Comparative evaluation of in-house manual, and commercial semi-automated and automated DNA extraction platforms in the sample preparation of human stool specimens for a Salmonella enterica 5'-nuclease assay.

PubMed

Schuurman, Tim; de Boer, Richard; Patty, Rachèl; Kooistra-Smid, Mirjam; van Zwet, Anton

2007-12-01

In the present study, three methods (NucliSens miniMAG [bioMérieux], MagNA Pure DNA Isolation Kit III Bacteria/Fungi [Roche], and a silica-guanidiniumthiocyanate {Si-GuSCN-F} procedure for extracting DNA from stool specimens were compared with regard to analytical performance (relative DNA recovery and down stream real-time PCR amplification of Salmonella enterica DNA), stability of the extracted DNA, hands-on time (HOT), total processing time (TPT), and costs. The Si-GuSCN-F procedure showed the highest analytical performance (relative recovery of 99%, S. enterica real-time PCR sensitivity of 91%) at the lowest associated costs per extraction (euro 4.28). However, this method did required the longest HOT (144 min) and subsequent TPT (176 min) when processing 24 extractions. Both miniMAG and MagNA Pure extraction showed similar performances at first (relative recoveries of 57% and 52%, S. enterica real-time PCR sensitivity of 85%). However, when difference in the observed Ct values after real-time PCR were taken into account, MagNA Pure resulted in a significant increase in Ct value compared to both miniMAG and Si-GuSCN-F (with on average +1.26 and +1.43 cycles). With regard to inhibition all methods showed relatively low inhibition rates (< 4%), with miniMAG providing the lowest rate (0.7%). Extracted DNA was stable for at least 1 year for all methods. HOT was lowest for MagNA Pure (60 min) and TPT was shortest for miniMAG (121 min). Costs, finally, were euro 4.28 for Si-GuSCN, euro 6.69 for MagNA Pure and euro 9.57 for miniMAG.

Constraint Optimization Problem For The Cutting Of A Cobalt Chrome Refractory Material

NASA Astrophysics Data System (ADS)

Lebaal, Nadhir; Schlegel, Daniel; Folea, Milena

2011-05-01

This paper shows a complete approach to solve a given problem, from the experimentation to the optimization of different cutting parameters. In response to an industrial problem of slotting FSX 414, a Cobalt-based refractory material, we have implemented a design of experiment to determine the most influent parameters on the tool life, the surface roughness and the cutting forces. After theses trials, an optimization approach has been implemented to find the lowest manufacturing cost while respecting the roughness constraints and cutting force limitation constraints. The optimization approach is based on the Response Surface Method (RSM) using the Sequential Quadratic programming algorithm (SQP) for a constrained problem. To avoid a local optimum and to obtain an accurate solution at low cost, an efficient strategy, which allows improving the RSM accuracy in the vicinity of the global optimum, is presented. With these models and these trials, we could apply and compare our optimization methods in order to get the lowest cost for the best quality, i.e. a satisfying surface roughness and limited cutting forces.

Relative costs of anesthesiologist prepared, hospital pharmacy prepared and outsourced anesthesia drugs.

PubMed

Jelacic, Srdjan; Craddick, Karen; Nair, Bala G; Bounthavong, Mark; Yeung, Kai; Kusulos, Dolly; Knutson, Jennifer A; Somani, Shabir; Bowdle, Andrew

2017-02-01

Anesthesia drugs can be prepared by anesthesia providers, hospital pharmacies or outsourcing facilities. The decision whether to outsource all or some anesthesia drugs is challenging since the costs associated with different anesthesia drug preparation methods remain poorly described. The costs associated with preparation of 8 commonly used anesthesia drugs were analyzed using a budget impact analysis for 4 different syringe preparation strategies: (1) all drugs prepared by anesthesiologist, (2) drugs prepared by anesthesiologist and hospital pharmacy, (3) drugs prepared by anesthesiologist and outsourcing facility, and (4) all drugs prepared by outsourcing facility. A strategy combining anesthesiologist and hospital pharmacy prepared drugs was associated with the lowest estimated annual cost in the base-case budget impact analysis with an annual cost of $225 592, which was lower than other strategies by a margin of greater than $86 000. A combination of anesthesiologist and hospital pharmacy prepared drugs resulted in the lowest annual cost in the budget impact analysis. However, the cost of drugs prepared by an outsourcing facility maybe lower if the capital investment needed for the establishment and maintenance of the US Pharmacopeial Convention Chapter <797> compliant facility is included in the budget impact analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

System and method for design and optimization of grid connected photovoltaic power plant with multiple photovoltaic module technologies

DOEpatents

Thomas, Bex George; Elasser, Ahmed; Bollapragada, Srinivas; Galbraith, Anthony William; Agamy, Mohammed; Garifullin, Maxim Valeryevich

2016-03-29

A system and method of using one or more DC-DC/DC-AC converters and/or alternative devices allows strings of multiple module technologies to coexist within the same PV power plant. A computing (optimization) framework estimates the percentage allocation of PV power plant capacity to selected PV module technologies. The framework and its supporting components considers irradiation, temperature, spectral profiles, cost and other practical constraints to achieve the lowest levelized cost of electricity, maximum output and minimum system cost. The system and method can function using any device enabling distributed maximum power point tracking at the module, string or combiner level.

48 CFR 47.306-2 - Lowest overall transportation costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... transportation costs. 47.306-2 Section 47.306-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.306-2 Lowest overall transportation costs. (a) For the evaluation of offers, the transportation officer shall give to the contracting...

48 CFR 47.306-2 - Lowest overall transportation costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... transportation costs. 47.306-2 Section 47.306-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.306-2 Lowest overall transportation costs. (a) For the evaluation of offers, the transportation officer shall give to the contracting...

48 CFR 47.306-2 - Lowest overall transportation costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... transportation costs. 47.306-2 Section 47.306-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.306-2 Lowest overall transportation costs. (a) For the evaluation of offers, the transportation officer shall give to the contracting...

48 CFR 47.306-2 - Lowest overall transportation costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... transportation costs. 47.306-2 Section 47.306-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.306-2 Lowest overall transportation costs. (a) For the evaluation of offers, the transportation officer shall give to the contracting...

48 CFR 47.306-2 - Lowest overall transportation costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... transportation costs. 47.306-2 Section 47.306-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.306-2 Lowest overall transportation costs. (a) For the evaluation of offers, the transportation officer shall give to the contracting...

Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews.

PubMed

Azar, Farbod Ebadifard; Azami-Aghdash, Saber; Pournaghi-Azar, Fatemeh; Mazdaki, Alireza; Rezapour, Aziz; Ebrahimi, Parvin; Yousefzadeh, Negar

2017-06-19

Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.

Inventory control of raw material using silver meal heuristic method in PR. Trubus Alami Malang

NASA Astrophysics Data System (ADS)

Ikasari, D. M.; Lestari, E. R.; Prastya, E.

2018-03-01

The purpose of this study was to compare the total inventory cost calculated using the method applied by PR. Trubus Alami and Silver Meal Heuristic (SMH) method. The study was started by forecasting the cigarette demand from July 2016 to June 2017 (48 weeks) using additive decomposition forecasting method. The additive decomposition was used because it has the lowest value of Mean Abosolute Deviation (MAD) and Mean Squared Deviation (MSD) compared to other methods such as multiplicative decomposition, moving average, single exponential smoothing, and double exponential smoothing. The forcasting results was then converted as a raw material needs and further calculated using SMH method to obtain inventory cost. As expected, the result shows that the order frequency of using SMH methods was smaller than that of using the method applied by Trubus Alami. This affected the total inventory cost. The result suggests that using SMH method gave a 29.41% lower inventory cost, giving the cost different of IDR 21,290,622. The findings, is therefore, indicated that the PR. Trubus Alami should apply the SMH method if the company wants to reduce the total inventory cost.

Estimated costs of production and potential prices for the WHO Essential Medicines List

PubMed Central

Hill, Andrew M; Barber, Melissa J

2018-01-01

Introduction There are persistent gaps in access to affordable medicines. The WHO Model List of Essential Medicines (EML) includes medicines considered necessary for functional health systems. Methods A generic price estimation formula was developed by reviewing published analyses of cost of production for medicines and assuming manufacture in India, which included costs of formulation, packaging, taxation and a 10% profit margin. Data on per-kilogram prices of active pharmaceutical ingredient exported from India were retrieved from an online database. Estimated prices were compared with the lowest globally available prices for HIV/AIDS, tuberculosis (TB) and malaria medicines, and current prices in the UK, South Africa and India. Results The estimation formula had good predictive accuracy for HIV/AIDS, TB and malaria medicines. Estimated generic prices ranged from US$0.01 to US$1.45 per unit, with most in the lower end of this range. Lowest available prices were greater than estimated generic prices for 214/277 (77%) comparable items in the UK, 142/212 (67%) in South Africa and 118/298 (40%) in India. Lowest available prices were more than three times above estimated generic price for 47% of cases compared in the UK and 22% in South Africa. Conclusion A wide range of medicines in the EML can be profitably manufactured at very low cost. Most EML medicines are sold in the UK and South Africa at prices significantly higher than those estimated from production costs. Generic price estimation and international price comparisons could empower government price negotiations and support cost-effectiveness calculations. PMID:29564159

Solid rocket propellant waste disposal/ingredient recovery study

NASA Technical Reports Server (NTRS)

Mcintosh, M. J.

1976-01-01

A comparison of facility and operating costs of alternate methods shows open burning to be the lowest cost incineration method of waste propellant disposal. The selection, development, and implementation of an acceptable alternate is recommended. The recovery of ingredients from waste propellant has the probability of being able to pay its way, and even show a profit, when large consistent quantities of composite propellant are available. Ingredients recovered from space shuttle waste propellant would be worth over $1.5 million. Open and controlled burning are both energy wasteful.

Costs of rearing children in agricultural economies: an alternative estimation approach and findings from rural Bangladesh.

