such as Brisbane, where over 80% of trips are made by private cars, shifts towards walking, cycling and public transport would cause substantial net health benefits and savings in health care costs. However, for such shifts to occur, investments are needed to ensure safe and convenient travel. PMID:29020093

Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

PubMed

Brown, V; Moodie, M; Cobiac, L; Mantilla Herrera, A M; Carter, R

2017-05-04

Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2 M in healthcare cost savings). Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness, potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.

A Global Geospatial Ecosystem Services Estimate of Urban Agriculture

NASA Astrophysics Data System (ADS)

Clinton, Nicholas; Stuhlmacher, Michelle; Miles, Albie; Uludere Aragon, Nazli; Wagner, Melissa; Georgescu, Matei; Herwig, Chris; Gong, Peng

2018-01-01

Though urban agriculture (UA), defined here as growing of crops in cities, is increasing in popularity and importance globally, little is known about the aggregate benefits of such natural capital in built-up areas. Here, we introduce a quantitative framework to assess global aggregate ecosystem services from existing vegetation in cities and an intensive UA adoption scenario based on data-driven estimates of urban morphology and vacant land. We analyzed global population, urban, meteorological, terrain, and Food and Agriculture Organization (FAO) datasets in Google Earth Engine to derive global scale estimates, aggregated by country, of services provided by UA. We estimate the value of four ecosystem services provided by existing vegetation in urban areas to be on the order of 33 billion annually. We project potential annual food production of 100-180 million tonnes, energy savings ranging from 14 to 15 billion kilowatt hours, nitrogen sequestration between 100,000 and 170,000 tonnes, and avoided storm water runoff between 45 and 57 billion cubic meters annually. In addition, we estimate that food production, nitrogen fixation, energy savings, pollination, climate regulation, soil formation and biological control of pests could be worth as much as 80-160 billion annually in a scenario of intense UA implementation. Our results demonstrate significant country-to-country variability in UA-derived ecosystem services and reduction of food insecurity. These estimates represent the first effort to consistently quantify these incentives globally, and highlight the relative spatial importance of built environments to act as change agents that alleviate mounting concerns associated with global environmental change and unsustainable development.

Regional prediction of long-term landfill gas to energy potential.

PubMed

Amini, Hamid R; Reinhart, Debra R

2011-01-01

Quantifying landfill gas to energy (LFGTE) potential as a source of renewable energy is difficult due to the challenges involved in modeling landfill gas (LFG) generation. In this paper a methodology is presented to estimate LFGTE potential on a regional scale over a 25-year timeframe with consideration of modeling uncertainties. The methodology was demonstrated for the US state of Florida, as a case study, and showed that Florida could increase the annual LFGTE production by more than threefold by 2035 through installation of LFGTE facilities at all landfills. The estimated electricity production potential from Florida LFG is equivalent to removing some 70 million vehicles from highways or replacing over 800 million barrels of oil consumption during the 2010-2035 timeframe. Diverting food waste could significantly reduce fugitive LFG emissions, while having minimal effect on the LFGTE potential; whereas, achieving high diversion goals through increased recycling will result in reduced uncollected LFG and significant loss of energy production potential which may be offset by energy savings from material recovery and reuse. Estimates showed that the power density for Florida LFGTE production could reach as high as 10 Wm(-2) with optimized landfill operation and energy production practices. The environmental benefits from increased lifetime LFG collection efficiencies magnify the value of LFGTE projects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cost-effectiveness of reducing sulfur emissions from ships.

PubMed

Wang, Chengfeng; Corbett, James J; Winebrake, James J

2007-12-15

We model cost-effectiveness of control strategies for reducing SO2 emissions from U.S. foreign commerce ships traveling in existing European or hypothetical U.S. West Coast SO(x) Emission Control Areas (SECAs) under international maritime regulations. Variation among marginal costs of control for individual ships choosing between fuel-switching and aftertreatment reveals cost-saving potential of economic incentive instruments. Compared to regulations prescribing low sulfur fuels, a performance-based policy can save up to $260 million for these ships with 80% more emission reductions than required because least-cost options on some individual ships outperform standards. Optimal simulation of a market-based SO2 control policy for approximately 4,700 U.S. foreign commerce ships traveling in the SECAs in 2002 shows that SECA emissions control targets can be achieved by scrubbing exhaust gas of one out of ten ships with annual savings up to $480 million over performance-based policy. A market-based policy could save the fleet approximately $63 million annually under our best-estimate scenario. Spatial evaluation of ship emissions reductions shows that market-based instruments can reduce more SO2 closer to land while being more cost-effective for the fleet. Results suggest that combining performance requirements with market-based instruments can most effectively control SO2 emissions from ships.

Change in Land Use and Evapotranspiration in the Manas River Basin, China with Long-term Water-saving Measures.

PubMed

Yang, Guang; Xue, Lianqing; He, Xinlin; Wang, Cui; Long, Aihua

2017-12-19

Widespread application of water-saving measures, especially advanced drip irrigation technologies, may significantly impact on the land use, and further potentially alter regional ecological environments in an arid area. In this study, the remote sensing and geographic information system technology were used to analyze the LANDSAT images (1976-2015) and the MOD16 evapotranspiration data (2000-2015) in the Manas River Basin (MRB), China where the water-saving technologies have experienced the past 40 years. Our results show that the area of the cultivated land was approximately doubled from 1976 to 2015 with a dynamic degree of cultivated land ranging from 1.7% to 4%. The reclamation rates were estimated at 9.5% in 1976 and 21.8% in 2015 and the comprehensive index of land use degree shows an increasing trend in the MRB. The evapotranspiration in the MRB suggests that the cultivated land is becoming more humid while the other regions are becoming more arid. Long-term change in the land use is mainly promoted due to the multiple years' efforts on development of the water-saving technologies. This study greatly improves our understanding of the interactions between change in ecological environments and human activities and may provide policy makers guidance of sustainable development at an arid area.

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012).

PubMed

Weir, Hannah K; Li, Chunyu; Henley, S Jane; Joseph, Djenaba

2017-05-01

Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States. Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars. Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss. Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups. Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR . ©2016 American Association for Cancer Research.

Household water use and conservation models using Monte Carlo techniques

NASA Astrophysics Data System (ADS)

Cahill, R.; Lund, J. R.; DeOreo, B.; Medellín-Azuara, J.

2013-04-01

The increased availability of water end use measurement studies allows for more mechanistic and detailed approaches to estimating household water demand and conservation potential. This study uses, probability distributions for parameters affecting water use estimated from end use studies and randomly sampled in Monte Carlo iterations to simulate water use in a single-family residential neighborhood. This model represents existing conditions and is calibrated to metered data. A two-stage mixed integer optimization model is then developed to estimate the least-cost combination of long- and short-term conservation actions for each household. This least-cost conservation model provides an estimate of the upper bound of reasonable conservation potential for varying pricing and rebate conditions. The models were adapted from previous work in Jordan and are applied to a neighborhood in San Ramon, California in eastern San Francisco Bay Area. The existing conditions model produces seasonal use results very close to the metered data. The least-cost conservation model suggests clothes washer rebates are among most cost-effective rebate programs for indoor uses. Retrofit of faucets and toilets is also cost effective and holds the highest potential for water savings from indoor uses. This mechanistic modeling approach can improve understanding of water demand and estimate cost-effectiveness of water conservation programs.

Standby Conservation Plan No. 3: Emergency advertising lighting restrictions. Economic analysis

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

Not Available

This report analyzes the potential economic impacts of the Emergency Advertising Lighting Restrictions Plan. The on-premise signs located within the confines of a business and off-premise located outside the confines of a business are affected. Illuminated signs essential to direct customers to an open business by identifying it and/or to inform customers of a product or service supplied by the open business are not restricted. The economic impact of implementing this plan is evaluated by first estimating the amount of petroleum saved by the lighting restrictions and to evaluate the economic impacts that would result. The amount of oil thatmore » could be diverted to other uses by implementation of this plan is estimated in Chapter 2, and amounts to about 4,000 barrels per day (the period analyzed is the fourth quarter of 1980 through the third quarter of 1981). Redistribution of petroleum saved by this measure is expected to result in small increases in GNP, personal consumption, and employment. The effects on inflation are negligible. Economic impacts for the businesses are evaluated in Chapter 3. Costs of implementing the measure are estimated to be about $3.1 million, including the cost of reimbursing the states for functions delegated to them. (MCW)« less

Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis

PubMed Central

Walker, Christa L. Fischer; Friberg, Ingrid K.; Binkin, Nancy; Young, Mark; Walker, Neff; Fontaine, Olivier; Weissman, Eva; Gupta, Akanksha; Black, Robert E.

2011-01-01

Background Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Methods and Findings We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Conclusion Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. Please see later in the article for the Editors' Summary PMID:21445330

Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.

PubMed

Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P

2015-08-01

Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.

Autonomous taxis could greatly reduce greenhouse-gas emissions of US light-duty vehicles

NASA Astrophysics Data System (ADS)

Greenblatt, Jeffery B.; Saxena, Samveg

2015-09-01

Autonomous vehicles (AVs) are conveyances to move passengers or freight without human intervention. AVs are potentially disruptive both technologically and socially, with claimed benefits including increased safety, road utilization, driver productivity and energy savings. Here we estimate 2014 and 2030 greenhouse-gas (GHG) emissions and costs of autonomous taxis (ATs), a class of fully autonomous shared AVs likely to gain rapid early market share, through three synergistic effects: (1) future decreases in electricity GHG emissions intensity, (2) smaller vehicle sizes resulting from trip-specific AT deployment, and (3) higher annual vehicle-miles travelled (VMT), increasing high-efficiency (especially battery-electric) vehicle cost-effectiveness. Combined, these factors could result in decreased US per-mile GHG emissions in 2030 per AT deployed of 87-94% below current conventionally driven vehicles (CDVs), and 63-82% below projected 2030 hybrid vehicles, without including other energy-saving benefits of AVs. With these substantial GHG savings, ATs could enable GHG reductions even if total VMT, average speed and vehicle size increased substantially. Oil consumption would also be reduced by nearly 100%.

Costs of paying higher prices for equivalent effects on the Pharmaceutical Benefits Scheme.

PubMed

Karnon, Jonathan; Edney, Laura; Sorich, Michael

2017-03-01

Objective The aims of the present study were to illustrate and discuss the effects of the non-maintenance of equivalent prices when the comparators of pharmaceuticals listed on the Pharmaceutical Benefits Schedule (PBS) on a cost-minimisation basis come off-patent and are subject to statutory price reductions, as well as further potential price reductions because of the effects of price disclosure. Methods Service use, benefits paid, and price data were analysed for a selected sample of pharmaceuticals recommended for listing on a cost-minimisation basis between 2008 and 2011, and their comparators, to estimate the cost savings to the PBS of maintaining equivalent prices. Results Potential cost savings for 12 pharmaceuticals, including alternative compounds and combination products across nine therapeutic groups, ranged from A$570000 to A$40million to April 2015. Potential savings increased significantly following recent amendments to the price disclosure process. Conclusions Potential savings from maintaining equivalent prices for all pharmaceuticals listed on the PBS on a cost-minimisation basis could be over A$500million per year. Actions to reduce these costs can be taken within existing policy frameworks, but legislative and political barriers may need to be addressed to minimise these costs, which are incurred by the taxpayer for no additional benefit. What is known about the topic? Pharmaceuticals listed on the PBS must provide value for money. Many pharmaceuticals achieve this by demonstrating equal effectiveness to an already listed pharmaceutical and requesting the same price as this comparator; that is, listing on a cost-minimisation basis. When the comparator moves off-patent, the price of the still-patented pharmaceutical is protected, whereas the off-patent drug is subject to price disclosure and often steep price reductions. What does this paper add? This paper adds to recent evidence on the costs to government of paying different prices for two or more pharmaceuticals that are equally effective. Between 2008 and 2011, the direct comparators for 68 pharmaceuticals listed on a cost-minimisation basis have moved onto the price disclosure list. Across 12 of these listings, the potential cost savings in the 10 months to April 2015 were A$73million. What are the implications for practitioners? The PBS costs the Australian government over A$9 billion per year. Annual savings over A$500million per year could be achieved by maintaining cost-minimisation across equally effective pharmaceuticals. This would improve the efficiency of the PBS at no risk to patients. Legislation is required to remove the existing F1 and F2 categorisation of listed pharmaceuticals, but the proposed changes would remove the need for therapeutic group premiums and simplify the pricing of PBS items.

25 CFR 170.618 - Can a tribe keep savings resulting from project administration?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can a tribe keep savings resulting from project... Agreements Under Isdeaa § 170.618 Can a tribe keep savings resulting from project administration? When actual... estimated costs, the Secretary will determine the use of the excess funds after consultation with the tribe...

25 CFR 170.618 - Can a tribe keep savings resulting from project administration?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Can a tribe keep savings resulting from project... Agreements Under Isdeaa § 170.618 Can a tribe keep savings resulting from project administration? When actual... estimated costs, the Secretary will determine the use of the excess funds after consultation with the tribe...

NSR&D Program Fiscal Year (FY) 2015 Call for Proposals Mitigation of Seismic Risk at Nuclear Facilities using Seismic Isolation

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

Coleman, Justin

2015-02-01

Seismic isolation (SI) has the potential to drastically reduce seismic response of structures, systems, or components (SSCs) and therefore the risk associated with large seismic events (large seismic event could be defined as the design basis earthquake (DBE) and/or the beyond design basis earthquake (BDBE) depending on the site location). This would correspond to a potential increase in nuclear safety by minimizing the structural response and thus minimizing the risk of material release during large seismic events that have uncertainty associated with their magnitude and frequency. The national consensus standard America Society of Civil Engineers (ASCE) Standard 4, Seismic Analysismore » of Safety Related Nuclear Structures recently incorporated language and commentary for seismically isolating a large light water reactor or similar large nuclear structure. Some potential benefits of SI are: 1) substantially decoupling the SSC from the earthquake hazard thus decreasing risk of material release during large earthquakes, 2) cost savings for the facility and/or equipment, and 3) applicability to both nuclear (current and next generation) and high hazard non-nuclear facilities. Issue: To date no one has evaluated how the benefit of seismic risk reduction reduces cost to construct a nuclear facility. Objective: Use seismic probabilistic risk assessment (SPRA) to evaluate the reduction in seismic risk and estimate potential cost savings of seismic isolation of a generic nuclear facility. This project would leverage ongoing Idaho National Laboratory (INL) activities that are developing advanced (SPRA) methods using Nonlinear Soil-Structure Interaction (NLSSI) analysis. Technical Approach: The proposed study is intended to obtain an estimate on the reduction in seismic risk and construction cost that might be achieved by seismically isolating a nuclear facility. The nuclear facility is a representative pressurized water reactor building nuclear power plant (NPP) structure. Figure 1: Project activities The study will consider a representative NPP reinforced concrete reactor building and representative plant safety system. This study will leverage existing research and development (R&D) activities at INL. Figure 1 shows the proposed study steps with the steps in blue representing activities already funded at INL and the steps in purple the activities that would be funded under this proposal. The following results will be documented: 1) Comparison of seismic risk for the non-seismically isolated (non-SI) and seismically isolated (SI) NPP, and 2) an estimate of construction cost savings when implementing SI at the site of the generic NPP.« less

Mathematical Modeling to Reduce Waste of Compounded Sterile Products in Hospital Pharmacies

PubMed Central

Dobson, Gregory; Haas, Curtis E.; Tilson, David

2014-01-01

Abstract In recent years, many US hospitals embarked on “lean” projects to reduce waste. One advantage of the lean operational improvement methodology is that it relies on process observation by those engaged in the work and requires relatively little data. However, the thoughtful analysis of the data captured by operational systems allows the modeling of many potential process options. Such models permit the evaluation of likely waste reductions and financial savings before actual process changes are made. Thus the most promising options can be identified prospectively, change efforts targeted accordingly, and realistic targets set. This article provides one example of such a datadriven process redesign project focusing on waste reduction in an in-hospital pharmacy. A mathematical model of the medication prepared and delivered by the pharmacy is used to estimate the savings from several potential redesign options (rescheduling the start of production, scheduling multiple batches, or reordering production within a batch) as well as the impact of information system enhancements. The key finding is that mathematical modeling can indeed be a useful tool. In one hospital setting, it estimated that waste could be realistically reduced by around 50% by using several process changes and that the greatest benefit would be gained by rescheduling the start of production (for a single batch) away from the period when most order cancellations are made. PMID:25477580

An assessment of the benefits of the use of NASA developed fuel conservative technology in the US commercial aircraft fleet

NASA Technical Reports Server (NTRS)

1975-01-01

Cost and benefits of a fuel conservative aircraft technology program proposed by NASA are estimated. NASA defined six separate technology elements for the proposed program: (a) engine component improvement (b) composite structures (c) turboprops (d) laminar flow control (e) fuel conservative engine and (f) fuel conservative transport. There were two levels postulated: The baseline program was estimated to cost $490 million over 10 years with peak funding in 1980. The level two program was estimated to cost an additional $180 million also over 10 years. Discussions with NASA and with representatives of the major commercial airframe manufacturers were held to estimate the combinations of the technology elements most likely to be implemented, the potential fuel savings from each combination, and reasonable dates for incorporation of these new aircraft into the fleet.

Modeling the injury prevention impact of mandatory alcohol ignition interlock installation in all new US vehicles.

PubMed

Carter, Patrick M; Flannagan, Carol A C; Bingham, C Raymond; Cunningham, Rebecca M; Rupp, Jonathan D

2015-05-01

We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System's General Estimates System data sets (2006-2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness. Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers.

Modeling the Injury Prevention Impact of Mandatory Alcohol Ignition Interlock Installation in All New US Vehicles

PubMed Central

Flannagan, Carol A. C.; Bingham, C. Raymond; Cunningham, Rebecca M.; Rupp, Jonathan D.

2015-01-01

Objectives. We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. Methods. We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System’s General Estimates System data sets (2006–2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness. Results. Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. Conclusions. Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers. PMID:25790385

U.S. Geological Survey - Virginia Department of Transportation: Bridge scour pilot study

USGS Publications Warehouse

Austin, Samuel H.

2018-02-27

BackgroundCost effective and safe highway bridge designs are required to ensure the long-term sustainability of Virginia’s road systems. The streamflows that, over time, scour streambed sediments from bridge piers inherently affect bridge safety and design costs. To ensure safety, bridge design must anticipate streambed scour at bridge piers over the lifespan of a bridge. Until recently Federal Highway Administration (FHWA) guidance provided only for scour estimates of granular, noncohesive, highly erosive material yielding overestimates of scour potential in instances when streambed materials offer some resistance to scour. This study seeks to estimate stream power and streambed scour for these more resistive sites, with bridge piers potentially established in cohesive soil or erodible rock. This new knowledge may provide significant construction cost savings while ensuring design and construction of safe highway bridges.

The costs of preventing the spread of respiratory infection in family physician offices: a threshold analysis.

PubMed

Hogg, William; Gray, David; Huston, Patricia; Zhang, Wei

2007-11-13

Influenza poses concerns about epidemic respiratory infection. Interventions designed to prevent the spread of respiratory infection within family physician (FP) offices could potentially have a significant positive influence on the health of Canadians. The main purpose of this paper is to estimate the explicit costs of such an intervention. A cost analysis of a respiratory infection control was conducted. The costs were estimated from the perspective of provincial government. In addition, a threshold analysis was conducted to estimate a threshold value of the intervention's effectiveness that could generate potential savings in terms of averted health-care costs by the intervention that exceed the explicit costs. The informational requirements for these implicit costs savings are high, however. Some of these elements, such as the cost of hospitalization in the event of contacting influenza, and the number of patients passing through the physicians' office, were readily available. Other pertinent points of information, such as the proportion of infected people who require hospitalization, could be imported from the existing literature. We take an indirect approach to calculate a threshold value for the most uncertain piece of information, namely the reduction in the probability of the infection spreading as a direct result of the intervention, at which the intervention becomes worthwhile. The 5-week intervention costs amounted to a total of $52,810.71, or $131,094.73 prorated according to the length of the flu season, or $512,729.30 prorated for the entire calendar year. The variable costs that were incurred for this 5-week project amounted to approximately $923.16 per participating medical practice. The (fixed) training costs per practice were equivalent to $73.27 for the 5-week intervention, or $28.14 for 13-week flu season, or $7.05 for an entire one-year period. Based on our conservative estimates for the direct cost savings, there are indications that the outreach facilitation intervention program would be cost effective if it can achieve a reduction in the probability of infection on the order of 0.83 (0.77, 1.05) percentage points. A facilitation intervention initiative tailored to the environment and needs of the family medical practice and walk-in clinics is of promise for improving respiratory infection control in the physicians' offices.

The costs of preventing the spread of respiratory infection in family physician offices: a threshold analysis

PubMed Central

Hogg, William; Gray, David; Huston, Patricia; Zhang, Wei

2007-01-01

Background Influenza poses concerns about epidemic respiratory infection. Interventions designed to prevent the spread of respiratory infection within family physician (FP) offices could potentially have a significant positive influence on the health of Canadians. The main purpose of this paper is to estimate the explicit costs of such an intervention. Methods A cost analysis of a respiratory infection control was conducted. The costs were estimated from the perspective of provincial government. In addition, a threshold analysis was conducted to estimate a threshold value of the intervention's effectiveness that could generate potential savings in terms of averted health-care costs by the intervention that exceed the explicit costs. The informational requirements for these implicit costs savings are high, however. Some of these elements, such as the cost of hospitalization in the event of contacting influenza, and the number of patients passing through the physicians' office, were readily available. Other pertinent points of information, such as the proportion of infected people who require hospitalization, could be imported from the existing literature. We take an indirect approach to calculate a threshold value for the most uncertain piece of information, namely the reduction in the probability of the infection spreading as a direct result of the intervention, at which the intervention becomes worthwhile. Results The 5-week intervention costs amounted to a total of $52,810.71, or $131,094.73 prorated according to the length of the flu season, or $512,729.30 prorated for the entire calendar year. The variable costs that were incurred for this 5-week project amounted to approximately $923.16 per participating medical practice. The (fixed) training costs per practice were equivalent to $73.27 for the 5-week intervention, or $28.14 for 13-week flu season, or $7.05 for an entire one-year period. Conclusion Based on our conservative estimates for the direct cost savings, there are indications that the outreach facilitation intervention program would be cost effective if it can achieve a reduction in the probability of infection on the order of 0.83 (0.77, 1.05) percentage points. A facilitation intervention initiative tailored to the environment and needs of the family medical practice and walk-in clinics is of promise for improving respiratory infection control in the physicians' offices. PMID:17999757

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

Khan, Yasin; Khare, Vaibhav Rai; Mathur, Jyotirmay

The paper describes a parametric study developed to estimate the energy savings potential of a radiant cooling system installed in a commercial building in India. The study is based on numerical modeling of a radiant cooling system installed in an Information Technology (IT) office building sited in the composite climate of Hyderabad. To evaluate thermal performance and energy consumption, simulations were carried out using the ANSYS FLUENT and EnergyPlus softwares, respectively. The building model was calibrated using the measured data for the installed radiant system. Then this calibrated model was used to simulate the energy consumption of a building usingmore » a conventional all-air system to determine the proportional energy savings. For proper handling of the latent load, a dedicated outside air system (DOAS) was used as an alternative to Fan Coil Unit (FCU). A comparison of energy consumption calculated that the radiant system was 17.5 % more efficient than a conventional all-air system and that a 30% savings was achieved by using a DOAS system compared with a conventional system. Computational Fluid Dynamics (CFD) simulation was performed to evaluate indoor air quality and thermal comfort. It was found that a radiant system offers more uniform temperatures, as well as a better mean air temperature range, than a conventional system. To further enhance the energy savings in the radiant system, different operational strategies were analyzed based on thermal analysis using EnergyPlus. Lastly, the energy savings achieved in this parametric run were more than 10% compared with a conventional all-air system.« less

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

Sullivan, W.N.

This report summarizes measured performance of residential geothermal heat pumps (GHP`s) that were installed in family housing units at Ft. Hood, Texas and at Selfridge Air National Guard base in Michigan. These units were built as part of a joint Department of Defense/Department of Energy program to evaluate the energy savings potential of GHP`s installed at military facilities. At the Ft. Hood site, the GHP performance was compared to conventional forced air electric air conditioning and natural gas heating. At Selfridge, the homes under test were originally equipped with electric baseboard heat and no air conditioning. Installation of the GHPmore » systems at both sites was straightforward but more problems and costs were incurred at Selfridge because of the need to install ductwork in the homes. The GHP`s at both sites produced impressive energy savings. These savings approached 40% for most of the homes tested. The low cost of energy on these bases relative to the incremental cost of the GHP conversions precludes rapid payback of the GHP`s from energy savings alone. Estimates based on simple payback (no inflation and no interest on capital) indicated payback times from 15 to 20 years at both sites. These payback times may be reduced by considering the additional savings possible due to reduced maintenance costs. Results are summarized in terms of 15 minute, hourly, monthly, and annual performance parameters. The results indicate that all the systems were working properly but several design shortcomings were identified. Recommendations are made for improvements in future installations at both sites.« less

Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial.

PubMed

Briffa, Tom G; Eckermann, Simon D; Griffiths, Alison D; Harris, Phillip J; Heath, M Rose; Freedman, Saul B; Donaldson, Lana T; Briffa, N Kathryn; Keech, Anthony C

2005-11-07

To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome. Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis. Two tertiary hospitals in Sydney. 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor. 113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded. Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility. The estimated incremental cost per QALY saved for rehabilitation relative to standard care was 42,535 US dollars when modelling included the reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective. The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.

The Importance of Powertrain Downsizing in a Benefit-Cost Analysis of Vehicle Lightweighting

NASA Astrophysics Data System (ADS)

Ward, J.; Gohlke, D.; Nealer, R.