PubMed

Khan, M M; Magnani, R J; Mock, N B; Saadat, Y S

1993-03-01

There are changes in child costs during demographic transition. This study examines household time allocation from 66 agricultural households in 3 villages in Tangail District in rural north central Bangladesh in 1984-85 (371 days). Component and total child-rearing costs are estimated in alternative ways. Conventional "opportunity wage" measures are considered overestimated. The methodological shortcomings of direct cost accounting procedures and consumer demand methods in computing time cost and monetary cost of child rearing are pointed out. In this study's alternative computation, age standardized equivalent costs are generated. Child food consumption costs were generated from a large national survey conducted in 1983. Nonfood expenditures were estimated by food to nonfood expenditure ratios taken from the aforementioned survey. For estimating breast-feeding costs, an estimate was produced based on the assumption that costs for infant food consumption were a fixed proportion of food costs for older children. Land ownership groups were set up to reflect socioeconomic status: 1) landless households, 2) marginal farm households with 1 acre or .4 hectares of land, 3) middle income households with 1-2 acres of land, 4) upper middle income households with 2-4 acres of land, and 5) upper income or rich households with over 4 acres of land. The nonmarket wage rate for hired household help was used to determine the value of cooking, fetching water, and household cleaning and repairing. The results confirm the low costs of child rearing in high fertility societies. Productive nonmarket activities are effective in subsidizing the costs of children. The addition of a child into households already with children has a low impact on time costs of children; "this economies of scale effect is estimated ... at 20%." The highest relative costs were found in the lowest income households, and the lowest costs were in the highest income households. 5% of total household income is devoted to child rearing in the lowest income households compared to 1% of income in the highest income households. The implications are that fertility decline is more directly related to structural changes in the economy, satisfaction of existing demand for family planning, and the producing additional demand for fertility control.

Comparison of Four Recruiting Strategies in a Smoking Cessation Trial

PubMed Central

Buller, David B.; Meenan, Richard; Severson, Herb; Halperin, Abigail; Edwards, Erika; Magnusson, Brooke

2012-01-01

Objectives To compare 4 on-line and off-line recruiting methods. Methods Young adult smokers (n=3353) were recruited to a trial comparing smoking cessation services with an on-line health risk assessment (HRA), on-line ads, off-line materials, and quit line screening. Results On-line ads (n=1426; $41.35) and off-line materials recruited the most smokers (n=1341; $56.23) for the lowest cost. Quit line screening was more expensive (n=189; $133.61), but enrollees used cessation services the most (34%-82%). On-line HRA was least successful and most costly (n=397; $630.85) but had the highest follow-up (45%-55%). Conclusions On-line ads and off-line materials were most effective and cost-effective methods. PMID:22584086

TH-CD-202-08: Feasibility Study of Planning Phase Optimization Using Patient Geometry-Driven Information for Better Dose Sparing of Organ at Risks

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

Kang, S; Kim, D; Kim, T

2016-06-15

Purpose: To propose a simple and effective cost value function to search optimal planning phase (gating window) and demonstrated its feasibility for respiratory correlated radiation therapy. Methods: We acquired 4DCT of 10 phases for 10 lung patients who have tumor located near OARs such as esophagus, heart, and spinal cord (i.e., central lung cancer patients). A simplified mathematical optimization function was established by using overlap volume histogram (OVH) between the target and organ at risk (OAR) at each phase and the tolerance dose of selected OARs to achieve surrounding OARs dose-sparing. For all patients and all phases, delineation of themore » target volume and selected OARs (esophagus, heart, and spinal cord) was performed (by one observer to avoid inter-observer variation), then cost values were calculated for all phases. After the breathing phases were ranked according to cost value function, the relationship between score and dose distribution at highest and lowest cost value phases were evaluated by comparing the mean/max dose. Results: A simplified mathematical cost value function showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. The lowest cost value which may result in lower mean/max dose to OARs was distributed at various phases for all patients. The mean doses of the OARs significantly decreased about 10% with statistical significance for all 3 OARs at the phase with the lowest cost value. Also, the max doses of the OARs were decreased about 2∼5% at the phase with the lowest cost value compared to the phase with the highest cost value. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist differently through each patient and the proposed cost value function can be a useful tool for determining such phases without performing dose optimization calculations. This research was supported by the Mid-career Researcher Program through NRF funded by the Ministry of Science, ICT & Future Planning of Korea (NRF-2014R1A2A1A10050270) and by the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)« less

Bidding cost evaluation with fuzzy methods on building project in Jakarta

NASA Astrophysics Data System (ADS)

Susetyo, Budi; Utami, Tin Budi

2017-11-01

National construction companies today demanded to become more competitive to face increasingly competition. Every construction company especially the contractor must work better than ever. Ability to prepare cost of the work that represents the efficiency and effectiveness of the implementation of the work necessary to produce cost - competitive. The project is considered successful if the target meets the quality, cost and time. From the aspect of cost, the project has been designed in accordance with certain technical criteria to be taken into account based on standard costs. To ensure the cost efficiency of the bidding process carried out meet the rules of a fairly and competitive. The research objective is to formulate the proper way to compare several deals with the standard cost of the work. The fuzzy technique is used as a evaluation methods to decision making. The evaluation not merely based on the lowest prices. The methods is looking for the most valuable and reasonable prices. The comparison is conducted to determine the most cost-competitive and reasonable as the winner of the bidding.

Green Energy in New Construction: Maximize Energy Savings and Minimize Cost

ERIC Educational Resources Information Center

Ventresca, Joseph

2010-01-01

People often use the term "green energy" to refer to alternative energy technologies. But green energy doesn't guarantee maximum energy savings at a minimum cost--a common misconception. For school business officials, green energy means getting the lowest energy bills for the lowest construction cost, which translates into maximizing green energy…

Modeling the Downstream Processing of Monoclonal Antibodies Reveals Cost Advantages for Continuous Methods for a Broad Range of Manufacturing Scales.

PubMed

Hummel, Jonathan; Pagkaliwangan, Mark; Gjoka, Xhorxhi; Davidovits, Terence; Stock, Rick; Ransohoff, Thomas; Gantier, Rene; Schofield, Mark

2018-01-17

The biopharmaceutical industry is evolving in response to changing market conditions, including increasing competition and growing pressures to reduce costs. Single-use (SU) technologies and continuous bioprocessing have attracted attention as potential facilitators of cost-optimized manufacturing for monoclonal antibodies. While disposable bioprocessing has been adopted at many scales of manufacturing, continuous bioprocessing has yet to reach the same level of implementation. In this study, the cost of goods of Pall Life Science's integrated, continuous bioprocessing (ICB) platform is modeled, along with that of purification processes in stainless-steel and SU batch formats. All three models include costs associated with downstream processing only. Evaluation of the models across a broad range of clinical and commercial scenarios reveal that the cost savings gained by switching from stainless-steel to SU batch processing are often amplified by continuous operation. The continuous platform exhibits the lowest cost of goods across 78% of all scenarios modeled here, with the SU batch process having the lowest costs in the rest of the cases. The relative savings demonstrated by the continuous process are greatest at the highest feed titers and volumes. These findings indicate that existing and imminent continuous technologies and equipment can become key enablers for more cost effective manufacturing of biopharmaceuticals. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Targeting excited states in all-trans polyenes with electron-pair states.

PubMed

Boguslawski, Katharina

2016-12-21

Wavefunctions restricted to electron pair states are promising models for strongly correlated systems. Specifically, the pair Coupled Cluster Doubles (pCCD) ansatz allows us to accurately describe bond dissociation processes and heavy-element containing compounds with multiple quasi-degenerate single-particle states. Here, we extend the pCCD method to model excited states using the equation of motion (EOM) formalism. As the cluster operator of pCCD is restricted to electron-pair excitations, EOM-pCCD allows us to target excited electron-pair states only. To model singly excited states within EOM-pCCD, we modify the configuration interaction ansatz of EOM-pCCD to contain also single excitations. Our proposed model represents a simple and cost-effective alternative to conventional EOM-CC methods to study singly excited electronic states. The performance of the excited state models is assessed against the lowest-lying excited states of the uranyl cation and the two lowest-lying excited states of all-trans polyenes. Our numerical results suggest that EOM-pCCD including single excitations is a good starting point to target singly excited states.

Comparison of 4 recruiting strategies in a smoking cessation trial.

PubMed

Buller, David B; Meenan, Richard; Severson, Herb; Halperin, Abigail; Edwards, Erika; Magnusson, Brooke

2012-09-01

To compare 4 online and off-line recruiting methods. Young adult smokers (n=3353) were recruited to a trial comparing smoking cessation services with an online health risk assessment (HRA), online ads, offline materials, and quit-line screening. Online ads (n=1426; $41.35) and off-line materials recruited the most smokers (n=1341; $56.23) for the lowest cost. Quitline screening was more expensive (n=189; $132.22), but enrollees used cessation services the most (34%-82%). Online HRA was least successful and most costly (n=397; $630.85) but had the highest follow-up (45%-55%). Online ads and off-line materials were most effective and cost-effective methods.

The relationship between pediatric combination vaccines and market effects.

PubMed

Behzad, Banafsheh; Jacobson, Sheldon H; Jokela, Janet A; Sewell, Edward C

2014-06-01

We explored market factors that affect pediatric combination vaccine uptake in the US public-sector pediatric vaccine market. We specifically examined how Pediarix and Pentacel earned a place in the 2009-2012 lowest overall cost formulary. Direct competition between Pediarix and Pentacel is driven by the indirect presence of the Merck Haemophilus influenzae type b vaccine and the Recommended Childhood Immunization Schedule requirement for a hepatitis B birth dose. The resulting analysis suggests that Pentacel would never have earned a place in the lowest overall cost formulary for 2009-2012 federal contract prices for any cost of an injection unless the Merck H influenzae type b advantage was ignored and the hepatitis B birth dose administration cost was recognized by health care providers in designing the lowest overall cost formularies.

The Relationship Between Pediatric Combination Vaccines and Market Effects

PubMed Central

Behzad, Banafsheh; Jokela, Janet A.; Sewell, Edward C.

2014-01-01

We explored market factors that affect pediatric combination vaccine uptake in the US public-sector pediatric vaccine market. We specifically examined how Pediarix and Pentacel earned a place in the 2009–2012 lowest overall cost formulary. Direct competition between Pediarix and Pentacel is driven by the indirect presence of the Merck Haemophilus influenzae type b vaccine and the Recommended Childhood Immunization Schedule requirement for a hepatitis B birth dose. The resulting analysis suggests that Pentacel would never have earned a place in the lowest overall cost formulary for 2009–2012 federal contract prices for any cost of an injection unless the Merck H influenzae type b advantage was ignored and the hepatitis B birth dose administration cost was recognized by health care providers in designing the lowest overall cost formularies. PMID:24825198

Are the lowest-cost healthful food plans culturally and socially acceptable?

PubMed Central

Maillot, Matthieu; Darmon, Nicole; Drewnowski, Adam

2014-01-01

Objective Nutritious yet inexpensive foods do exist. However, many such foods are rejected by the low-income consumer. Is it because their use violates unspoken social norms? The present study was designed to assess the variety and cost of the lowest-cost market basket of foods that simultaneously met required dietary standards and progressively stricter consumption constraints. Design A mathematical optimisation model was used to develop the lowest-cost food plans to meet three levels of nutritional requirements and seven levels of consumption constraints. Subjects: The nationally representative INCA (National Individual Survey of Food Consumption) dietary survey study of 1332 adults provided population estimates of food consumption patterns in France. Food plan costs were based on retail food prices. Results The lowest-cost food plans that provided 9204 kJ/d (2200 kcal/d) for men and 7531 kJ/d (1800 kcal/d) for women and met specified dietary standards could be obtained for ,1?50 h/d. The progressive imposition of consumption constraints designed to create more mainstream French diets sharply increased food plan costs, without improving nutritional value. Conclusions Minimising diet costs, while meeting nutrition standards only, led to food plans that provided little variety and deviated substantially from social norms. Aligning the food plan with mainstream consumption led to higher costs. Food plans designed for low-income groups need to be socially acceptable as well as affordable and nutritious. PMID:20105388

Cost-Effectiveness Analysis of Health Care Waste Treatment Facilities in Iran Hospitals; a Provider Perspective

PubMed Central

RASHIDIAN, Arash; ALINIA, Cyrus; MAJDZADEH, Reza

2015-01-01

Background: Our aim was to make right and informative decision about choosing the most cost-effectiveness heterogeneous infectious waste treatment methods and devices. Methods: In this descriptive study, decision tree analysis, with 10-yr time horizon in bottom-up approach was used to estimate the costs and effectiveness criteria of the employed devices at provider perspective in Iranian hospitals. We used the one-way and scenario sensitivity analysis to measure the effects of variables with uncertainty. The resources of data were national Environmental and Occupational Health Center Survey (EOHCS) in 2012, field observation and completing questionnaire by relevant authorities in mentioned centers. Results: Devices called Saray 2, Autoclave based, and Newster 10, Hydroclave based, with 92032.4 (±12005) and 6786322.9 (±826453) Dollars had the lowest and highest costs respectively in studied time period and given the 5–10% discount rate. Depending on effectiveness factor type, Newster 10 with Ecodas products and Saray products respectively had the highest and lowest effectiveness. In most considered scenarios, Caspian-Alborz device was the most cost-effectiveness alternative, so for the treatment of each adjusted unit of volume and weight of infectious waste in a 10 year period and in different conditions, between 39.4 (±5.1) to 915 (±111.4) dollars must be spent. Conclusion: The findings indicate the inefficiency and waste of resources, so in order to efficient resource allocation and to encourage further cost containment in infectious waste management we introduce policy recommendation that be taken in three levels. PMID:25905078

Measuring diet cost at the individual level: a comparison of three methods.

PubMed

Monsivais, P; Perrigue, M M; Adams, S L; Drewnowski, A

2013-11-01

Household-level food spending data are not suitable for population-based studies of the economics of nutrition. This study compared three methods of deriving diet cost at the individual level. Adult men and women (n=164) completed 4-day diet diaries and a food frequency questionnaire (FFQ). Food expenditures over 4 weeks and supermarket prices for 384 foods were obtained. Diet costs (US$/day) were estimated using: (1) diet diaries and expenditures; (2) diet diaries and supermarket prices; and (3) FFQs and supermarket prices. Agreement between the three methods was assessed on the basis of Pearson correlations and limits of agreement. Income-related differences in diet costs were estimated using general linear models. Diet diaries yielded mean (s.d.) diet costs of $10.04 (4.27) based on Method 1 and $8.28 (2.32) based on Method 2. FFQs yielded mean diet costs of $7.66 (2.72) based on Method 3. Correlations between energy intakes and costs were highest for Method 3 (r(2)=0.66), lower for Method 2 (r(2)=0.24) and lowest for Method 1 (r(2)=0.06). Cost estimates were significantly associated with household incomes. The weak association between food expenditures and food intake using Method 1 makes it least suitable for diet and health research. However, merging supermarket food prices with standard dietary assessment tools can provide estimates of individual diet cost that are more closely associated with food consumed. The derivation of individual diet cost can provide insights into some of the economic determinants of food choice, diet quality and health.

Cost-Efficacy Analysis of Out-of-District Special Education Placements: An Evaluative Measure of Behavior Support Intervention in Public Schools.

ERIC Educational Resources Information Center

Putnam, Robert F.; Luiselli, James K.; Sennett, Kenneth; Malonson, Joanne

2002-01-01

Evaluation of out-of-district special education placement costs in the 15 largest Massachusetts public school districts found the criterion school district (which had developed a system-wide approach to behavioral intervention) had the lowest per capita cost, lowest percentage of total school budget consumed by out-of-district placements, and the…

Factors associated with variations in hospital expenditures for acute heart failure in the United States.

PubMed

Ziaeian, Boback; Sharma, Puza P; Yu, Tzy-Chyi; Johnson, Katherine Waltman; Fonarow, Gregg C

2015-02-01

Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States. A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes. Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P < .001). Acute heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Probabilistic estimation of numbers and costs of future landslides in the San Francisco Bay region

USGS Publications Warehouse

Crovelli, R.A.; Coe, J.A.

2009-01-01

We used historical records of damaging landslides triggered by rainstorms and a newly developed Probabilistic Landslide Assessment Cost Estimation System (PLACES) to estimate the numbers and direct costs of future landslides in the 10-county San Francisco Bay region. Historical records of damaging landslides in the region are incomplete. Therefore, our estimates of numbers and costs of future landslides are minimal estimates. The estimated mean annual number of future damaging landslides for the entire 10-county region is about 65. Santa Cruz County has the highest estimated mean annual number of damaging future landslides (about 18), whereas Napa, San Francisco, and Solano Counties have the lowest estimated mean numbers of damaging landslides (about 1 each). The estimated mean annual cost of future landslides in the entire region is about US $14.80 million (year 2000 $). The estimated mean annual cost is highest for San Mateo County ($3.24 million) and lowest for Solano County ($0.18 million). The annual per capita cost for the entire region will be about $2.10. Santa Cruz County will have the highest annual per capita cost at $8.45, whereas San Francisco County will have the lowest per capita cost at $0.31. Normalising costs by dividing by the percentage of land area with slopes equal to or greater than 17% indicates that San Francisco County will have the highest cost per square km ($7,101), whereas Santa Clara County will have the lowest cost per square km ($229). These results indicate that the San Francisco Bay region has one of the highest levels of landslide risk in the United States. Compared with landslide cost estimates from the rest of the world, the risk level in the Bay region seems high, but not exceptionally high.

Socioeconomic Disparities in the Economic Impact of Childhood Food Allergy.

PubMed

Bilaver, Lucy A; Kester, Kristen M; Smith, Bridget M; Gupta, Ruchi S

2016-05-01

We compared direct medical costs borne by the health care system and out-of-pocket costs borne by families for children with food allergy by socioeconomic characteristics. We analyzed cross-sectional survey data collected between November 2011 and January 2012 from 1643 US caregivers with a food-allergic child. We used a 2-part regression model to estimate mean costs and identified differences by levels of household income and race or ethnicity. Children in the lowest income stratum incurred 2.5 times the amount of emergency department and hospitalization costs as a result of their food allergy than higher-income children ($1021, SE ±$209, vs $416, SE ±$94; P < .05). Costs incurred for specialist visits were lower in the lowest income group ($228, SE ±$21) compared with the highest income group ($311, SE ±$18; P < .01) as was spending on out-of-pocket medication costs ($117, SE ± $26, lowest income; $366, SE ±$44, highest income; P < .001). African American caregivers incurred the lowest amount of direct medical costs and spent the least on out-of-pocket costs, with average adjusted costs of $493 (SE ±$109) and $395 (SE ±$452), respectively. Disparities exist in the economic impact of food allergy based on socioeconomic status. Affordable access to specialty care, medications, and allergen-free foods are critical to keep all food-allergic children safe, regardless of income and race. Copyright © 2016 by the American Academy of Pediatrics.

41 CFR 101-26.100-1 - Procurement of lowest cost items.

Code of Federal Regulations, 2010 CFR

2010-07-01

... similar items to meet particular end-use requirements under the GSA stock program, special order program... functional end-use procurement needs of the various ordering agencies. Therefore, in submitting requisitions... source from which the lowest cost item can be obtained which will adequately serve the functional end-use...

Eighth-order explicit two-step hybrid methods with symmetric nodes and weights for solving orbital and oscillatory IVPs

NASA Astrophysics Data System (ADS)

Franco, J. M.; Rández, L.

The construction of new two-step hybrid (TSH) methods of explicit type with symmetric nodes and weights for the numerical integration of orbital and oscillatory second-order initial value problems (IVPs) is analyzed. These methods attain algebraic order eight with a computational cost of six or eight function evaluations per step (it is one of the lowest costs that we know in the literature) and they are optimal among the TSH methods in the sense that they reach a certain order of accuracy with minimal cost per step. The new TSH schemes also have high dispersion and dissipation orders (greater than 8) in order to be adapted to the solution of IVPs with oscillatory solutions. The numerical experiments carried out with several orbital and oscillatory problems show that the new eighth-order explicit TSH methods are more efficient than other standard TSH or Numerov-type methods proposed in the scientific literature.