2017-04-01

Reducing vehicle weight is an important avenue to improve energy efficiency and decrease greenhouse gas emissions from our cars and trucks. Conventionally, models have estimated acceptable increased manufacturing cost as proportional to the lifetime fuel savings associated with reduced vehicle weight. Vehicle lightweighting also enables a decrease in powertrain size and significant reductions in powertrain cost. Accordingly, we propose and apply a method for calculating the maximum net benefits and breakeven cost of vehicle lightweighting that considers both efficiency and powertrain downsizing for a conventional internal combustion engine vehicle, a battery electric vehicle with a range of 300 miles (BEV300), and a fuel cell electric vehicle (FCEV). We find that excluding powertrain downsizing cost savings undervalues the potential total net benefits of vehicle lightweighting, especially for the BEV300 and FCEV.

Examination of the costs, benefits and enery conservation aspects of the NASA aircraft fuel conservation technology program

NASA Technical Reports Server (NTRS)

1975-01-01

The costs and benefits of the NASA Aircraft Fuel Conservation Technology Program are discussed. Consideration is given to a present worth analysis of the planned program expenditures, an examination of the fuel savings to be obtained by the year 2005 and the worth of this fuel savings relative to the investment required, a comparison of the program funding with that planned by other Federal agencies for energy conservation, an examination of the private industry aeronautical research and technology financial posture for the period FY 76 - FY 85, and an assessment of the potential impacts on air and noise pollution. To aid in this analysis, a computerized fleet mix forecasting model was developed. This model enables the estimation of fuel consumption and present worth of fuel expenditures for selected commerical aircraft fleet mix scenarios.

China's medical savings accounts: an analysis of the price elasticity of demand for health care.

PubMed

Yu, Hao

2017-07-01

Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis.

Regional distribution of nitrogen fertilizer use and N-saving potential for improvement of food production and nitrogen use efficiency in China.

PubMed

Wang, Xiaobin; Cai, Dianxiong; Hoogmoed, Willem B; Oenema, Oene

2011-08-30

An apparently large disparity still exists between developed and developing countries in historical trends of the amounts of nitrogen (N) fertilizers consumed, and the same situation holds true in China. The situation of either N overuse or underuse has become one of the major limiting factors in agricultural production and economic development in China. The issue of food security in N-poor regions has been given the greatest attention internationally. Balanced and appropriate use of N fertilizer for enriching soil fertility is an effective step in preventing soil degradation, ensuring food security, and further contributing to poverty alleviation and rural economic development in the N-poor regions. Based on the China Statistical Yearbook (2007), there could be scope for improvement of N use efficiency (NUE) in N-rich regions by reducing N fertilizer input to an optimal level (≤180 kg N ha(-1)), and also potential for increasing yield in the N-poor regions by further increasing N fertilizer supply (up to 116 kg N ha(-1)). For the N-rich regions, the average estimated potential of N saving and NUE increase could be about 15% and 23%, respectively, while for the N-poor regions the average estimated potential for yield increase could be 21% on a regional scale, when N input is increased by 13%. The study suggests that to achieve the goals of regional yield improvement, it is necessary to readjust and optimize regional distribution of N fertilizer use between the N-poor and N-rich regions in China, in combination with other nutrient management practices. Copyright © 2011 Society of Chemical Industry.

A Water Budget for Riparian Vegetation on the Lower Colorado River: the Myth of Water Salvage

NASA Astrophysics Data System (ADS)

Nagler, P. L.; Glenn, E. P.; Webb, R. H.; Howard, K. A.

2007-05-01

For many years, river managers have envisaged large saving of water by clearing the exotic plant, saltcedar (Tamarix ramosissima) from western U.S. rivers. Early estimates of evapotranspiration (ET) by saltcedar ranged as high as 3-4 m/yr, and it was estimated that saltcedar on the Lower Colorado River used more water than Los Angeles. Furthermore, saltcedar was considered to have low habitat value, so clearing projects might enhance habitat value by allowing the return of more valuable native species. We have examined these assumptions based on recent evidence. Moisture flux towers set in dense saltcedar stands show that ET is moderate, ranging from 0.8-1.4 m/yr with a mean value of 1 m/yr over five studies on three rivers, similar to wide-area estimates from remote sensing studies. Projected over the 18,200 ha of dense saltcedar monocultures estimated for the Lower Colorado River riparian corridor in the U.S., the potential water saving would only be about 1 percent of the annual flow (assuming no replacement vegetation). A similar acreage of saltcedar monoculture exists in the Colorado River delta in Mexico, but these stands are supported by outflow of brackish water from the irrigation district rather than river water. The assumption of low habitat value is not supported by recent studies. For example, Hinojosa- Huerta (2006) found that saltcedar monocultures away from the river channel supported 65 percent as many bird numbers and 74 percent as many bird species as the best habitat type, mixed saltcedar and native trees in proximity to water, in the delta of the Colorado River in Mexico, and saltcedar provided equal habitat value as native trees for endangered willow flycatchers on Arizona and New Mexico rivers (Owen et al., 2005). Hence, the prospects for saving water without destroying habitat by clearing saltcedar are doubtful for this river system.

Energy-Efficiency and Air-Pollutant Emissions-Reduction Opportunities for the Ammonia Industry in China

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

Ma, Ding; Hasanbeigi, Ali; Chen, Wenying

As one of the most energy-intensive and polluting industries, ammonia production is responsible for significant carbon dioxide (CO 2) and air-pollutant emissions. Although many energy-efficiency measures have been proposed by the Chinese government to mitigate greenhouse gas emissions and improve air quality, lack of understanding of the cost-effectiveness of such improvements has been a barrier to implementing these measures. Assessing the costs, benefits, and cost-effectiveness of different energy-efficiency measures is essential to advancing this understanding. In this study, a bottom-up energy conservation supply curve model is developed to estimate the potential for energy savings and emissions reductions from 26 energy-efficiencymore » measures that could be applied in China’s ammonia industry. Cost-effective implementation of these measures saves a potential 271.5 petajoules/year for fuel and 5,443 gigawatt-hours/year for electricity, equal to 14% of fuel and 14% of electricity consumed in China’s ammonia industry in 2012. These reductions could mitigate 26.7 million tonnes of CO 2 emissions. This study also quantifies the co-benefits of reducing air-pollutant emissions and water use that would result from saving energy in China’s ammonia industry. This quantitative analysis advances our understanding of the cost-effectiveness of energy-efficiency measures and can be used to augment efforts to reduce energy use and environmental impacts.« less

BEST Winery Guidebook: Benchmarking and Energy and Water SavingsTool for the Wine Industry

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

Galitsky, Christina; Worrell, Ernst; Radspieler, Anthony

2005-10-15

Not all industrial facilities have the staff or the opportunity to perform a detailed audit of their operations. The lack of knowledge of energy efficiency opportunities provides an important barrier to improving efficiency. Benchmarking has demonstrated to help energy users understand energy use and the potential for energy efficiency improvement, reducing the information barrier. In California, the wine making industry is not only one of the economic pillars of the economy; it is also a large energy consumer, with a considerable potential for energy-efficiency improvement. Lawrence Berkeley National Laboratory and Fetzer Vineyards developed an integrated benchmarking and self-assessment tool formore » the California wine industry called ''BEST''(Benchmarking and Energy and water Savings Tool) Winery. BEST Winery enables a winery to compare its energy efficiency to a best practice winery, accounting for differences in product mix and other characteristics of the winery. The tool enables the user to evaluate the impact of implementing energy and water efficiency measures. The tool facilitates strategic planning of efficiency measures, based on the estimated impact of the measures, their costs and savings. BEST Winery is available as a software tool in an Excel environment. This report serves as background material, documenting assumptions and information on the included energy and water efficiency measures. It also serves as a user guide for the software package.« less

Operational Evaluatioin of Dynamic Weather Routes at American Airlines

NASA Technical Reports Server (NTRS)

McNally, David; Sheth, Kapil; Gong, Chester; Borchers, Paul; Osborne, Jeff; Keany, Desmond; Scott, Brennan; Smith, Steve; Sahlman, Scott; Lee, Chuhan;

A Global-Scale Estimate of Ecosystem Services from Urban Agriculture: Understanding Incentives for Natural Capital in Cities

NASA Astrophysics Data System (ADS)

Clinton, N.; Stuhlmacher, M.; Miles, A.; Uludere, N.; Wagner, M.; Georgescu, M.; Herwig, C.; Gong, P.

2017-12-01

Despite substantial interest in urban agriculture, little is known about the aggregate benefits conferred by natural capital for growing food in cities. Here we perform a scenario-based analysis to quantify ecosystem services from adoption of urban agriculture at varying intensity. To drive the scenarios, we created global-scale estimates of vacant land, rooftop and building surface area, at one kilometer resolution, from remotely sensed and modeled geospatial data. We used national scale agricultural reports, climate and other geospatial data at global scale to estimate agricultural production and economic returns, storm-water avoidance, energy savings from avoided heating and cooling costs, and ecosystem services provided by nitrogen sequestration, pollination and biocontrol of pests. The results indicate that vacant lands, followed by rooftops, represent the largest opportunities for natural capital put to agricultural use in urban areas. Ecosystem services from putting such spaces to productive use are dominated by agricultural returns, but energy savings conferred by insulative characteristics of growth substrate also provide economic incentives. Storm water avoidance was estimated to be substantial, but no economic value was estimated. Relatively low economic returns were estimated from the other ecosystem services examined. In aggregate, approximately $10-100 billion in economic incentives, before costs, were estimated. The results showed that relatively developed, high-income countries stand the most to gain from urban agricultural adoption due to the unique combination of climate, crop mixture and crop prices. While the results indicate that urban agriculture is not a panacea for urban food security issues, there is potential to simultaneously ameliorate multiple issues around food, energy and water in urbanized areas.

Validation of a Cytotechnologist Manual Counting Service for the Ki67 Index in Neuroendocrine Tumors of the Pancreas and Gastrointestinal Tract.

PubMed

Cottenden, Jennielee; Filter, Emily R; Cottreau, Jon; Moore, David; Bullock, Martin; Huang, Weei-Yuarn; Arnason, Thomas

2018-03-01

- Pathologists routinely assess Ki67 immunohistochemistry to grade gastrointestinal and pancreatic neuroendocrine tumors. Unfortunately, manual counts of the Ki67 index are very time consuming and eyeball estimation has been criticized as unreliable. Manual Ki67 counts performed by cytotechnologists could potentially save pathologist time and improve accuracy. - To assess the concordance between manual Ki67 index counts performed by cytotechnologists versus eyeball estimates and manual Ki67 counts by pathologists. - One Ki67 immunohistochemical stain was retrieved from each of 18 archived gastrointestinal or pancreatic neuroendocrine tumor resections. We compared pathologists' Ki67 eyeball estimates on glass slides and printed color images with manual counts performed by 3 cytotechnologists and gold standard manual Ki67 index counts by 3 pathologists. - Tumor grade agreement between pathologist image eyeball estimate and gold standard pathologist manual count was fair (κ = 0.31; 95% CI, 0.030-0.60). In 9 of 20 cases (45%), the mean pathologist eyeball estimate was 1 grade higher than the mean pathologist manual count. There was almost perfect agreement in classifying tumor grade between the mean cytotechnologist manual count and the mean pathologist manual count (κ = 0.910; 95% CI, 0.697-1.00). In 20 cases, there was only 1 grade disagreement between the 2 methods. Eyeball estimation by pathologists required less than 1 minute, whereas manual counts by pathologists required a mean of 17 minutes per case. - Eyeball estimation of the Ki67 index has a high rate of tumor grade misclassification compared with manual counting. Cytotechnologist manual counts are accurate and save pathologist time.

Establishing the value of occupational health nurses' contributions to worker health and safety: a pilot test of a user-friendly estimation tool.

PubMed

Graeve, Catherine; McGovern, Patricia; Nachreiner, Nancy M; Ayers, Lynn

2014-01-01

Occupational health nurses use their knowledge and skills to improve the health and safety of the working population; however, companies increasingly face budget constraints and may eliminate health and safety programs. Occupational health nurses must be prepared to document their services and outcomes, and use quantitative tools to demonstrate their value to employers. The aim of this project was to create and pilot test a quantitative tool for occupational health nurses to track their activities and potential cost savings for on-site occupational health nursing services. Tool developments included a pilot test in which semi-structured interviews with occupational health and safety leaders were conducted to identify currents issues and products used for estimating the value of occupational health nursing services. The outcome was the creation of a tool that estimates the economic value of occupational health nursing services. The feasibility and potential value of this tool is described.

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.

Chapter 10: Peak Demand and Time-Differentiated Energy Savings Cross-Cutting Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Stern, Frank; Spencer, Justin

Savings from electric energy efficiency measures and programs are often expressed in terms of annual energy and presented as kilowatt-hours per year (kWh/year). However, for a full assessment of the value of these savings, it is usually necessary to consider the measure or program's impact on peak demand as well as time-differentiated energy savings. This cross-cutting protocol describes methods for estimating the peak demand and time-differentiated energy impacts of measures implemented through energy efficiency programs.