More choice in health insurance marketplaces may reduce the value of the subsidies available to low-income enrollees.

PubMed

Taylor, Erin A; Saltzman, Evan; Bauhoff, Sebastian; Pacula, Rosalie L; Eibner, Christine

2015-01-01

Federal subsidies available to enrollees in health insurance Marketplaces are pegged to the premium of the second-lowest-cost silver plan available in each rating area (as defined by each state). People who qualify for the subsidy contribute a percentage of their income to purchase coverage, and the federal government covers the remaining cost up to the price of that premium. Because the number of plans offered and plan premiums vary substantially across rating areas, the effective value of the subsidy may vary geographically. We found that the availability of more plans in a rating area was associated with lower premiums but higher deductibles for enrollees in the second-lowest-cost silver plan. In rating areas with more than twenty plans, the average deductible in the second-lowest-cost silver plan was nearly $1,000 higher than it was in rating areas with fewer than thirteen plans. Because premium costs for second-lowest-cost silver plans are capped, deductibles may be a more salient measure of plan value for enrollees than premiums are. Greater standardization of plans or an alternative approach to calculating the subsidy could provide a more consistent benefit to enrollees across various rating areas. Project HOPE—The People-to-People Health Foundation, Inc.

Measuring diet cost at the individual level: a comparison of three methods

PubMed Central

Monsivais, P; Perrigue, M M; Adams, S L; Drewnowski, A

2013-01-01

Background/objectives: Household-level food spending data are not suitable for population-based studies of the economics of nutrition. This study compared three methods of deriving diet cost at the individual level. Subjects/methods: Adult men and women (n=164) completed 4-day diet diaries and a food frequency questionnaire (FFQ). Food expenditures over 4 weeks and supermarket prices for 384 foods were obtained. Diet costs (US$/day) were estimated using: (1) diet diaries and expenditures; (2) diet diaries and supermarket prices; and (3) FFQs and supermarket prices. Agreement between the three methods was assessed on the basis of Pearson correlations and limits of agreement. Income-related differences in diet costs were estimated using general linear models. Results: Diet diaries yielded mean (s.d.) diet costs of $10.04 (4.27) based on Method 1 and $8.28 (2.32) based on Method 2. FFQs yielded mean diet costs of $7.66 (2.72) based on Method 3. Correlations between energy intakes and costs were highest for Method 3 (r2=0.66), lower for Method 2 (r2=0.24) and lowest for Method 1 (r2=0.06). Cost estimates were significantly associated with household incomes. Conclusion: The weak association between food expenditures and food intake using Method 1 makes it least suitable for diet and health research. However, merging supermarket food prices with standard dietary assessment tools can provide estimates of individual diet cost that are more closely associated with food consumed. The derivation of individual diet cost can provide insights into some of the economic determinants of food choice, diet quality and health. PMID:24045791

The influence of various test plans on mission reliability. [for Shuttle Spacelab payloads

NASA Technical Reports Server (NTRS)

Stahle, C. V.; Gongloff, H. R.; Young, J. P.; Keegan, W. B.

1977-01-01

Methods have been developed for the evaluation of cost effective vibroacoustic test plans for Shuttle Spacelab payloads. The shock and vibration environments of components have been statistically represented, and statistical decision theory has been used to evaluate the cost effectiveness of five basic test plans with structural test options for two of the plans. Component, subassembly, and payload testing have been performed for each plan along with calculations of optimum test levels and expected costs. The tests have been ranked according to both minimizing expected project costs and vibroacoustic reliability. It was found that optimum costs may vary up to $6 million with the lowest plan eliminating component testing and maintaining flight vibration reliability via subassembly tests at high acoustic levels.

Cost analysis of different diagnostic algorithms for pulmonary tuberculosis varying in placement of Xpert MTB/RIF.

PubMed

Chadha, V K; Sebastian, George; Kumar, P

2016-01-01

We undertook cost analysis for diagnosis of pulmonary tuberculosis (PTB) using present algorithm under Revised National Tuberculosis Control programme and using Xpert MTB/RIF (Xpert) as frontline test or in conjunction with smear microscopy and/or chest radiography. Costs were estimated for different strategies: (A) present algorithm involving sputum smear examination followed by antibiotic trial in smear negative patients, repeat smear examination (RE) if symptoms continue and chest radiography if RE negative; (B) direct Xpert; (C) smear microscopy followed by Xpert in smear negative patients; (D) radiography followed by Xpert in those having abnormal pulmonary shadows; and (E) smear examination followed by radiography among smear negative patients and Xpert in presence of abnormal pulmonary shadow. Cost to program was estimated lowest with Strategy A and highest with Strategy B. Compared to the latter, program cost reduces by 7%, 4.5%, and 17.4% by strategies C, D, and E, respectively. Cost to the group of individuals with presumptive PTB and their attendants is significantly higher for Strategy A compared to other four strategies. Among the latter, the patients' cost was minimum with Strategy B and maximum with Strategy C. Program cost per case diagnosed was lowest by Strategy A and highest by Strategy B. Patient cost per case diagnosed was highest by Strategy A and lowest by Strategy B. Using Xpert, Strategy E had the lowest program as well as overall cost per case diagnosed. Strategy E may be chosen for diagnosis of PTB. When resources would no longer be a constraint, direct Xpert would reduce costs incurred by the patients. Copyright © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

78 FR 54996 - Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-09

... employer-sponsored plan is affordable if the employee's required contribution for the lowest-cost self-only... the lowest-cost employer-sponsored self-only coverage that provides minimum value to verify the... the premium tax credit, the Exchanges will employ a verification process. Because the information...

Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

PubMed Central

Clarke, Philip M.; Glasziou, Paul; Patel, Anushka; Chalmers, John; Woodward, Mark; Harrap, Stephen B.; Salomon, Joshua A.

2010-01-01

Background Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. Methods and Findings Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%–96% across regions) and lowest for nephropathy (15%–26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17–32 d across region) and heart failure (16–31 d) and lowest for nephropathy (12–23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. Conclusions Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems. Please see later in the article for the Editors' Summary PMID:20186272

Organic matter and heavy metals content modeling in sewage sludge treated with reed bed system

NASA Astrophysics Data System (ADS)

Boruszko, Dariusz; Dąbrowski, Wojciech; Malinowski, Paweł

2017-11-01

The long process of sludge stabilization (7-15 years) remarkably reduces the organic matter content and causes the process of sludge humifaction. This paper presents the results of using low-cost methods of sludge treatment in the wastewater treatment plant located in Zambrow, Podlaskie Province. The results of studies on the organic matter and heavy metals content in sewage sludge after treatment in a reed bed system are presented. The aim of the research was to evaluate and model organic matter and heavy metals concentrations during sewage stabilization in reed bed lagoons. The lowest concentration, below 1.3 mg/kg DM of the examined seven heavy metals was mercury (Hg). The highest concentration, exceeding 1300 mg/kg DM was zinc (Zn). The obtained results for the heavy metals in sewage sludge from the reed bed lagoons in Zambrow show that the average content of the analyzed heavy metals is approximately 1620 mg/kg DM. The results of the study demonstrate a high efficiency of low-cost methods used in Zambrów WWTP in terms of the quality of the processed sludge. Sewage sludge from the lowest layer of the reed lagoon (12-14 years of dewatering and transformation) is characterized by the lowest organic matter and heavy metals content. The higher a sediment layer lies, i.e. the shorter the time of processing, the higher is the heavy metals content. This indicates a great role of reeds in the accumulation of these compounds.

Some regional costs of a synthetic fuel industry: The case of illinois

USGS Publications Warehouse

Attanasi, E.D.; Green, E.K.

1981-01-01

The Federal Government's efforts to induce development of a coal-based synthetic fuel industry include direct subsidies, tax concessions, and assurances that it will purchase the industry's output, even if above the market price. In this note it is argued that these subsidies will enable this industry to secure a region's largest and lowest-cost coal deposits and that the costs imposed on other coal users will be substantial. Moreover, because the lowest-cost coal deposits will be committed to synthetic fuels production regardless of the industry's commercial viability, distortions in regional coal markets will develop. If economic efficiency requires that the price of the resource reflect its replacement value, then a State government is justified in imposing a tax on coal destined for subsidized synthetic fuel plants. Amounts of such a tax, based on the higher costs of coal that must be accepted by other users as the result of the subsidized synthetic fuel plants' preempting the largest and lowest-cost deposits, are estimated for the case of Illinois strippable coal. ?? 1981 Annals of Regional Science.

Estimating the Cost of Cancer Care in British Columbia and Ontario: A Canadian Inter-Provincial Comparison

PubMed Central

Pataky, Reka; Bremner, Karen E.; Rangrej, Jagadish; Chan, Kelvin K.W.; Cheung, Winson Y.; Hoch, Jeffrey S.; Peacock, Stuart; Krahn, Murray D.

2017-01-01

Background: Costing studies are useful to measure the economic burden of cancer. Comparing costs between healthcare systems can inform evaluation, development or modification of cancer care policies. Objectives: To estimate and compare cancer costs in British Columbia and Ontario from the payers' perspectives. Methods: Using linked cancer registry and administrative data, and standardized costing methodology and analyses, we estimated costs for 21 cancer sites by phase of care to determine potential differences between provinces. Results: Overall, costs were higher in Ontario. Costs were highest in the initial post-diagnosis and pre-death phases and lowest in the pre-diagnosis and continuing phases, and generally higher for brain cancer and multiple myeloma, and lower for melanoma. Hospitalization was the major cost category. Costs for physician services and diagnostic tests differed the most between provinces. Conclusions: The standardization of data and costing methodology is challenging, but it enables interprovincial and international comparative costing analyses. PMID:28277207

Economic Analysis of Different Electric Vehicle Charging Scenarios

NASA Astrophysics Data System (ADS)

Ying, Li; Haiming, Zhou; Xiufan, Ma; Hao, Wang

2017-05-01

Influence of electric vehicles (EV) to grid cannot be ignored. Research on the economy analysis of different charging scenarios is helpful to guide the user to charge or discharge orderly. EV charging models are built such as disordered charging, valley charging, intelligent charging, and V2G (Vehicle to Grid), by which changes of charging load in different scenarios can be seen to analyze the influence to initial load curve, and comparison can be done about user’s average cost. Monte Carlo method is used to simulate the electric vehicle charging behavior, cost in different charging scenarios are compared, social cost is introduced in V2G scene, and the relationship between user’s average cost and social cost is analyzed. By test, it is proved that user’s cost is the lowest in V2G scenario, and the larger the scale of vehicles is, the more the social cost can save.

The Rapid Transit System That Achieves Higher Performance with Lower Life-Cycle Costs

NASA Astrophysics Data System (ADS)

Sone, Satoru; Takagi, Ryo

In the age of traction system made of inverter and ac traction motors, distributed traction system with pure electric brake of regenerative mode has been recognised very advantageous. This paper proposes a new system as the lowest life-cycle cost system for high performance rapid transit, a new architecture and optimum parameters of power feeding system, and a new running method of trains. In Japan, these components of this proposal, i.e. pure electric brake and various countermeasures of reducing loss of regeneration have been already popular but not as yet the new running method for better utilisation of the equipment and for lower life-cycle cost. One example of what are proposed in this paper will be made as Tsukuba Express, which is under construction as the most modern commuter railway in Greater Tokyo area.

Cost per remission and cost per response with infliximab, adalimumab, and golimumab for the treatment of moderately-to-severely active ulcerative colitis.

PubMed

Toor, Kabirraaj; Druyts, Eric; Jansen, Jeroen P; Thorlund, Kristian

2015-06-01

To determine the short-term costs per sustained remission and sustained response of three tumor necrosis factor inhibitors (infliximab, adalimumab, and golimumab) in comparison to conventional therapy for the treatment of moderately-to-severely active ulcerative colitis. A probabilistic Markov model was developed. This included an 8-week induction period, and 22 subsequent 2-week cycles (up to 1 year). The model included three disease states: remission, response, and relapse. Costs were from a Canadian public payer perspective. Estimates for the additional cost per 1 year of sustained remission and sustained response were obtained. Golimumab 100 mg provided the lowest cost per additional remission ($935) and cost per additional response ($701) compared with conventional therapy. Golimumab 50 mg yielded slightly higher costs than golimumab 100 mg. Infliximab was associated with the largest additional number of estimated remissions and responses, but also higher cost at $1975 per remission and $1311 per response. Adalimumab was associated with the largest cost per remission ($7430) and cost per response ($2361). The cost per additional remission and cost per additional response associated with infliximab vs golimumab 100 mg was $14,659 and $4753, respectively. The results suggest that the additional cost of 1 full year of remission and response are lowest with golimumab 100 mg, followed by golimumab 50 mg. Although infliximab has the highest efficacy, it did not exhibit the lowest cost per additional remission or response. Adalimumab produced the highest cost per additional remission and response.

Noviodunum Roman Fortress. a Survey on a City Wall Section

NASA Astrophysics Data System (ADS)

Teodor, A.; Teodor, E. S.; Florea, M. S.; Popescu, M. A.

2011-09-01

The paper presents in detail the method used to acquire 2D and 3D representations for the Large Tower of the Roman fortress from Noviodunum (Isaccea, Tulcea County). The available implements were a total station, a digital camera and some software for handling data. The method is not new by any rate, but well fitted to the aims - recording archaeological data on ruined but massif walls, with rough surfaces - and with a limited budget. Lately considered as a low cost procedure, laser scanning is still costly and rare in some East-European countries. Our method, as simple as it is, provides reliable data as a 3D survey, along texture details, at the lowest price, on unfinished fieldwork, preserving and picturing a stage of knowledge about the site and the architectural bodies.

National Conference on Integrated Resource Planning: Proceedings

NASA Astrophysics Data System (ADS)

Until recently, state regulators have focused most of their attention on the development of least-cost or integrated resource planning (IRP) processes for electric utilities. A number of commissions are beginning to scrutinize the planning processes of local gas distribution companies (LDCs) because of the increased control that LDCs have over their purchased gas costs (as well as the associated risks) and because of questions surrounding the role and potential of gas end-use efficiency options. Traditionally, resource planning (LDCs) has concentrated on options for purchasing and storing gas. Integrated resource planning involves the creation of a process in which supply-side and demand-side options are integrated to create a resource mix that reliably satisfies customers' short-term and long-term energy service needs at the lowest cost. As applied to gas utilities, an integrated resource plan seeks to balance cost and reliability, and should not be interpreted simply as the search for lowest commodity costs. The National Association of Regulatory Utility Commissioners' (NARUC) Energy Conservation committee asked Lawrence Berkeley Laboratory (LBL) to survey state PUCs to determine the extent to which they have undertaken least cost planning for gas utilities. The survey included the following topics: status of state PUC least-cost planning regulations and practices for gas utilities; type and scope of natural gas DSM programs in effect, including fuel substitution; economic tests and analysis methods used to evaluate DSM programs; relationship between prudency reviews of gas utility purchasing practices and integrated resource planning; and key regulatory issues facing gas utilities during the next five years.

Improving building performance using smart building concept: Benefit cost ratio comparison

NASA Astrophysics Data System (ADS)

Berawi, Mohammed Ali; Miraj, Perdana; Sayuti, Mustika Sari; Berawi, Abdur Rohim Boy

2017-11-01

Smart building concept is an implementation of technology developed in the construction industry throughout the world. However, the implementation of this concept is still below expectations due to various obstacles such as higher initial cost than a conventional concept and existing regulation siding with the lowest cost in the tender process. This research aims to develop intelligent building concept using value engineering approach to obtain added value regarding quality, efficiency, and innovation. The research combined quantitative and qualitative approach using questionnaire survey and value engineering method to achieve the research objectives. The research output will show additional functions regarding technology innovation that may increase the value of a building. This study shows that smart building concept requires higher initial cost, but produces lower operational and maintenance costs. Furthermore, it also confirms that benefit-cost ratio on the smart building was much higher than a conventional building, that is 1.99 to 0.88.

Economic viability of thin-film tandem solar modules in the United States

NASA Astrophysics Data System (ADS)

Sofia, Sarah E.; Mailoa, Jonathan P.; Weiss, Dirk N.; Stanbery, Billy J.; Buonassisi, Tonio; Peters, I. Marius

2018-05-01

Tandem solar cells are more efficient but more expensive per unit area than established single-junction (SJ) solar cells. To understand when specific tandem architectures should be utilized, we evaluate the cost-effectiveness of different II-VI-based thin-film tandem solar cells and compare them to the SJ subcells. Levelized cost of electricity (LCOE) and energy yield are calculated for four technologies: industrial cadmium telluride and copper indium gallium selenide, and their hypothetical two-terminal (series-connected subcells) and four-terminal (electrically independent subcells) tandems, assuming record SJ quality subcells. Different climatic conditions and scales (residential and utility scale) are considered. We show that, for US residential systems with current balance-of-system costs, the four-terminal tandem has the lowest LCOE because of its superior energy yield, even though it has the highest US per watt (US W-1) module cost. For utility-scale systems, the lowest LCOE architecture is the cadmium telluride single junction, the lowest US W-1 module. The two-terminal tandem requires decreased subcell absorber costs to reach competitiveness over the four-terminal one.

Evaluation of the Effects of Physical Activity, Cardiorespiratory Condition, and Neuromuscular Fitness on Direct Healthcare Costs and Sickness-Related Absence Among Nursing Personnel With Recurrent Nonspecific Low Back Pain.

PubMed

Kolu, Päivi; Tokola, Kari; Kankaanpää, Markku; Suni, Jaana

2017-06-01

A cross-sectional study, part of a randomized controlled trial. To evaluate the association of physical activity, cardiorespiratory fitness, and neuromuscular fitness with direct healthcare costs and sickness-related absence among nursing personnel with nonspecific low back pain. Low back pain creates a huge economic burden due to increased sick leave and use of healthcare services. Female nursing personnel with nonspecific low back pain were included (n = 219). Physical activity was assessed with accelerometry and a questionnaire. In addition, measurements of cardiorespiratory and muscular fitness were conducted. Direct costs and sickness-related absence for a 6-month period were collected retrospectively by questionnaire. Health care utilization and absence from work were analyzed with a general linear model. The mean total costs were 80.5% lower among women who met physical activity recommendations than inactive women. Those with a higher mean daily intensity level of 10-minute activity sessions showed lower total costs than women in the lowest tertile (middle: 64.0% of the lowest; highest: 54.3% of the lowest). Women with good cardiorespiratory fitness (the highest tertile) as measured with the 6-minute-walk test (based on walking distance) had 77.0% lower total costs when compared with the lowest tertile. Women in the highest third for the modified push-up test had 84.0% lower total costs than those with the poorest results (the bottom tertile). High cardiorespiratory and muscular fitness and meeting physical activity recommendations for aerobic and muscular fitness were strongly associated with lower total costs among nursing personnel with pain-related disorders of recurrent nonspecific low back pain. Actions to increase physical activity and muscle conditioning may significantly save on healthcare costs and decrease sick-leave costs due to low back pain.

VIA/VILI is more suitable for cervical cancer prevention in Chinese poverty-stricken region: a health economic evaluation.