Levonorgestrel Intrauterine Device as an Endometrial Cancer Prevention Strategy in Obese Women: A Cost-Effectiveness Analysis.

PubMed

Dottino, Joseph A; Hasselblad, Vic; Secord, Angeles Alvarez; Myers, Evan R; Chino, Junzo; Havrilesky, Laura J

2016-10-01

To estimate the cost-effectiveness of the levonorgestrel intrauterine device (IUD) as an endometrial cancer prevention strategy in obese women. A modified Markov model was used to compare IUD placement at age 50 with usual care among women with a body mass index (BMI, kg/m) 40 or greater or BMI 30 or greater. The effects of obesity on incidence and survival were incorporated. The IUD was assumed to confer a 50% reduction in cancer incidence over 5 years. Costs of IUD and cancer care were included. Clinical outcomes were cancer diagnosis and deaths from cancer. Incremental cost-effectiveness ratios were calculated in 2015 U.S. dollars per year of life saved. One-way and two-way sensitivity analyses and Monte Carlo probabilistic analyses were performed. For a 50 year old with BMI 40 or greater, the IUD strategy is costlier and more effective than usual care with an incremental cost-effectiveness ratio of $74,707 per year of life saved. If the protective effect of the levonorgestrel IUD is assumed to be 10 years, the incremental cost-effectiveness ratio decreases to $37,858 per year of life saved. In sensitivity analysis, a levonorgestrel IUD that reduces cancer incidence by at least 68% in women with BMIs of 40 or greater or costs less than $500 is potentially cost-effective. For BMI 30 or greater, the incremental cost-effectiveness ratio of IUD strategy is $137,223 per year of life saved compared with usual care. In Monte Carlo analysis, IUD placement for BMI 40 or greater is cost-effective in 50% of simulations at a willingness-to-pay threshold of $100,000 per year of life saved. The levonorgestrel IUD is a potentially cost-effective strategy for prevention of deaths from endometrial cancer in obese women.

Effects of Dram Shop, Responsible Beverage Service Training, and State Alcohol Control Laws on Underage Drinking Driver Fatal Crash Ratios.

PubMed

Scherer, Michael; Fell, James C; Thomas, Sue; Voas, Robert B

2015-01-01

In this study, we aimed to determine whether three minimum legal drinking age 21 (MLDA-21) laws-dram shop liability, responsible beverage service (RBS) training, and state control of alcohol sales-have had an impact on underage drinking and driving fatal crashes using annual state-level data, and compared states with strong laws to those with weak laws to examine their effect on beer consumption and fatal crash ratios. Using the Fatality Analysis Reporting System, we calculated the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes as our key outcome measure. We used structural equation modeling to evaluate the three MLDA-21 laws. We controlled for covariates known to impact fatal crashes including: 17 additional MLDA-21 laws; administrative license revocation; blood alcohol concentration limits of.08 and.10 for driving; seat belt laws; sobriety checkpoint frequency; unemployment rates; and vehicle miles traveled. Outcome variables, in addition to the fatal crash ratios of drinking to nondrinking drivers under age 21 included state per capita beer consumption. Dram shop liability laws were associated with a 2.4% total effect decrease (direct effects: β =.019, p =.018). Similarly, RBS training laws were associated with a 3.6% total effect decrease (direct effect: β =.048, p =.001) in the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes. There was a significant relationship between dram shop liability law strength and per capita beer consumption, F (4, 1528) = 24.32, p <.001, partial η(2) =.016, showing states with strong dram shop liability laws (Mean (M) = 1.276) averaging significantly lower per capita beer consumption than states with weak laws (M = 1.340). Dram shop liability laws and RBS laws were both associated with significantly reduced per capita beer consumption and fatal crash ratios. In practical terms, this means that dram shop liability laws are currently associated with saving an estimated 64 lives in the 45 jurisdictions that currently have the law. If the remaining 6 states adopted the dram shop law, an additional 9 lives could potentially be saved annually. Similarly, RBS training laws are associated with saving an estimated 83 lives in the 37 jurisdictions that currently have the laws. If the remaining 14 states adopted these RBS training laws, we estimate that an additional 28 lives could potentially be saved.

Effects of Dram Shop, Responsible Beverage Service Training, and State Alcohol Control Laws on Underage Drinking Driver Fatal Crash Ratios

PubMed Central

Scherer, Michael; Fell, James C.; Thomas, Sue; Voas, Robert B.

2015-01-01

Objectives In this study, we aimed to determine whether three minimum legal drinking age 21 (MLDA-21) laws—dram shop liability, responsible beverage service (RBS) training, and state control of alcohol sales—have had an impact on underage drinking-and-driving fatal crashes using annual state-level data, and compared states with strong laws to those with weak laws to examine their effect on beer consumption and fatal crash ratios. Methods Using the Fatality Analysis Reporting System, we calculated the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes as our key outcome measure. We used structural equation modeling to evaluate the three MLDA-21 laws. We controlled for covariates known to impact fatal crashes including: 17 additional MLDA-21 laws; administrative license revocation; blood alcohol concentration limits of .08 and .10 for driving; seat belt laws; sobriety checkpoint frequency; unemployment rates; and vehicle miles traveled. Outcome variables, in addition to the fatal crash ratios of drinking to nondrinking drivers under age 21 included state per capita beer consumption. Results Dram shop liability laws were associated with a 2.4% total effect decrease (direct effects: β = .019, p = .018). Similarly, RBS training laws were associated with a 3.6% total effect decrease (direct effects: β = .048, p = .001) in the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes. There was a significant relationship between dram shop liability law strength and per capita beer consumption, F (4, 1528) = 24.32, p < .001, partial η2 = .016, showing states with strong dram shop liability laws (Mean (M) = 1.276) averaging significantly lower per capita beer consumption than states with weak laws (M = 1.340). Conclusions Dram shop liability laws and RBS laws were both associated with significantly reduced per capita beer consumption and fatal crash ratios. In practical terms, this means that dram shop liability laws are currently associated with saving an estimated 64 lives in the 45 jurisdictions that currently have the law. If the remaining 6 states adopted the dram shop law, an additional 9 lives could potentially be saved annually. Similarly, RBS training laws are associated with saving an estimated 83 lives in the 37 jurisdictions that currently have the law. If the remaining 14 states adopted these RBS training laws, we estimate that an additional 28 lives could potentially be saved. PMID:26436244

How much could be saved in Chinese hospitals in procurement of anti-hypertensives and anti-diabetics?

PubMed

Sun, Jing; Ren, Luo; Wirtz, Veronika

2016-09-01

Efficient use of government funding has been increasingly relevant for the success and sustainability of ongoing health-system reform in China; however, as there is no generic substitution policy, patients and basic health-insurance programs pay more for public-preferred brand originators. Such phenomenon is especially typical in public hospitals. The objective of this study is to estimate the potential cost savings in procurement by Chinese public hospitals when switching from brand originators of anti-hypertensive and anti-diabetic medications to their generic equivalents between 2012-2014. IMS Health volume and value consumption data (IMS China Hospitals Audit system 2012-2014) were used, which covered all Chinese hospitals with 100 beds and above. The top 60% IMS volume consumption of respective anti-hypertensive and anti-diabetic medication with unique dosage form and strength were included. The potential cost savings were calculated from a switch of brand originators with their generic equivalents on the Chinese and international market. An independent sample t-test was conducted to compare the difference of proportion of cost savings in value between the Chinese and international market. An average of 44% (US$44 million) and 87% (US$90 million) and a total of US$1.4 and 2.8 billion (2014 US$) could be saved from a switch from originator brand anti-hypertensives and anti-diabetics to domestically and internationally available generic equivalents, respectively. The differences of cost savings (in proportion) between domestic and international market were statistically significant (α = 0.005, p = 0.003, p = 0.002, p = 0.000). Expensive brand originators dominated the anti-hypertensive and anti-diabetic market in Chinese hospitals between 2012-2014. Preference of brand originators wastes a huge amount of health resources in China and these limited resources could have been used more efficiently. As one of the world's key generic suppliers, if China wants to use its health resource more efficiently on medicines, comprehensive measures are needed to address both demand-side (consumers' low trust in the quality of local generics) and supply-side barriers (health professionals' preference of brand originators).

Evaluating large-scale blood transfusion therapy for the current Ebola epidemic in Liberia.

PubMed

Gutfraind, Alexander; Meyers, Lauren Ancel

2015-04-15

To combat the 2014-2015 Ebola virus disease (EVD) epidemic in West Africa, the World Health Organization urged the rapid evaluation of convalescent whole blood (CWB) and plasma (CP) transfusion therapy. However, the feasibility and likely impacts of broad implementation of transfusions are yet unknown. We extended an Ebola virus transmission model published by the Centers for Disease Control and Prevention to include hospital-based convalescent donations and transfusions. Using recent epidemiological estimates for EVD in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% (range, 7.5%-17.5%), we projected the impacts of a countrywide ramp-up of transfusion therapy. Under the 10% case-hospitalization rate estimated for Liberia in September 2014, large-scale CP therapy is expected to save 3586 lives by October 2015 (3.1% mortality reduction; 95% confidence interval [CI], .52%-4.5%). Under a higher 30% hospitalization rate, CP transfusions are expected to save 151 lives (0.9% of the total; 95% CI, .21%-11%). Transfusion therapy for EVD is a low-cost measure that can potentially save many lives in West Africa but will not measurably influence the prevalence. Under all scenarios considered, CP transfusions are predicted to achieve greater reductions in mortality than CWB. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model.

PubMed

Levy, D T; Benjakul, S; Ross, H; Ritthiphakdee, B

2008-02-01

With the male smoking prevalence near 60% in 1991, Thailand was one of the first Asian nations to implement strict tobacco control policies. However, the success of their efforts has not been well documented. The role of tobacco control policies are examined using the "SimSmoke" tobacco control model. We first validated the model against survey data on smoking prevalence. We then distinguished the effect of policies implemented between 1991 and 2006 from long-term trends in smoking rates. We also estimated smoking attributable deaths and lives saved as a result of the policies. The model validates well against survey data. The model shows that by the year 2006, policies implemented between 1991 and 2006 had already decreased smoking prevalence by 25% compared to what it would have been in the absence of the policies. Tax increases on cigarettes and advertising bans had the largest impact, followed by media anti-smoking campaigns, clean air laws and health warnings. The model estimates that the policies saved 31 867 lives by 2006 and will have saved 319,456 lives by 2026. The results document the success of Thailand in reducing smoking prevalence and reducing the number of lives lost to smoking, thereby showing the potential of tobacco control policies specifically in a middle-income country. Additional improvements can be realised through higher taxes, stronger clean air policies, comprehensive cessation treatment policies, and targeted media campaigns.

Long-term implications of sustained wind power growth in the United States: Direct electric system impacts and costs

DOE PAGES

Lantz, Eric; Mai, Trieu; Wiser, Ryan H.; ...

2016-07-22

This paper evaluates potential changes in the power system associated with sustained growth in wind generation in the United States to 35% of end-use demand by 2050; Wiser et al. (forthcoming) evaluates societal benefits and other impacts for this same scenario. Under reference or central conditions, the analysis finds cumulative wind capacity of 404 GW would be required to reach this level and drive 2050 incremental electricity rate and cumulative electric sector savings of 2% and 3%, respectively, relative to a scenario with no new wind capacity additions. Greater savings are estimated under higher fossil fuel costs or with greatermore » advancements in wind technologies. Conversely, incremental costs are found when fossil fuel costs are lower than central assumptions or wind technology improvements are more-limited. Through 2030 the primary generation sources displaced by new wind capacity include natural gas and coal-fired generation. By 2050 wind could displace other renewables. Incremental new transmission infrastructure totaling 29 million MW-miles is estimated to be needed by 2050. In conjunction with related societal benefits, this work demonstrates that 35% wind energy by 2050 is plausible, could support enduring benefits, and could result in long-term consumer savings, if nearer-term (pre-2030) cost barriers are overcome; at the same time, these opportunities are not anticipated to be realized in their full form under “business-as-usual” conditions.« less

Cost analysis of nursing home registered nurse staffing times.

PubMed

Dorr, David A; Horn, Susan D; Smout, Randall J

2005-05-01

To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

Data analytics for simplifying thermal efficiency planning in cities.