PubMed

Xie, Yu; Tan, Xiaodong; Shao, Haiyan; Liu, Qing; Tou, Jiyu; Zhang, Yuling; Luo, Qiong; Xiang, Qunying

2017-01-25

Screening is the main preventive method for cervical cancer in developing countries, but each type of screening has advantages and disadvantages. To investigate the most suitable method for low-income areas in China, we conducted a health economic analysis comparing three methods: visual inspection with acetic acid and Lugol's iodine (VIA/VILI), ThinPrep cytology test (TCT), and human papillomavirus (HPV) test. We recruited 3086 women aged 35-65 years using cluster random sampling. Each participant was randomly assigned to one of three cervical cancer screening groups: VIA/VILI, TCT, or HPV test. In order to calculate the number of disability-adjusted life years (DALYs) averted by each screening method, we used Markov models to estimate the natural development of cervical cancer over a 15-year period to estimate the age of onset and duration of each disease stage. The cost-effectiveness ratios (CERs), net present values (NPVs), benefit-cost ratios (BCRs), and cost-utility ratios (CURs) were used as outcomes in the health economic analysis. The positive detection rate in the VIA/VILI group was 1.39%, which was 4.6 and 2.0 times higher than the rates in the TCT and HPV test groups, respectively. The positive predictive value of VIA/VILI (10.53%) was highest while the rate of referral for colposcopy was lowest for those in the HPV + TCT group (0.60%). VIA/VILI performed the best in terms of health economic evaluation results, as the cost of per positive case detected was 8467.9 RMB, which was 24503.0 RMB lower than that for TCT and 5755.9 RMB lower than that for the HPV test. In addition, the NPV and BCR values were 258011.5 RMB and 3.18 (the highest), and the CUR was 2341.8 RMB (the lowest). The TCT performed the worst, since its NPV was <0 and the BCR was <1, indicative of being poorly cost-beneficial. With the best economic evaluation results and requiring minimum medical resources, VIA/VILI is recommended for cervical cancer screening in poverty-stricken areas in China with high incidence of cervical cancer and lack of medical resources.

Variation in costs of cone beam CT examinations among healthcare systems

PubMed Central

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-01-01

Objectives To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, “out of pocket” costs for examination fee and visits). Results The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range €0–102.02). Conclusions Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances. PMID:22499131

Investigation of test methods, material properties and processes for solar cell encapsulants

NASA Technical Reports Server (NTRS)

Willis, P. B.; Baum, B.

1983-01-01

The goal of the program is to identify, test, evaluate and recommend encapsulation materials and processes for the fabrication of cost-effective and long life solar modules. Of the $18 (1948 $) per square meter allocated for the encapsulation components approximately 50% of the cost ($9/sq m) may be taken by the load bearing component. Due to the proportionally high cost of this element, lower costing materials were investigated. Wood based products were found to be the lowest costing structural materials for module construction, however, they require protection from rainwater and humidity in order to acquire dimensional stability. The cost of a wood product based substrate must, therefore, include raw material costs plus the cost of additional processing to impart hygroscopic inertness. This protection is provided by a two step, or split process in which a flexible laminate containing the cell string is prepared, first in a vacuum process and then adhesively attached with a back cover film to the hardboard in a subsequent step.

Cost analysis when open surgeons perform minimally invasive hysterectomy.

PubMed

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

2014-01-01

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

Comparative cost effectiveness of varicella, hepatitis A, and pneumococcal conjugate vaccines.

PubMed

Jacobs, R J; Meyerhoff, A S

2001-12-01

Several state and local U.S. governments are considering making varicella, hepatitis A, and/or pneumococcal conjugate vaccination conditions of day care or school entry. These requirements will likely be issued sequentially, because simultaneous mandates exacerbate budget constraints and complicate communication with parents and providers. Cost-effectiveness assessments should aid the establishment of vaccination priorities, but comparing results of published studies is confounded by their dissimilar methods. We reviewed U.S. cost-effectiveness studies of childhood varicella, hepatitis A, and pneumococcal conjugate vaccines and identified four providing data required to standardize methods. Vaccination, disease treatment, and work-loss costs were estimated from original study results and current prices. Estimated life-years saved were derived from original study results, epidemiological evidence, and alternative procedures for discounting to present values. Hepatitis A vaccine would have the lowest health system costs per life-year saved. Varicella vaccine would provide the greatest reduction in societal costs, mainly through reduced parent work loss. Pneumococcal conjugate vaccine would cost twice the amount of varicella and hepatitis A vaccines combined and be less cost effective than the other vaccines. Hepatitis A and varicella vaccines, but not pneumococcal conjugate vaccine, meet or exceed conventional standards of cost effectiveness. Copyright 2001 American Health Foundation and Elsevier Science.

Cost-effectiveness analysis of colorectal cancer screening methods in Iran.

PubMed

Allameh, Zahra; Davari, Majid; Emami, Mohammad Hasan

2011-03-01

Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran. Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100,000 apparently healthy persons of ages 45-65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model. The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively. Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 - 65-year-old population in Iran.

Assessment of wind energy potential and cost estimation of wind-generated electricity at hilltops surrounding the city of Maroua in Cameroon

NASA Astrophysics Data System (ADS)

Kaoga, Dieudonné Kidmo; Bogno, Bachirou; Aillerie, Michel; Raidandi, Danwe; Yamigno, Serge Doka; Hamandjoda, Oumarou; Tibi, Beda

2016-07-01

In this work, 28 years of wind data, measured at 10m above ground level (AGL), from Maroua meteorological station is utilized to assess the potential of wind energy at exposed ridges tops of mountains surrounding the city of Maroua. The aim of this study is to estimate the cost of wind-generated electricity using six types of wind turbines (50 to 2000 kW). The Weibull distribution function is employed to estimate Weibull shape and scale parameters using the energy pattern factor method. The considered wind shear model to extrapolate Weibull parameters and wind profiles is the empirical power law correlation. The results show that hilltops in the range of 150-350m AGL in increments of 50, fall under Class 3 or greater of the international system of wind classification and are deemed suitable to outstanding for wind turbine applications. A performance of the selected wind turbines is examined as well as the costs of wind-generated electricity at the considered hilltops. The results establish that the lowest costs per kWh are obtained using YDF-1500-87 (1500 kW) turbine while the highest costs are delivered by P-25-100 (90 kW). The lowest costs (US) per kWh of electricity generated are found to vary between a minimum of 0.0294 at hilltops 350m AGL and a maximum of 0.0366 at hilltops 150m AGL, with corresponding energy outputs that are 6,125 and 4,932 MWh, respectively. Additionally, the matching capacity factors values are 38.05% at hilltops 150m AGL and 47.26% at hilltops 350m AGL. Furthermore, YDF-1500-87 followed by Enercon E82-2000 (2000 kW) wind turbines provide the lowest cost of wind generated electricity and are recommended for use for large communities. Medium wind turbine P-15-50 (50 kW), despite showing the best coefficients factors (39.29% and 48.85% at hilltops 150 and 350m AGL, in that order), generates electricity at an average higher cost/kWh of US0.0547 and 0.0440 at hilltops 150 and 350m AGL, respectively. P-15-50 is deemed a more advantageous option for off-grid electrification of small and remote communities.

A finite difference Davidson procedure to sidestep full ab initio hessian calculation: Application to characterization of stationary points and transition state searches

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

Sharada, Shaama Mallikarjun; Bell, Alexis T., E-mail: mhg@bastille.cchem.berkeley.edu, E-mail: bell@cchem.berkeley.edu; Head-Gordon, Martin, E-mail: mhg@bastille.cchem.berkeley.edu, E-mail: bell@cchem.berkeley.edu

2014-04-28

The cost of calculating nuclear hessians, either analytically or by finite difference methods, during the course of quantum chemical analyses can be prohibitive for systems containing hundreds of atoms. In many applications, though, only a few eigenvalues and eigenvectors, and not the full hessian, are required. For instance, the lowest one or two eigenvalues of the full hessian are sufficient to characterize a stationary point as a minimum or a transition state (TS), respectively. We describe here a method that can eliminate the need for hessian calculations for both the characterization of stationary points as well as searches for saddlemore » points. A finite differences implementation of the Davidson method that uses only first derivatives of the energy to calculate the lowest eigenvalues and eigenvectors of the hessian is discussed. This method can be implemented in conjunction with geometry optimization methods such as partitioned-rational function optimization (P-RFO) to characterize stationary points on the potential energy surface. With equal ease, it can be combined with interpolation methods that determine TS guess structures, such as the freezing string method, to generate approximate hessian matrices in lieu of full hessians as input to P-RFO for TS optimization. This approach is shown to achieve significant cost savings relative to exact hessian calculation when applied to both stationary point characterization as well as TS optimization. The basic reason is that the present approach scales one power of system size lower since the rate of convergence is approximately independent of the size of the system. Therefore, the finite-difference Davidson method is a viable alternative to full hessian calculation for stationary point characterization and TS search particularly when analytical hessians are not available or require substantial computational effort.« less

Life-cycle assessment of Nebraska bridges.

DOT National Transportation Integrated Search

2013-05-01

Life-cycle cost analysis (LCCA) is a necessary component in bridge management systems (BMSs) for : assessing investment decisions and identifying the most cost-effective improvement alternatives. The : LCCA helps to identify the lowest cost alternati...

7 CFR 1770.5 - Periods of retention.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., would have been expected to accomplish the desired result consistent with cost effectiveness... lowest reasonable cost consistent with cost effectiveness, reliability, safety, and expedition. (b... utility service, all removal and restoration activities are completed, and all costs are retired from the...

Resin transfer molding of textile preforms for aircraft structural applications

NASA Technical Reports Server (NTRS)

Hasko, Gregory H.; Dexter, H. Benson; Weideman, Mark H.

1992-01-01

The NASA LaRC is conducting and supporting research to develop cost-effective fabrication methods that are applicable to primary composite aircraft structures. One of the most promising fabrication methods that has evolved is resin transfer molding (RTM) of dry textile material forms. RTM has been used for many years for secondary structures, but has received increased emphasis because it is an excellent method for applying resin to damage-tolerant textile preforms at low cost. Textile preforms based on processes such as weaving, braiding, knitting, stitching, and combinations of these have been shown to offer significant improvements in damage tolerance compared to laminated tape composites. The use of low-cost resins combined with textile preforms could provide a major breakthrough in achieving cost-effective composite aircraft structures. RTM uses resin in its lowest cost form, and storage and spoilage costs are minimal. Near net shape textile preforms are expected to be cost-effective because automated machines can be used to produce the preforms, post-cure operations such as machining and fastening are minimized, and material scrap rate may be reduced in comparison with traditional prepreg molding. The purpose of this paper is to discuss experimental and analytical techniques that are under development at NASA Langley to aid the engineer in developing RTM processes for airframe structural elements. Included are experimental techniques to characterize preform and resin behavior and analytical methods that were developed to predict resin flow and cure kinetics.

Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study.

PubMed

Sharma, K M; Ranjani, H; Zabetian, A; Datta, M; Deepa, M; Moses, C R Anand; Narayan, K M V; Mohan, V; Ali, M K

2016-01-01

There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study. Persons with diabetes ( n  = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status ( n  = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs. Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs ( p  < 0.001). Older age ( p  = 0.02) and longer duration of diabetes ( p  < 0.001) were associated with higher total lost work days. Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.

The Economic Burden Attributable to a Child’s Inpatient Admission for Diarrheal Disease in Rwanda

PubMed Central

Ngabo, Fidele; Mvundura, Mercy; Gazley, Lauren; Gatera, Maurice; Rugambwa, Celse; Kayonga, Eugene; Tuyishime, Yvette; Niyibaho, Jeanne; Mwenda, Jason M.; Donnen, Philippe; Lepage, Philippe; Binagwaho, Agnes; Atherly, Deborah

2016-01-01

Background Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. Methods This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child’s caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Results Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction. Conclusion Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile. PMID:26901113

Economic analysis of pandemic influenza mitigation strategies for five pandemic severity categories

PubMed Central

2013-01-01

Background The threat of emergence of a human-to-human transmissible strain of highly pathogenic influenza A(H5N1) is very real, and is reinforced by recent results showing that genetically modified A(H5N1) may be readily transmitted between ferrets. Public health authorities are hesitant in introducing social distancing interventions due to societal disruption and productivity losses. This study estimates the effectiveness and total cost (from a societal perspective, with a lifespan time horizon) of a comprehensive range of social distancing and antiviral drug strategies, under a range of pandemic severity categories. Methods An economic analysis was conducted using a simulation model of a community of ~30,000 in Australia. Data from the 2009 pandemic was used to derive relationships between the Case Fatality Rate (CFR) and hospitalization rates for each of five pandemic severity categories, with CFR ranging from 0.1% to 2.5%. Results For a pandemic with basic reproduction number R0 = 1.8, adopting no interventions resulted in total costs ranging from $441 per person for a pandemic at category 1 (CFR 0.1%) to $8,550 per person at category 5 (CFR 2.5%). For severe pandemics of category 3 (CFR 0.75%) and greater, a strategy combining antiviral treatment and prophylaxis, extended school closure and community contact reduction resulted in the lowest total cost of any strategy, costing $1,584 per person at category 5. This strategy was highly effective, reducing the attack rate to 5%. With low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, whereas higher severity pandemic costs are dominated by healthcare costs and costs arising from productivity losses due to death. Conclusions For pandemics in high severity categories the strategies with the lowest total cost to society involve rigorous, sustained social distancing, which are considered unacceptable for low severity pandemics due to societal disruption and cost. PMID:23496898

Spatial multiobjective optimization of agricultural conservation practices using a SWAT model and an evolutionary algorithm.

PubMed

Rabotyagov, Sergey; Campbell, Todd; Valcu, Adriana; Gassman, Philip; Jha, Manoj; Schilling, Keith; Wolter, Calvin; Kling, Catherine

2012-12-09

Finding the cost-efficient (i.e., lowest-cost) ways of targeting conservation practice investments for the achievement of specific water quality goals across the landscape is of primary importance in watershed management. Traditional economics methods of finding the lowest-cost solution in the watershed context (e.g.,(5,12,20)) assume that off-site impacts can be accurately described as a proportion of on-site pollution generated. Such approaches are unlikely to be representative of the actual pollution process in a watershed, where the impacts of polluting sources are often determined by complex biophysical processes. The use of modern physically-based, spatially distributed hydrologic simulation models allows for a greater degree of realism in terms of process representation but requires a development of a simulation-optimization framework where the model becomes an integral part of optimization. Evolutionary algorithms appear to be a particularly useful optimization tool, able to deal with the combinatorial nature of a watershed simulation-optimization problem and allowing the use of the full water quality model. Evolutionary algorithms treat a particular spatial allocation of conservation practices in a watershed as a candidate solution and utilize sets (populations) of candidate solutions iteratively applying stochastic operators of selection, recombination, and mutation to find improvements with respect to the optimization objectives. The optimization objectives in this case are to minimize nonpoint-source pollution in the watershed, simultaneously minimizing the cost of conservation practices. A recent and expanding set of research is attempting to use similar methods and integrates water quality models with broadly defined evolutionary optimization methods(3,4,9,10,13-15,17-19,22,23,25). In this application, we demonstrate a program which follows Rabotyagov et al.'s approach and integrates a modern and commonly used SWAT water quality model(7) with a multiobjective evolutionary algorithm SPEA2(26), and user-specified set of conservation practices and their costs to search for the complete tradeoff frontiers between costs of conservation practices and user-specified water quality objectives. The frontiers quantify the tradeoffs faced by the watershed managers by presenting the full range of costs associated with various water quality improvement goals. The program allows for a selection of watershed configurations achieving specified water quality improvement goals and a production of maps of optimized placement of conservation practices.

One fish, two fish, red fish, blue fish: effects of price frames, brand names, and choice set size on Medicare Part D insurance plan decisions.

PubMed

Barnes, Andrew J; Hanoch, Yaniv; Wood, Stacey; Liu, Pi-Ju; Rice, Thomas

2012-08-01

Because many seniors choose Medicare Part D plans offering poorer coverage at greater cost, the authors examined the effect of price frames, brand names, and choice set size on participants' ability to choose the lowest cost plan. A 2×2×2 within-subjects design was used with 126 participants aged 18 to 91 years old. Mouselab, a web-based program, allowed participants to choose drug plans across eight trials that varied using numeric or symbolic prices, real or fictitious drug plan names, and three or nine drug plan options. Results from the multilevel models suggest numeric versus symbolic prices decreased the likelihood of choosing the lowest cost plan (-8.0 percentage points, 95% confidence interval=-14.7 to -0.9). The likelihood of choosing the lowest cost plan decreased as the amount of information increased suggesting that decision cues operated independently and collectively when selecting a drug plan. Redesigning the current Medicare Part D plan decision environment could improve seniors' drug plan choices.

Variation in costs of cone beam CT examinations among healthcare systems.

PubMed

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-10-01

To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

Various contract settings and their impact on the cost of medical services.

PubMed

Magnezi, R; Dankner, R; Kedem, R; Reuveni, H

2007-03-01

This study analyzes the effect of outsourcing healthcare on career soldiers in the Israel Defense Forces (IDF) in different settings, so as to develop a model for predicting per capita medical costs Demographic information and data on healthcare utilization and costs were gathered from three computerized billing database systems: The IDF Medical Corps; a civilian hospital; and a healthcare fund, providing services to 3,746; 3,971; and 6,400 career soldiers, respectively. Visits to primary care physicians and specialists, laboratory and imaging exams, number of sick-leave days, and hospitalization days, were totaled for men and women separately for each type of clinic. A uniform cost was assigned to each type of treatment to create an average annual per capita cost for medical services of career soldiers. Significantly more visits were recorded to primary care physician and to specialists, as well as imaging examinations by Leumit Healthcare Services (LHS), than visits and tests in hospitals or in military clinics (p < 0.001). The number of referrals to emergency rooms and sick-leave days were lowest in the LHS as compared to the hospital and military clinics (p < 0.001). The medical cost per capita/year was lowest in LHS as well. Outsourcing primary care for career soldiers to a civilian healthcare fund represents a major cost effective change, lowest consumption and lower cost of medical care. Co-payment should be integrated into every agreement with the medical corps.

18 CFR 4.51 - Contents of application.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the total project as proposed specifying any projected changes in the costs (life-cycle costs) over the estimated financing or licensing period if the applicant takes such changes into account... lowest cost alternative source, specifying any projected changes in the cost of power from that source...

18 CFR 4.51 - Contents of application.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the total project as proposed specifying any projected changes in the costs (life-cycle costs) over the estimated financing or licensing period if the applicant takes such changes into account... lowest cost alternative source, specifying any projected changes in the cost of power from that source...

18 CFR 4.51 - Contents of application.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the total project as proposed specifying any projected changes in the costs (life-cycle costs) over the estimated financing or licensing period if the applicant takes such changes into account... lowest cost alternative source, specifying any projected changes in the cost of power from that source...

18 CFR 4.51 - Contents of application.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the total project as proposed specifying any projected changes in the costs (life-cycle costs) over the estimated financing or licensing period if the applicant takes such changes into account... lowest cost alternative source, specifying any projected changes in the cost of power from that source...

18 CFR 4.51 - Contents of application.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the total project as proposed specifying any projected changes in the costs (life-cycle costs) over the estimated financing or licensing period if the applicant takes such changes into account... lowest cost alternative source, specifying any projected changes in the cost of power from that source...

Landslide risk in the San Francisco Bay region

USGS Publications Warehouse

Coe, J.A.; Crovelli, R.A.

2008-01-01

We have used historical records of damaging landslides triggered by rainstorms, and a newly developed Probabilistic Landslide Assessment Cost Estimation System (PLACES), to estimate the numbers and direct costs of future landslides in the San Francisco Bay region. The estimated annual cost of future landslides in the entire region is about US $15 million (year 2000 $). The estimated annual cost is highest for San Mateo County ($3.32 million) and lowest for Solano County ($0.18 million). Normalizing costs by dividing by the percentage of land area with slopes equal or greater than about 10° indicates that San Francisco County will have the highest cost per square km ($7,400), whereas Santa Clara County will have the lowest cost per square km ($230). These results indicate that the San Francisco Bay region has one of the highest levels of landslide risk in the United States. Compared to landslide cost estimates from the rest of the world, the risk level in the Bay region seems high, but not exceptionally high.

A program needs-driven approach to selecting dietary assessment methods for decision-making in food fortification programs.