PubMed

Abdolhosseini Qomi, Mohammad Javad; Noshadravan, Arash; Sobstyl, Jake M; Toole, Jameson; Ferreira, Joseph; Pellenq, Roland J-M; Ulm, Franz-Josef; Gonzalez, Marta C

2016-04-01

More than 44% of building energy consumption in the USA is used for space heating and cooling, and this accounts for 20% of national CO2emissions. This prompts the need to identify among the 130 million households in the USA those with the greatest energy-saving potential and the associated costs of the path to reach that goal. Whereas current solutions address this problem by analysing each building in detail, we herein reduce the dimensionality of the problem by simplifying the calculations of energy losses in buildings. We present a novel inference method that can be used via a ranking algorithm that allows us to estimate the potential energy saving for heating purposes. To that end, we only need consumption from records of gas bills integrated with a building's footprint. The method entails a statistical screening of the intricate interplay between weather, infrastructural and residents' choice variables to determine building gas consumption and potential savings at a city scale. We derive a general statistical pattern of consumption in an urban settlement, reducing it to a set of the most influential buildings' parameters that operate locally. By way of example, the implications are explored using records of a set of (N= 6200) buildings in Cambridge, MA, USA, which indicate that retrofitting only 16% of buildings entails a 40% reduction in gas consumption of the whole building stock. We find that the inferred heat loss rate of buildings exhibits a power-law data distribution akin to Zipf's law, which provides a means to map an optimum path for gas savings per retrofit at a city scale. These findings have implications for improving the thermal efficiency of cities' building stock, as outlined by current policy efforts seeking to reduce home heating and cooling energy consumption and lower associated greenhouse gas emissions. © 2016 The Author(s).

Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis

PubMed Central

Mantilla-Herrera, Ana Maria; Veerman, Lennert; Backholer, Kathryn; Moodie, Marjory; Siahpush, Mohammad; Carter, Rob; Peeters, Anna

2017-01-01

Background A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. Methods and findings Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011–12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. Conclusions This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged quintiles in Australia. Whilst those in more disadvantaged areas would pay more SSB tax, the difference between areas is small. The equity of the tax could be further improved if the tax revenue were used to fund initiatives benefiting those with greater disadvantage. PMID:28654688

Energy-efficient drinking water disinfection for greenhouse gas mitigation

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

Gadgil, A.J.; Greene, D.M.; Rosenfeld, A.

Anecdotal evidence suggests that approximately one billion people worldwide use cookstoves to boil their drinking water. About half of this population is in China. Some populations (e.g. Jakarta) spend 1% of their GDP on boiling drinking water. Impoverished and/or ignorant populations not yet boiling their drinking water will do so when they can both afford it and understand the risks of unsafe drinking water. A recently developed water disinfection technology (UV Waterworks) can produce safe drinking water while earning tradable carbon credits (or credit as a clean development mechanism) when implemented as part of national energy, health, and carbon emissionsmore » trading policy, UV Waterworks uses approximately 6,000 times less energy than boiling over a biomass cookstove. Each unit that replaces boiling may save up to 175 or 300 tons/year of carbon-equivalent GHG emissions, depending on if it replaces sustainably harvested biomass (SHB) or non-SHB. For the approximately 500M Chinese boiling their drinking water over biomass (assumed SHB), this suggests a technical potential (that is, potential under the limiting case of 100% market adoption) of saving 87M tons/year of carbon-equivalent non-CO{sub 2} GHG emissions. The energy savings and corresponding emissions reductions will vary with cookstove fuels and stove efficiency: non-SHB and kerosene represent the most and least GHG-producing cookstove fuels, respectively, among those readily available to the populations of interest. The authors bracket the global technical potential for carbon emission reductions resulting from implementation of UV Waterworks, and estimate the value of tradable carbon credits earned from these reductions.« less

A Priori Estimation of Organic Reaction Yields

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

Emami, Fateme S.; Vahid, Amir; Wylie, Elizabeth K.

2015-07-21

A thermodynamically guided calculation of free energies of substrate and product molecules allows for the estimation of the yields of organic reactions. The non-ideality of the system and the solvent effects are taken into account through the activity coefficients calculated at the molecular level by perturbed-chain statistical associating fluid theory (PC-SAFT). The model is iteratively trained using a diverse set of reactions with yields that have been reported previously. This trained model can then estimate a priori the yields of reactions not included in the training set with an accuracy of ca. ±15 %. This ability has the potential tomore » translate into significant economic savings through the selection and then execution of only those reactions that can proceed in good yields.« less

The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention
.

PubMed

Masbah, Norliana; Macleod, Mary Joan

2017-03-01

Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Hospitalization records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospitalizations. Only 254 patients (39.4%) with confirmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically insignificant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.
.

The business case for One Health.

PubMed

Grace, Delia

2014-04-23

This article outlines a pathway to develop the business case for One Health. It describes the origin and development of One Health and then identifies five potential areas where One Health can add value and reduce costs. These are: (1) sharing health resources between the medical and veterinary sectors; (2) controlling zoonoses in animal reservoirs; (3) early detection and response to emerging diseases; (4) prevention of pandemics; and (5) generating insights and adding value to health research and development. Examples are given for each category along with preliminary estimates of the potential savings from adopting the One Health approach. The literature reviewed suggests that one dollar invested in One Health can generate five dollars worth of benefits and a global investment of US$25 billion over 10 years could generate benefits worth at least US$125 billion. Conservation implications: the time has come to make the bigger case for massive investment in One Health in order to transform the management of neglected and emerging zoonoses and to save the lives of millions of people and hundreds of millions of animals whose production supports and nourishes billions of impoverished people per annum.

The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.

PubMed

Zapata-Diomedi, Belen; Herrera, Ana Maria Mantilla; Veerman, J Lennert

2016-11-01

Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Shah, Nihar K.; Wei, Max; Letschert, Virginie

Hydrofluorocarbons (HFCs) emitted from uses such as refrigerants and thermal insulating foam, are now the fastest growing greenhouse gases (GHGs), with global warming potentials (GWP) thousands of times higher than carbon dioxide (CO2). Because of the short lifetime of these molecules in the atmosphere,1 mitigating the amount of these short-lived climate pollutants (SLCPs) provides a faster path to climate change mitigation than control of CO2 alone. This has led to proposals from Africa, Europe, India, Island States, and North America to amend the Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) to phase-down high-GWP HFCs. Simultaneously, energymore » efficiency market transformation programs such as standards, labeling and incentive programs are endeavoring to improve the energy efficiency for refrigeration and air conditioning equipment to provide life cycle cost, energy, GHG, and peak load savings. In this paper we provide an estimate of the magnitude of such GHG and peak electric load savings potential, for room air conditioning, if the refrigerant transition and energy efficiency improvement policies are implemented either separately or in parallel.« less

Advanced Sensors and Controls for Building Applications: Market Assessment and Potential R&D Pathways

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

Brambley, Michael R.; Haves, Philip; McDonald, Sean C.

2005-04-13

Significant energy savings can be achieved in commercial building operation, along with increased comfort and control for occupants, through the implementation of advanced technologies. This document provides a market assessment of existing building sensors and controls and presents a range of technology pathways (R&D options) for pursuing advanced sensors and building control strategies. This paper is actually a synthesis of five other white papers: the first describes the market assessment including estimates of market potential and energy savings for sensors and control strategies currently on the market as well as a discussion of market barriers to these technologies. The othermore » four cover technology pathways: (1) current applications and strategies for new applications, (2) sensors and controls, (3) networking, security, and protocols and standards, and (4) automated diagnostics, performance monitoring, commissioning, optimal control and tools. Each technology pathway chapter gives an overview of the technology or application. This is followed by a discussion of needs and the current status of the technology. Finally, a series of research topics is proposed.« less

Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project.

PubMed

Esperato, Alexo; Bishai, David; Hyder, Adnan A

2012-01-01

The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.

National Weatherization Assistance Program Impact Evaluation: Energy Impacts for Large Multifamily Buildings

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

Blasnik, Michael; Dalhoff, Greg; Carroll, David

This report estimates energy savings, energy cost savings, and cost effectiveness attributable to weatherizing large multifamily buildings under the auspices of the Department of Energy's Weatherization Assistance Program during Program Year 2008.

National Weatherization Assistance Program Impact Evaluation: Energy Impacts for Small Multifamily Buildings

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

Blasnik, Michael; Dalhoff, Greg; Carroll, David

2014-09-01

This report estimates energy savings, energy cost savings, and cost effectiveness attributable to weatherizing small multifamily buildings under the auspices of the Department of Energy's Weatherization Assistance Program during Program Year 2008.

Toward an energy efficient community

NASA Astrophysics Data System (ADS)

Horn, M.

1980-10-01

The current oil policy of the OPEC countries means that a substantial oil shortage may be expected in the future. Conservative estimates indicate an oil shortage of 65 billion tons in the year 2000. The results of numerous new studies show that (from the technological point of view) the savings potential is high enough to achieve an absolute decrease in total energy consumption by the year 2000, provided better use is made of secondary energy sources in the form of electric power, gas, and solar heat.

Retail Building Guide for Entrance Energy Efficiency Measures

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

Stein, J.; Kung, F.

2012-03-01

This booklet is based on the findings of an infiltration analysis for supermarkets and large retail buildings without refrigerated cases. It enables retail building managers and engineers to calculate the energy savings potential for vestibule additions for supermarkets; and bay door operation changes in large retail stores without refrigerated cases. Retail managers can use initial estimates to decide whether to engage vendors or contractors of vestibules for pricing or site-specific analyses, or to decide whether to test bay door operation changes in pilot stores, respectively.

Using learning curves on energy-efficient technologies to estimate future energy savings and emission reduction potentials in the U.S. iron and steel industry

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

Karali, Nihan; Park, Won Young; McNeil, Michael A.

Increasing concerns on non-sustainable energy use and climate change spur a growing research interest in energy efficiency potentials in various critical areas such as industrial production. This paper focuses on learning curve aspects of energy efficiency measures in the U.S iron and steel sector. A number of early-stage efficient technologies (i.e., emerging or demonstration technologies) are technically feasible and have the potential to make a significant contribution to energy saving and CO 2 emissions reduction, but fall short economically to be included. However, they may also have the cost effective potential for significant cost reduction and/or performance improvement in themore » future under learning effects such as ‘learning-by-doing’. The investigation is carried out using ISEEM, a technology oriented, linear optimization model. We investigated how steel demand is balanced with/without the availability learning curve, compared to a Reference scenario. The retrofit (or investment in some cases) costs of energy efficient technologies decline in the scenario where learning curve is applied. The analysis also addresses market penetration of energy efficient technologies, energy saving, and CO 2 emissions in the U.S. iron and steel sector with/without learning impact. Accordingly, the study helps those who use energy models better manage the price barriers preventing unrealistic diffusion of energy-efficiency technologies, better understand the market and learning system involved, predict future achievable learning rates more accurately, and project future savings via energy-efficiency technologies with presence of learning. We conclude from our analysis that, most of the existing energy efficiency technologies that are currently used in the U.S. iron and steel sector are cost effective. Penetration levels increases through the years, even though there is no price reduction. However, demonstration technologies are not economically feasible in the U.S. iron and steel sector with the current cost structure. In contrast, some of the demonstration technologies are adapted in the mid-term and their penetration levels increase as the prices go down with learning curve. We also observe large penetration of 225kg pulverized coal injection with the presence of learning.« less

Direct Government Lending: The Bottom Line. A Critique of GAO's Report on Guaranteed Student Loans versus Direct Lending and Revised Savings Estimates.

ERIC Educational Resources Information Center

Quick, Perry D.

This report addresses the dollar savings described in the Government Accounting Office's (GAO) report supporting direct lending as opposed to the present guaranteed student loan program. The critique explains the changes in the GAO model assumptions and projections that are believed necessary to move from the original $4.8 billion savings to a…

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.

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.

Managing prices for hospital pharmaceuticals: a successful strategy for New Zealand?

PubMed

Tordoff, June M; Norris, Pauline T; Reith, David M

2005-01-01

In 2002, as part of a National Hospital Pharmaceutical Strategy, the New Zealand (NZ) government agency PHARMAC commenced a 3-year period of negotiating prices for 90% of hospital pharmaceuticals on behalf of all NZ public hospitals. The present study was undertaken to determine the effects of this first year of "pooled procurement." Using price changes and volume data for each of their top 150 pharmaceutical items, chief pharmacists at 11 public hospitals calculated projected cost savings for the financial year July 2003 to June 2004. Researchers calculated total projected savings for all 11 hospitals, and for three types of hospitals. Estimates of projected savings were made for all 29 major public hospitals by using savings per bed and savings per bed-day. A sensitivity analysis was undertaken. Items showing savings were categorized by using the Anatomical Therapeutic Chemical classification system. For the 11 hospitals, the top 150 items comprised 612 different items. Projected savings for 2003 to 2004 were NZ dollar 2,652,814, NZ dollar 658,984, and NZ dollar 127,952 for tertiary, secondary, and rural/special hospitals, respectively. Percentage savings as a median (range) of the total top 150 expenditure were: tertiary 5.28% (3.09-16.05%), secondary 7.41% (4.67-12.85%), and rural/special 9.55% (6.27-10.09%). For all 29 hospitals, estimated projected savings were NZ dollar 5,234,919 (NZ dollar 3,304,606-NZ dollar 8,044,482) by savings per bed, and NZ dollar 5,255,781 (NZ dollar 2,936,850-NZ dollar 8,693,239) by savings per bed-day. The main contributors to savings were: agents for infections, the nervous system, musculoskeletal system, and blood/blood-forming organs. The first year of pooled procurement under the National Hospital Pharmaceutical Strategy (2002-2003) has resulted in moderate savings. For all 29 major public hospitals, savings of around NZ dollar 5.2 million (dollar 2.9 million-dollar 8.7 million) or 3.7% were projected for 2003 to 2004. Longer-term effects, however, on patient outcomes and availability of pharmaceuticals, as well as on pharmaceutical expenditure, have yet to be evaluated.

Estimated time of arrival and debiasing the time saving bias.

PubMed

Eriksson, Gabriella; Patten, Christopher J D; Svenson, Ola; Eriksson, Lars

2015-01-01

The time saving bias predicts that the time saved when increasing speed from a high speed is overestimated, and underestimated when increasing speed from a slow speed. In a questionnaire, time saving judgements were investigated when information of estimated time to arrival was provided. In an active driving task, an alternative meter indicating the inverted speed was used to debias judgements. The simulated task was to first drive a distance at a given speed, and then drive the same distance again at the speed the driver judged was required to gain exactly 3 min in travel time compared with the first drive. A control group performed the same task with a speedometer and saved less than the targeted 3 min when increasing speed from a high speed, and more than 3 min when increasing from a low speed. Participants in the alternative meter condition were closer to the target. The two studies corroborate a time saving bias and show that biased intuitive judgements can be debiased by displaying the inverted speed. Practitioner Summary: Previous studies have shown a cognitive bias in judgements of the time saved by increasing speed. This simulator study aims to improve driver judgements by introducing a speedometer indicating the inverted speed in active driving. The results show that the bias can be reduced by presenting the inverted speed and this finding can be used when designing in-car information systems.

[Direct costs of diabetes mellitus in Germany: first estimation of the differences related to educational level].

PubMed

Korber, K; Teuner, C M; Lampert, T; Mielck, A; Leidl, R

2013-12-01

There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective. Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level. The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs. The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative. © Georg Thieme Verlag KG Stuttgart · New York.

Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

PubMed

Rottenkolber, Dominik; Schmiedl, Sven; Rottenkolber, Marietta; Farker, Katrin; Saljé, Karen; Mueller, Silke; Hippius, Marion; Thuermann, Petra A; Hasford, Joerg

2011-06-01

German hospital reimbursement modalities changed as a result of the introduction of Diagnosis Related Groups (DRG) in 2004. Therefore, no data on the direct costs of adverse drug reactions (ADRs) resulting in admissions to departments of internal medicine are available. The objective was to quantify the ADR-related economic burden (direct costs) of hospitalizations in internal medicine wards in Germany. Record-based study analyzing the patient records of about 57,000 hospitalizations between 2006 and 2007 of the Net of Regional Pharmacovigilance Centers (Germany). All ADRs were evaluated by a team of experts in pharmacovigilance for severity, causality, and preventability. The calculation of accurate person-related costs for ADRs relied on the German DRG system (G-DRG 2009). Descriptive and bootstrap statistical methods were applied for data analysis. The incidence of hospitalization due to at least 'possible' serious outpatient ADRs was estimated to be approximately 3.25%. Mean age of the 1834 patients was 71.0 years (SD 14.7). Most frequent ADRs were gastrointestinal hemorrhage (n = 336) and drug-induced hypoglycemia (n = 270). Average inpatient length-of-stay was 9.3 days (SD 7.1). Average treatment costs of a single ADR were estimated to be approximately €2250. The total costs sum to €434 million per year for Germany. Considering the proportion of preventable cases (20.1%), this equals a saving potential of €87 million per year. Preventing ADRs is advisable in order to realize significant nationwide savings potential. Our cost estimates provide a reliable benchmark as they were calculated based on an intensified ADR surveillance and an accurate person-related cost application. Copyright © 2011 John Wiley & Sons, Ltd.

Cost implications of implementation of pathogen-inactivated platelets

PubMed Central

McCullough, Jeffrey; Goldfinger, Dennis; Gorlin, Jed; Riley, William J; Sandhu, Harpreet; Stowell, Christopher; Ward, Dawn; Clay, Mary; Pulkrabek, Shelley; Chrebtow, Vera; Stassinopoulos, Adonis

2015-01-01

BACKGROUND Pathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact. STUDY DESIGN AND METHODS Cost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing 1) special requests and 2) test results, 3) quality control and proficiency testing, 4) equipment acquisition and maintenance, 5) replacement of units lost to positive tests, 6) seasonal or geographic testing, and 7) health department interactions. RESULTS All costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage. CONCLUSIONS While PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing. PMID:25989465

Cost implications of implementation of pathogen-inactivated platelets.

PubMed

McCullough, Jeffrey; Goldfinger, Dennis; Gorlin, Jed; Riley, William J; Sandhu, Harpreet; Stowell, Christopher; Ward, Dawn; Clay, Mary; Pulkrabek, Shelley; Chrebtow, Vera; Stassinopoulos, Adonis

2015-10-01

Pathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact. Cost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing (1) special requests and (2) test results, (3) quality control and proficiency testing, (4) equipment acquisition and maintenance, (5) replacement of units lost to positive tests, (6) seasonal or geographic testing, and (7) health department interactions. All costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage. While PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing. © 2015 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness.

PubMed

Asfaw, Abay; Rosa, Roger; Pana-Cryan, Regina

2017-09-01

Most U.S. employers are not required to provide paid sick leave (PSL), and there is limited information on the economic return of providing PSL. We estimated potential benefits to employers of PSL in reducing absenteeism related to the spread of influenza-like illness (ILI). We used nationally representative data and a negative binomial random effects model to estimate the impact of PSL in reducing overall absence due to illness or injury. We used published data to compute the share of ILI from the total days of absence, ILI transmission rates at workplaces, wages, and other parameters. Providing PSL could have saved employers $0.63 to $1.88 billion in reduced ILI-related absenteeism costs per year during 2007 to 2014 in 2016 dollars. These findings might help employers consider PSL as an investment rather than as a cost without any return.

Household water use and conservation models using Monte Carlo techniques

NASA Astrophysics Data System (ADS)

Cahill, R.; Lund, J. R.; DeOreo, B.; Medellín-Azuara, J.

2013-10-01

The increased availability of end use measurement studies allows for mechanistic and detailed approaches to estimating household water demand and conservation potential. This study simulates water use in a single-family residential neighborhood using end-water-use parameter probability distributions generated from Monte Carlo sampling. This model represents existing water use conditions in 2010 and is calibrated to 2006-2011 metered data. A two-stage mixed integer optimization model is then developed to estimate the least-cost combination of long- and short-term conservation actions for each household. This least-cost conservation model provides an estimate of the upper bound of reasonable conservation potential for varying pricing and rebate conditions. The models were adapted from previous work in Jordan and are applied to a neighborhood in San Ramon, California in the eastern San Francisco Bay Area. The existing conditions model produces seasonal use results very close to the metered data. The least-cost conservation model suggests clothes washer rebates are among most cost-effective rebate programs for indoor uses. Retrofit of faucets and toilets is also cost-effective and holds the highest potential for water savings from indoor uses. This mechanistic modeling approach can improve understanding of water demand and estimate cost-effectiveness of water conservation programs.

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.

Comparative analysis of operational forecasts versus actual weather conditions in airline flight planning, volume 1

NASA Technical Reports Server (NTRS)

Keitz, J. F.

1982-01-01

The impact of more timely and accurate weather data on airline flight planning with the emphasis on fuel savings is studied. This volume of the report discusses the results of Task 1 of the four major tasks included in the study. Task 1 compares flight plans based on forecasts with plans based on the verifying analysis from 33 days during the summer and fall of 1979. The comparisons show that: (1) potential fuel savings conservatively estimated to be between 1.2 and 2.5 percent could result from using more timely and accurate weather data in flight planning and route selection; (2) the Suitland forecast generally underestimates wind speeds; and (3) the track selection methodology of many airlines operating on the North Atlantic may not be optimum resulting in their selecting other than the optimum North Atlantic Organized Track about 50 percent of the time.

Potential time savings to radiology department personnel in a PACS-based environment

NASA Astrophysics Data System (ADS)

Saarinen, Allan O.; Wilson, M. C.; Iverson, Scott C.; Loop, John W.

1990-08-01

A purported benefit of digital imaging and archiving of radiographic procedures is the presumption of time savings to radiologists, radiology technologists, and radiology departmentpersonnel involved with processingfilms and managing theflimfile room. As part of the University of Washington's evaluation of Picture Archiving and Communication Systems (PACS)for the U.S. Army Medical Research and Development Command, a study was performed which evaluated the current operationalpractices of the film-based radiology department at the University of Washington Medical Center (UWMC). Industrial engineering time and motion studies were conducted to document the length of time requiredforfilm processing in various modalities, the proportion of the total exam time usedforfilm processing, the amount of time radiologists spent searchingfor and looking at images, and the amount of time file room personnel spent collating reports, making loans, updatingfilm jacket information, and purging files. This evaluation showed that better than one-half of the tasks in the file room may be eliminated with PACS and radiologists may save easily 10 percent of the time they spend reading films by no longer having to searchforfilms. Radiology technologists may also save as much as 10 percent of their time with PACS, although this estimate is subject to significant patient mix aberrations and measurement error. Given that the UWMC radiology department operates efficiently, similar improvements are forecast for other radiology departments and larger improvements areforecastfor less efficient departments.

ACHP | Sustainability and Historic Preservation Links

Science.gov Websites

Energy) Realizing the Energy Efficiency Potential of Small Buildings: Saving Energy, Money and Jobs Improving the Energy Efficiency of Historic Buildings (National Park Service) Saving Windows, Saving Money

A framework for improving the cost-effectiveness of DSM program evaluations

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

Sonnenblick, R.; Eto, J.

The prudence of utility demand-side management (DSM) investments hinges on their performance, yet evaluating performance is complicated because the energy saved by DSM programs can never be observed directly but only inferred. This study frames and begins to answer the following questions: (1) how well do current evaluation methods perform in improving confidence in the measurement of energy savings produced by DSM programs; (2) in view of this performance, how can limited evaluation resources be best allocated to maximize the value of the information they provide? The authors review three major classes of methods for estimating annual energy savings: trackingmore » database (sometimes called engineering estimates), end-use metering, and billing analysis and examine them in light of the uncertainties in current estimates of DSM program measure lifetimes. The authors assess the accuracy and precision of each method and construct trade-off curves to examine the costs of increases in accuracy or precision. Several approaches for improving evaluations for the purpose of assessing program cost effectiveness are demonstrated. The methods can be easily generalized to other evaluation objectives, such as shared savings incentive payments.« less

Potential gains from hospital mergers in Denmark.

PubMed

Kristensen, Troels; Bogetoft, Peter; Pedersen, Kjeld Moeller

2010-12-01

The Danish hospital sector faces a major rebuilding program to centralize activity in fewer and larger hospitals. We aim to conduct an efficiency analysis of hospitals and to estimate the potential cost savings from the planned hospital mergers. We use Data Envelopment Analysis (DEA) to estimate a cost frontier. Based on this analysis, we calculate an efficiency score for each hospital and estimate the potential gains from the proposed mergers by comparing individual efficiencies with the efficiency of the combined hospitals. Furthermore, we apply a decomposition algorithm to split merger gains into technical efficiency, size (scale) and harmony (mix) gains. The motivation for this decomposition is that some of the apparent merger gains may actually be available with less than a full-scale merger, e.g., by sharing best practices and reallocating certain resources and tasks. Our results suggest that many hospitals are technically inefficient, and the expected "best practice" hospitals are quite efficient. Also, some mergers do not seem to lower costs. This finding indicates that some merged hospitals become too large and therefore experience diseconomies of scale. Other mergers lead to considerable cost reductions; we find potential gains resulting from learning better practices and the exploitation of economies of scope. To ensure robustness, we conduct a sensitivity analysis using two alternative returns-to-scale assumptions and two alternative estimation approaches. We consistently find potential gains from improving the technical efficiency and the exploitation of economies of scope from mergers.

Energy Cost Impact of Non-Residential Energy Code Requirements

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

Zhang, Jian; Hart, Philip R.; Rosenberg, Michael I.

2016-08-22

The 2012 International Energy Conservation Code contains 396 separate requirements applicable to non-residential buildings; however, there is no systematic analysis of the energy cost impact of each requirement. Consequently, limited code department budgets for plan review, inspection, and training cannot be focused on the most impactful items. An inventory and ranking of code requirements based on their potential energy cost impact is under development. The initial phase focuses on office buildings with simple HVAC systems in climate zone 4C. Prototype building simulations were used to estimate the energy cost impact of varying levels of non-compliance. A preliminary estimate of themore » probability of occurrence of each level of non-compliance was combined with the estimated lost savings for each level to rank the requirements according to expected savings impact. The methodology to develop and refine further energy cost impacts, specific to building type, system type, and climate location is demonstrated. As results are developed, an innovative alternative method for compliance verification can focus efforts so only the most impactful requirements from an energy cost perspective are verified for every building and a subset of the less impactful requirements are verified on a random basis across a building population. The results can be further applied in prioritizing training material development and specific areas of building official training.« less

Cost-utility of enoxaparin compared with unfractionated heparin in unstable coronary artery disease

PubMed Central

Nicholson, Tricia; McGuire, Alistair; Milne, Ruairidh

2001-01-01

Background Low molecular weight heparins hold several advantages over unfractionated heparin including convenience of administration. Enoxaparin is one such heparin licensed in the UK for use in unstable coronary artery disease (unstable stable angina and non-Q wave myocardial infarction). In these patients, two large randomised controlled trials and their meta-analysis showed small benefits for enoxaparin over unfractionated heparin at 30–43 days and potentially at one year. We found no relevant published full economic evaluations, only cost studies, one of which was conducted in the UK. The other studies, from the US, Canada and France, are difficult to interpret since their resource use and costs may not reflect UK practice. Methods We aimed to compare the benefits and costs of short-term treatment (two to eight days) with enoxaparin and unfractionated heparin in unstable coronary artery disease. We used published data sources to estimate the incremental cost per quality adjusted life year (QALY), adopting a NHS perspective and using 1998 prices. Results The base case was a 0.013 QALY gain and net cost saving of £317 per person treated with enoxaparin instead of unfractionated heparin. All but one sensitivity analysis showed net savings and QALY gains, the exception (the worst case) being a cost per QALY of £3,305. Best cases were a £495 saving and 0.013 QALY gain, or a £317 saving and 0.014 QALY gain per person. Conclusions Enoxaparin appears cost saving compared with unfractionated heparin in patients with unstable coronary artery disease. However, cost implications depend on local revascularisation practice. PMID:11701090

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

PubMed

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

2017-04-27

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

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

PubMed

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

2015-04-01

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

Are there financial savings associated with supplementing current diagnostic practice for preeclampsia with a novel test? Learnings from a modeling analysis from a German payer perspective.

PubMed

Hadker, Nandini; Garg, Suchita; Costanzo, Cory; van der Helm, Wim; Creeden, James

2013-05-01

To quantify the financial impact of adding a novel serum test to the current diagnostic toolkit for preeclampsia (PE) detection in Germany. A decision-analytic model was created to quantify the economic impact of adding a recently developed novel diagnostic test for PE (Roche Diagnostics, Rotkreuz, Switzerland) to current diagnostic practice in Germany. The model simulated a cohort of 1000 pregnant patients receiving obstetric care and quantified the budget impact of adding the novel test to current German PE detection and management practices. The model estimates that the costs associated with managing a typical pregnancy in Germany are €941 when the novel test is used versus €1579 with standard practice. This represents savings of €637 per pregnant woman, even when the test is used as a supplementary diagnostic tool. The savings are attributed to the novel test's ability to better classify patients relative to current practice, specifically, its ability to reduce false negatives by 67% and false positives by 71%. The novel PE test has the potential to provide substantial cost savings to German healthcare payers, even when used as an addition to standard practice. Better classification of patients at risk for developing PE and declassification of those that are not compared to current practice leads to economic savings for the healthcare system. Furthermore, by reducing the rates of false-positive and false-negative classification relative to current standard of care, the test helps better target healthcare spending and lowers overall costs associated with PE care.

Performance evaluation of radiant cooling system integrated with air system under different operational strategies

DOE PAGES

Khan, Yasin; Khare, Vaibhav Rai; Mathur, Jyotirmay; ...

2015-03-26

The paper describes a parametric study developed to estimate the energy savings potential of a radiant cooling system installed in a commercial building in India. The study is based on numerical modeling of a radiant cooling system installed in an Information Technology (IT) office building sited in the composite climate of Hyderabad. To evaluate thermal performance and energy consumption, simulations were carried out using the ANSYS FLUENT and EnergyPlus softwares, respectively. The building model was calibrated using the measured data for the installed radiant system. Then this calibrated model was used to simulate the energy consumption of a building usingmore » a conventional all-air system to determine the proportional energy savings. For proper handling of the latent load, a dedicated outside air system (DOAS) was used as an alternative to Fan Coil Unit (FCU). A comparison of energy consumption calculated that the radiant system was 17.5 % more efficient than a conventional all-air system and that a 30% savings was achieved by using a DOAS system compared with a conventional system. Computational Fluid Dynamics (CFD) simulation was performed to evaluate indoor air quality and thermal comfort. It was found that a radiant system offers more uniform temperatures, as well as a better mean air temperature range, than a conventional system. To further enhance the energy savings in the radiant system, different operational strategies were analyzed based on thermal analysis using EnergyPlus. Lastly, the energy savings achieved in this parametric run were more than 10% compared with a conventional all-air system.« less

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.

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

High-pitch computed tomography coronary angiography-a new dose-saving algorithm: estimation of radiation exposure.

PubMed

Ketelsen, Dominik; Buchgeister, Markus; Korn, Andreas; Fenchel, Michael; Schmidt, Bernhard; Flohr, Thomas G; Thomas, Christoph; Schabel, Christoph; Tsiflikas, Ilias; Syha, Roland; Claussen, Claus D; Heuschmid, Martin

2012-01-01

Purpose. To estimate effective dose and organ equivalent doses of prospective ECG-triggered high-pitch CTCA. Materials and Methods. For dose measurements, an Alderson-Rando phantom equipped with thermoluminescent dosimeters was used. The effective dose was calculated according to ICRP 103. Exposure was performed on a second-generation dual-source scanner (SOMATOM Definition Flash, Siemens Medical Solutions, Germany). The following scan parameters were used: 320 mAs per rotation, 100 and 120 kV, pitch 3.4 for prospectively ECG-triggered high-pitch CTCA, scan range of 13.5 cm, collimation 64 × 2 × 0.6 mm with z-flying focal spot, gantry rotation time 280 ms, and simulated heart rate of 60 beats per minute. Results. Depending on the applied tube potential, the effective whole-body dose of the cardiac scan ranged from 1.1 mSv to 1.6 mSv and from 1.2 to 1.8 mSv for males and females, respectively. The radiosensitive breast tissue in the range of the primary beam caused an increased female-specific effective dose of 8.6%±0.3% compared to males. Decreasing the tube potential, a significant reduction of the effective dose of 35.8% and 36.0% can be achieved for males and females, respectively (P < 0.001). Conclusion. The radiologist and the CT technician should be aware of this new dose-saving strategy to keep the radiation exposure as low as reasonablly achievable.

Potentially avoidable hospitalisation for constipation in Victoria, Australia in 2010-11.

PubMed

Ansari, Humaira; Ansari, Zahid; Hutson, John M; Southwell, Bridget R

2014-07-11

When primary care of constipation fails, the patient may need emergency hospitalisation for disimpaction. This study aimed to provide population-based data on the number of unplanned admissions and the cost to the healthcare system for constipation in Victoria, Australia in financial year 2010-11. The Victorian Admitted Episodes Dataset was examined to find the number of emergency hospital separations coded as constipation (ICD-10-AM Code K390). An estimate of costs was determined from the number of weighted inlier equivalent separations (WIES) multiplied by the WEIS price, used by the Victorian Government for funding purposes. There were 3978 emergency separations for constipation in Victoria in 2010-2011, 92% in public hospitals. Fifty-five percent were female and 38% > 75 years old. One third stayed overnight and 1/3 more than 1 day. The emergency bed day rate was 7.1 per 10,000 of population. The estimate of cost, based on WEIS, was approximately $8.3 million. Potential savings could be made by reducing the number of separations in 6 Local Government Areas (LGAs). This study shows that the burden (in number of admissions, emergency bed days and overall direct costs) in managing emergency admissions for constipation in Victoria, Australia, is very significant and likely to be similar in other developed countries. Improved primary healthcare and alternative ways to achieve faecal disimpaction without emergency admission could save the public health system a proportion of this $8.3 million.

Economic evaluation of an oral rabies vaccination program for control of a domestic dog-coyote rabies epizootic: 1995-2006.

PubMed

Shwiff, Stephanie A; Kirkpatrick, Katy N; Sterner, Ray T

2008-12-01

To conduct a benefit-cost analysis of the results of the domestic dog and coyote (DDC) oral rabies vaccine (ORV) program in Texas from 1995 through 2006 by use of fiscal records and relevant public health data. Retrospective benefit-cost analysis. Procedures-Pertinent economic data were collected in 20 counties of south Texas affected by a DDC-variant rabies epizootic. The costs and benefits afforded by a DDC ORV program were then calculated. Costs were the total expenditures of the ORV program. Benefits were the savings associated with the number of potentially prevented human postexposure prophylaxis (PEP) treatments and animal rabies tests for the DDC-variant rabies virus in the epizootic area and an area of potential disease expansion. Total estimated benefits of the program approximately ranged from $89 million to $346 million, with total program costs of $26,358,221 for the study period. The estimated savings (ie, damages avoided) from extrapolated numbers of PEP treatments and animal rabies tests yielded benefit-cost ratios that ranged from 3.38 to 13.12 for various frequen-cies of PEP and animal testing. In Texas, the use of ORV stopped the northward spread and led to the progressive elimination of the DDC variant of rabies in coyotes (Canis latrans). The decision to implement an ORV program was cost-efficient, although many unknowns were involved in the original decision, and key economic variables were identified for consideration in future planning of ORV programs.

Incidence and Prevalence of Opportunistic and Other Infections and the Impact of Antiretroviral Therapy Among HIV-infected Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis

PubMed Central

B-Lajoie, Marie-Renée; Drouin, Olivier; Bartlett, Gillian; Nguyen, Quynh; Low, Andrea; Gavriilidis, Georgios; Easterbrook, Philippa; Muhe, Lulu

2016-01-01

Background. We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)–infected children (aged <18 years) in low- and middle-income countries (LMICs), to understand regional burden of disease, and inform delivery of HIV services. Methods. Eligible studies described the incidence of OIs and other infections in ART-naive and -exposed children from January 1990 to November 2013, using Medline, Global Health, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases. Summary incident risk (IR) and prevalent risk for each OI in ART-naive and ART-exposed children were calculated, and unadjusted odds ratios calculated for impact of ART. The number of OI cases and associated costs averted were estimated using the AIDS impact model. Results. We identified 4542 citations, and 88 studies were included, comprising 55 679 HIV-infected children. Bacterial pneumonia and tuberculosis were the most common incident and prevalent infections in both ART-naive and ART-exposed children. There was a significant reduction in IR with ART for the majority of OIs. There was a smaller impact on bacterial sepsis and pneumonia, and an increase observed for varicella zoster. ART initiation based on 2010 World Health Organization guidelines criteria for ART initiation in children was estimated to potentially avert >161 000 OIs (2013 UNAIDS data) with estimated cost savings of at least US$17 million per year. Conclusions. There is a decrease in the risk of most OIs with ART use in HIV-infected children in LMICs, and estimated large potential cost savings in OIs averted with ART use, although there are greater uncertainties in pediatric data compared with that of adults. PMID:27001796

Achieving energy efficiency during collective communications

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

Sundriyal, Vaibhav; Sosonkina, Masha; Zhang, Zhao

2012-09-13

Energy consumption has become a major design constraint in modern computing systems. With the advent of petaflops architectures, power-efficient software stacks have become imperative for scalability. Techniques such as dynamic voltage and frequency scaling (called DVFS) and CPU clock modulation (called throttling) are often used to reduce the power consumption of the compute nodes. To avoid significant performance losses, these techniques should be used judiciously during parallel application execution. For example, its communication phases may be good candidates to apply the DVFS and CPU throttling without incurring a considerable performance loss. They are often considered as indivisible operations although littlemore » attention is being devoted to the energy saving potential of their algorithmic steps. In this work, two important collective communication operations, all-to-all and allgather, are investigated as to their augmentation with energy saving strategies on the per-call basis. The experiments prove the viability of such a fine-grain approach. They also validate a theoretical power consumption estimate for multicore nodes proposed here. While keeping the performance loss low, the obtained energy savings were always significantly higher than those achieved when DVFS or throttling were switched on across the entire application run« less

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

The long term financial impacts of CVD: living standards in retirement.

PubMed

Schofield, Deborah; Kelly, Simon; Shrestha, Rupendra; Passey, Megan; Callander, Emily; Percival, Richard

2012-03-22

Cardiovascular disease (CVD) has significant economic costs, however these are generally estimated for the present-time and little consideration is given to the long term economic consequences. This study estimates the value of savings those who retire early due to CVD will have accumulated by the time they reach the traditional retirement age of 65 years, and how much lower the value of these savings are compared to those who remained healthy and in the workforce. Using Health&WealthMOD - a microsimulation model of Australians aged 45 to 64 years, regression models were used to analyse the differences between the projected savings and the retirement incomes of people by the time they reach age 65 for those currently working with no chronic condition, and people not in the labour force due to CVD. Over 99% of individuals who are employed full-time will have accumulated some savings at age 65; whereas only 77% of those who are out of the labour force due to CVD will have done so. Those who retire early due to CVD will have a median value of total savings by the time they are 65 of $1833. This is far lower than the expected median value of savings for those who remained in the labour force full-time, who will have $281841 of savings. Not only will early retirement due to cardiovascular disease limit the immediate income and wealth available to individuals, but also reduce their long term financial capacity by reducing their savings. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Cost-effectiveness analysis of eliminating industrial and all trans fats in England and Wales: modelling study.

PubMed

Pearson-Stuttard, Jonathan; Hooton, William; Critchley, Julia; Capewell, Simon; Collins, Marissa; Mason, Helen; Guzman-Castillo, Maria; O'Flaherty, Martin

2017-09-01

Coronary heart disease (CHD) remains a leading cause of UK mortality. Dietary trans fats (TFA) represent a powerful CHD risk factor. However, UK efforts to reduce intake have been less successful than other nations. We modelled the potential health and economic effects of eliminating industrial and all TFA up to 2020. We extended the previously validated IMPACTsec model, to estimate the potential effects on health and economic outcomes of mandatory reformulation or a complete ban on dietary TFA in England and Wales from 2011 to 2020. We modelled two policy scenarios: 1) Elimination of industrial TFA consumption, from 0.8% to 0.4% daily energy 2) Elimination of all TFA consumption, from 0.8% to 0. Elimination of industrial TFA across the England and Wales population could result in approximately 1600 fewer deaths per year, with some 4000 fewer hospital admissions; gaining approximately 14 000 additional life years. Health inequalities would be substantially reduced in both scenarios. Elimination of industrial TFA would be cost saving. This would include approximately £100 m saved in direct healthcare costs. Elimination of all TFA would double the health and economic gains. Eliminating industrial or all UK dietary intake of TFA could substantially reduce CHD mortality and inequalities, while resulting in substantial annual savings. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Cost-effectiveness of traffic enforcement: case study from Uganda.

PubMed

Bishai, D; Asiimwe, B; Abbas, S; Hyder, A A; Bazeyo, W

2008-08-01

In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at $72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17% drop in road deaths after the intervention. The average cost-effectiveness of better road safety enforcement in Uganda is $603 per death averted or $27 per life year saved discounted at 3% (equivalent to 9% of Uganda's $300 GDP per capita). The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective.

A meta-analysis of the greenhouse gas abatement of bioenergy factoring in land use changes.

PubMed

El Akkari, M; Réchauchère, O; Bispo, A; Gabrielle, B; Makowski, D

2018-06-04

Non-food biomass production is developing rapidly to fuel the bioenergy sector and substitute dwindling fossil resources, which is likely to impact land-use patterns worldwide. Recent publications attempting to factor this effect into the climate mitigation potential of bioenergy chains have come to widely variable conclusions depending on their scope, data sources or methodology. Here, we conducted a first of its kind, systematic review of scientific literature on this topic and derived quantitative trends through a meta-analysis. We showed that second-generation biofuels and bioelectricity have a larger greenhouse gas (GHG) abatement potential than first generation biofuels, and stand the best chances (with a 80 to 90% probability range) of achieving a 50% reduction compared to fossil fuels. Conversely, directly converting forest ecosystems to produce bioenergy feedstock appeared as the worst-case scenario, systematically leading to negative GHG savings. On the other hand, converting grassland appeared to be a better option and entailed a 60% chance of halving GHG emissions compared to fossil energy sources. Since most climate mitigation scenarios assume still larger savings, it is critical to gain better insight into land-use change effects to provide a more realistic estimate of the mitigation potential associated with bioenergy.

Integrating water use into Southern California's power dispatch: an evaluation of the potential for cost-effective water conservation

NASA Astrophysics Data System (ADS)

Bolorinos, J.; Ajami, N.; Yu, Y.; Rajagopal, R.

2016-12-01

Urban water supply and energy systems in the arid Southwestern United States are closely linked. Freshwater use by the electricity sector in particular represents a sizable portion of total water consumption in the region. Nonetheless, the dispatch of water and energy resources is managed separately, and no research to-date has examined the water conservation potential presented by the electricity sector. This study gauges the potential water savings that could be achieved including water use in the power dispatch process in Southern California by simulating a DC Optimal Power Flow for a simplified model of the region's power network. The simulation uses historical power consumption data, historical power production data and water use data from the US Geological Survey, the California Energy Commission and the US Energy Information Administration to estimate freshwater consumption by the region's thermoelectric power generation fleet. Preliminary results indicate that power system freshwater consumption could be reduced by as much as 20% at a minimal cost penalty, with potential for even greater savings. Model results show that Southern California's power system has the ability to competitively shift the use of some of the region's water resources from electricity to urban consumption, and suggests that water use should be incorporated into the policy-making process to enhance the efficient use of the state's interconnected water and energy resources.

Assessing Potential Energy Savings in Household Travel: Methodological and Empirical Considerations of Vehicle Capability Constraints and Multi-day Activity Patterns

NASA Astrophysics Data System (ADS)

Bolon, Kevin M.

The lack of multi-day data for household travel and vehicle capability requirements is an impediment to evaluations of energy savings strategies, since (1) travel requirements vary from day-to-day, and (2) energy-saving transportation options often have reduced capability. This work demonstrates a survey methodology and modeling system for evaluating the energy-savings potential of household travel, considering multi-day travel requirements and capability constraints imposed by the available transportation resources. A stochastic scheduling model is introduced---the multi-day Household Activity Schedule Estimator (mPHASE)---which generates synthetic daily schedules based on "fuzzy" descriptions of activity characteristics using a finite-element representation of activity flexibility, coordination among household members, and scheduling conflict resolution. Results of a thirty-household pilot study are presented in which responses to an interactive computer assisted personal interview were used as inputs to the mPHASE model in order to illustrate the feasibility of generating complex, realistic multi-day household schedules. Study vehicles were equipped with digital cameras and GPS data acquisition equipment to validate the model results. The synthetically generated schedules captured an average of 60 percent of household travel distance, and exhibited many of the characteristics of complex household travel, including day-to-day travel variation, and schedule coordination among household members. Future advances in the methodology may improve the model results, such as encouraging more detailed and accurate responses by providing a selection of generated schedules during the interview. Finally, the Constraints-based Transportation Resource Assignment Model (CTRAM) is introduced. Using an enumerative optimization approach, CTRAM determines the energy-minimizing vehicle-to-trip assignment decisions, considering trip schedules, occupancy, and vehicle capability. Designed to accept either actual or synthetic schedules, results of an application of the optimization model to the 2001 and 2009 National Household Travel Survey data show that U.S. households can reduce energy use by 10 percent, on average, by modifying the assignment of existing vehicles to trips. Households in 2009 show a higher tendency to assign vehicles optimally than in 2001, and multi-vehicle households with diverse fleets have greater savings potential, indicating that fleet modification strategies may be effective, particularly under higher energy price conditions.

Data management using the personal digital assistant in an acute pain service.

PubMed

Chan, S S; Chu, C P; Cheng, B C; Chen, P P

2004-02-01

Handheld personal digital assistants (PDA) are increasingly being used by physicians for a variety of information and data management purposes. We evaluated a PDA-based data management system for our acute pain service. A structured questionnaire survey was conducted to assess staff experience and attitude towards the paper system before the introduction of the PDA, and three months after introduction of the PDA system. We compared the time taken to conduct the acute pain round before and after the implementation of the PDA. The time saved in data management and the amount of paper saved were estimated. Data from 177 patients with a total of 635 acute pain follow-up visits were entered over a three-month period. User satisfaction, ease of access to drug reference and clinical guidelines were similar between the two systems. The respondents found that the PDA was easy to use but less so than the paper system (P = 0.007), in particular, when accessing a patient's cumulative data (P = 0.007). There was no missed follow-up or data entry with the use of PDA. The time taken to attend follow-up visits was similar for the two systems (Paper: 8.8 +/- 3.2 compared to PDA: 7.0 +/- 2.0 minutes, P = 0.151). The estimated annual amount of paper and time saved in data management was 650 sheets and 130 man-hours respectively. Our experience with the use of the PDA in APS was satisfactory. The PDA system can potentially reduce time and paper use and missed data entry and patient follow-up.

Impacts of Illiteracy on the Risk of Dementia: A Global Health Perspective.

PubMed

Suh, Seung Wan; Han, Ji Won; Park, Jae Young; Hong, Jong Woo; Kim, Kayoung; Kim, Taehyun; Lee, Kyoung Hwan; Han, Guehee; Jeong, Hyeon; Seo, Jiyeong; Kim, Tae Hui; Lee, Dong Young; Lee, Dong Woo; Ryu, Seung-Ho; Kim, Shin-Gyeom; Youn, Jong Chul; Jhoo, Jin Hyeong; Kim, Jeong Lan; Lee, Seok Bum; Lee, Jung Jae; Kwak, Kyung Phil; Kim, Bong-Jo; Moon, Seok Woo; Park, Joon Hyuk; Kim, Ki Woong

2016-05-23

Despite its significance as a contributing factor for late-life dementia risk, illiteracy is frequently underappreciated in the management of dementia. In this study, we estimated the proportion of dementia cases attributable to illiteracy using the population attributable fraction (PAF), and calculated to what extent the monetary cost of dementia could be saved in the future by reducing illiteracy from the South Korean, Latin American, South Asian/Middle Eastern, and African populations. We collected necessary data from the 2011 United Nations Human Development Report and prevalence studies conducted in these regions. Additional variables not included in the above sources were estimated using a logit model under a "trend scenario"-based assumption. Around 16% of the total number of dementia cases in South Korea in 2015 can be attributed to illiteracy, with this figure predicted to decline to around 2% by 2050. This translates to a saving in dementia care costs of approximately 52 billion USD, providing we are successful in theoretically eradicating illiteracy as of 2015, in the population aged 65 years or under. Likewise, reducing illiteracy to 50% in Latin America, South Asia/The Middle East, and Africa by 2050 could generate further cost savings of between 71 and 244 billion, 13 and 94 billion, and 17 and 78 billion USD, respectively. Even public policies aimed solely at reducing illiteracy in the childhood, adolescent, or middle-aged population could potentially have a role in the primary prevention of dementia. Moving forward, governments will need to address this issue in a purposeful and systematic manner.

Managing acute acetaminophen poisoning with oral versus intravenous N-acetylcysteine: a provider-perspective cost analysis.

PubMed

Marchetti, Albert; Rossiter, Richard

2009-01-01

Acetaminophen (APAP) overdose, which can lead to hepatotoxicity, is the most commonly reported poisoning in the United States and has the highest rate of mortality, with more than 100,000 exposures and 300 deaths reported annually (1) . The treatment of choice, N-acetylcysteine (NAC), is effective in both oral (PO) and intravenous (IV) formulations. The main difference in therapies, other than administration route, is time to complete delivery--72 hours for PO NAC versus 21 hours for IV NAC, according to full prescribing information. This distinction is the primary basis for variation in management costs for hospitalized patients receiving these products. To quantify and compare full treatment costs from the provider perspective to manage acute APAP poisoning with either PO or IV NAC in a standard treatment regimen. A cost model was developed and populated with published data comprising probabilities of potential clinical outcomes and the costs of resources consumed during patient care. For patients who present <10 hours post-ingestion, the estimated total cost of care with PO NAC in the treatment regimen is $5,817 (ICU patients) or $3,850, (ward patients) compared with $3,765 and $2,768 for similar care with IV NAC. Potential cost savings equal - $2,052 (-35%) or -$1,083 (-28%), respectively, in favor of IV NAC. Similar potential savings were estimated for patients presenting 10-24 hours post-ingestion. IV NAC is the less costly therapeutic option for APAP poisonings, based on simulation modeling and retrospective data. The current economic evaluation is restricted by the absence of comparative data from head-to-head, matched-cohort studies and the limitations common to retrospective APAP toxicology datasets. Additional research could refine these results.

Optimizing Data Centre Energy and Environmental Costs

NASA Astrophysics Data System (ADS)

Aikema, David Hendrik

Data centres use an estimated 2% of US electrical power which accounts for much of their total cost of ownership. This consumption continues to grow, further straining power grids attempting to integrate more renewable energy. This dissertation focuses on assessing and reducing data centre environmental and financial costs. Emissions of projects undertaken to lower the data centre environmental footprints can be assessed and the emission reduction projects compared using an ISO-14064-2-compliant greenhouse gas reduction protocol outlined herein. I was closely involved with the development of the protocol. Full lifecycle analysis and verifying that projects exceed business-as-usual expectations are addressed, and a test project is described. Consuming power when it is low cost or when renewable energy is available can be used to reduce the financial and environmental costs of computing. Adaptation based on the power price showed 10--50% potential savings in typical cases, and local renewable energy use could be increased by 10--80%. Allowing a fraction of high-priority tasks to proceed unimpeded still allows significant savings. Power grid operators use mechanisms called ancillary services to address variation and system failures, paying organizations to alter power consumption on request. By bidding to offer these services, data centres may be able to lower their energy costs while reducing their environmental impact. If providing contingency reserves which require only infrequent action, savings of up to 12% were seen in simulations. Greater power cost savings are possible for those ceding more control to the power grid operator. Coordinating multiple data centres adds overhead, and altering at which data centre requests are processed based on changes in the financial or environmental costs of power is likely to increase this overhead. Tests of virtual machine migrations showed that in some cases there was no visible increase in power use while in others power use rose by 20--30W. Estimates of how migration was likely to impact other services used in current cloud environments were derived.