PubMed

Coates, Jennifer; Colaiezzi, Brooke; Fiedler, John L; Wirth, James; Lividini, Keith; Rogers, Beatrice

2012-09-01

Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists. To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs. Twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods. Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity. HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes. Each dietary assessment method has strengths and weaknesses that vary by context and purpose. Method selection must be driven by the program's data needs, the suitability of the methods for the purpose, and a clear understanding of the tradeoffs involved.

Costs and Efficiency of Online and Offline Recruitment Methods: A Web-Based Cohort Study

PubMed Central

Riis, Anders H; Hatch, Elizabeth E; Wise, Lauren A; Nielsen, Marie G; Rothman, Kenneth J; Toft Sørensen, Henrik; Mikkelsen, Ellen M

2017-01-01

Background The Internet is widely used to conduct research studies on health issues. Many different methods are used to recruit participants for such studies, but little is known about how various recruitment methods compare in terms of efficiency and costs. Objective The aim of our study was to compare online and offline recruitment methods for Internet-based studies in terms of efficiency (number of recruited participants) and costs per participant. Methods We employed several online and offline recruitment methods to enroll 18- to 45-year-old women in an Internet-based Danish prospective cohort study on fertility. Offline methods included press releases, posters, and flyers. Online methods comprised advertisements placed on five different websites, including Facebook and Netdoktor.dk. We defined seven categories of mutually exclusive recruitment methods and used electronic tracking via unique Uniform Resource Locator (URL) and self-reported data to identify the recruitment method for each participant. For each method, we calculated the average cost per participant and efficiency, that is, the total number of recruited participants. Results We recruited 8252 study participants. Of these, 534 were excluded as they could not be assigned to a specific recruitment method. The final study population included 7724 participants, of whom 803 (10.4%) were recruited by offline methods, 3985 (51.6%) by online methods, 2382 (30.8%) by online methods not initiated by us, and 554 (7.2%) by other methods. Overall, the average cost per participant was €6.22 for online methods initiated by us versus €9.06 for offline methods. Costs per participant ranged from €2.74 to €105.53 for online methods and from €0 to €67.50 for offline methods. Lowest average costs per participant were for those recruited from Netdoktor.dk (€2.99) and from Facebook (€3.44). Conclusions In our Internet-based cohort study, online recruitment methods were superior to offline methods in terms of efficiency (total number of participants enrolled). The average cost per recruited participant was also lower for online than for offline methods, although costs varied greatly among both online and offline recruitment methods. We observed a decrease in the efficiency of some online recruitment methods over time, suggesting that it may be optimal to adopt multiple online methods. PMID:28249833

Recruitment methods and costs for a randomized, placebo-controlled trial of chiropractic care for lumbar spinal stenosis: a single-site pilot study.

PubMed

Cambron, Jerrilyn A; Dexheimer, Jennifer M; Chang, Mabel; Cramer, Gregory D

2010-01-01

The purpose of this article is to describe the methods for recruitment in a clinical trial on chiropractic care for lumbar spinal stenosis. This randomized, placebo-controlled pilot study investigated the efficacy of different amounts of total treatment dosage over 6 weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects were recruited for this study through several media venues, focusing on successful and cost-effective strategies. Included in our efforts were radio advertising, newspaper advertising, direct mail, and various other low-cost initiatives. Of the 1211 telephone screens, 60 responders (5.0%) were randomized into the study. The most successful recruitment method was radio advertising, generating more than 64% of the calls (776 subjects). Newspaper and magazine advertising generated approximately 9% of all calls (108 subjects), and direct mail generated less than 7% (79 subjects). The total direct cost for recruitment was $40 740 or $679 per randomized patient. The costs per randomization were highest for direct mail ($995 per randomization) and lowest for newspaper/magazine advertising ($558 per randomization). Success of recruitment methods may vary based on target population and location. Planning of recruitment efforts is essential to the success of any clinical trial. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

PubMed

Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

2013-07-01

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

Detecting and treating occlusal caries lesions: a cost-effectiveness analysis.

PubMed

Schwendicke, F; Stolpe, M; Meyer-Lueckel, H; Paris, S

2015-02-01

The health gains and costs resulting from using different caries detection strategies might not only depend on the accuracy of the used method but also the treatment emanating from its use in different populations. We compared combinations of visual-tactile, radiographic, or laser-fluorescence-based detection methods with 1 of 3 treatments (non-, micro-, and invasive treatment) initiated at different cutoffs (treating all or only dentinal lesions) in populations with low or high caries prevalence. A Markov model was constructed to follow an occlusal surface in a permanent molar in an initially 12-y-old male German patient over his lifetime. Prevalence data and transition probabilities were extracted from the literature, while validity parameters of different methods were synthesized or obtained from systematic reviews. Microsimulations were performed to analyze the model, assuming a German health care setting and a mixed public-private payer perspective. Radiographic and fluorescence-based methods led to more overtreatments, especially in populations with low prevalence. For the latter, combining visual-tactile or radiographic detection with microinvasive treatment retained teeth longest (mean 66 y) at lowest costs (329 and 332 Euro, respectively), while combining radiographic or fluorescence-based detections with invasive treatment was the least cost-effective (<60 y, >700 Euro). In populations with high prevalence, combining radiographic detection with microinvasive treatment was most cost-effective (63 y, 528 Euro), while sensitive detection methods combined with invasive treatments were again the least cost-effective (<59 y, >690 Euro). The suitability of detection methods differed significantly between populations, and the cost-effectiveness was greatly influenced by the treatment initiated after lesion detection. The accuracy of a detection method relative to a "gold standard" did not automatically convey into better health or reduced costs. Detection methods should be evaluated not only against their criterion validity but also the long-term effects resulting from their use in different populations. © International & American Associations for Dental Research 2014.

An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis.

PubMed

Betts, Keith A; Griffith, Jenny; Friedman, Alan; Zhou, Zheng-Yi; Signorovitch, James E; Ganguli, Arijit

2016-01-01

Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.

Pursuing the perfect patient experience.

PubMed

Kaplan, Gary S

2013-01-01

Adapting the principles and tools of the Toyota Production System to healthcare in the form of the Virginia Mason Production System has enabled Virginia Mason Medical Center to transform itself as an organization. Virginia Mason has worked persistently for more than a decade to apply Toyota methods to eliminate waste, improve safety and quality, and provide the community it serves with the highest-quality healthcare at the lowest cost. We have made great progress in this pursuit.

Economic evaluation of bivalirudin with or without glycoprotein IIb/IIIa inhibition versus heparin with routine glycoprotein IIb/IIIa inhibition for early invasive management of acute coronary syndromes.

PubMed

Pinto, Duane S; Stone, Gregg W; Shi, Chunxue; Dunn, Elizabeth S; Reynolds, Matthew R; York, Meghan; Walczak, Joshua; Berezin, Ronna H; Mehran, Roxana; McLaurin, Brent T; Cox, David A; Ohman, E Magnus; Lincoff, A Michael; Cohen, David J

2008-11-25

The aim of this study was to determine the economic impact of several anticoagulation strategies for moderate- and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients managed invasively. The ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial demonstrated that bivalirudin monotherapy yields similar rates of ischemic complications and less bleeding than regimens incorporating glycoprotein IIb/IIIa receptor inhibitors (GPI) for moderate- and high-risk NSTE-ACS. In ACUITY, 7,851 U.S. patients were randomized to: 1) heparin (unfractionated or enoxaparin) + GPI; 2) bivalirudin + GPI; or 3) bivalirudin monotherapy. Patients assigned to GPI were also randomized to upstream GPI before catheterization or selective GPI only with percutaneous coronary intervention. Resource use data were collected prospectively through 30-day follow-up. Costs were estimated with standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. At 30 days, ischemic events were similar for all groups. Major bleeding was reduced with bivalirudin monotherapy compared with heparin + GPI or bivalirudin + GPI (p < 0.001). Length of stay was lowest with bivalirudin monotherapy or bivalirudin + catheterization laboratory GPI (p = 0.02). Despite higher drug costs, aggregate hospital stay costs were lowest with bivalirudin monotherapy (mean difference range: $184 to $1,081, p < 0.001 for overall comparison) and at 30 days (mean difference range: $123 to $938, p = 0.005). Regression modeling demonstrated that hospital savings were primarily due to less major and minor bleeding with bivalirudin ($8,658/event and $2,282/event, respectively). Among U.S. patients in the ACUITY trial, bivalirudin monotherapy compared with heparin + GPI resulted in similar protection from ischemic events, reduced bleeding, and shorter length of stay. Despite higher drug costs, aggregate hospital and 30-day costs were lowest with bivalirudin monotherapy. Thus bivalirudin monotherapy seems to be an economically attractive alternative to heparin + GPI for patients with moderate- and high-risk NSTE-ACS. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

Cost effectiveness of a targeted age-based West Nile virus vaccination program.

PubMed

Shankar, Manjunath B; Staples, J Erin; Meltzer, Martin I; Fischer, Marc

2017-05-25

West Nile virus (WNV) is the leading cause of domestically-acquired arboviral disease in the United States. Several WNV vaccines are in various stages of development. We estimate the cost-effectiveness of WNV vaccination programs targeting groups at increased risk for severe WNV disease. We used a mathematical model to estimate costs and health outcomes of vaccination with WNV vaccine compared to no vaccination among seven cohorts, spaced at 10year intervals from ages 10 to 70years, each followed until 90-years-old. U.S. surveillance data were used to estimate WNV neuroinvasive disease incidence. Data for WNV seroprevalence, acute and long-term care costs of WNV disease patients, quality-adjusted life-years (QALYs), and vaccine characteristics were obtained from published reports. We assumed vaccine efficacy to either last lifelong or for 10years with booster doses given every 10years. There was a statistically significant difference in cost-effectiveness ratios across cohorts in both models and all outcomes assessed (Kruskal-Wallis test p<0.0001). The 60-year-cohort had a mean cost per neuroinvasive disease case prevented of $664,000 and disability averted of $1,421,000 in lifelong model and $882,000 and $1,887,000, respectively in 10-year immunity model; these costs were statistically significantly lower than costs for other cohorts (p<0.0001). Vaccinating 70-year-olds had the lowest cost per death averted in both models at around $4.7 million (95%CI $2-$8 million). Cost per disease case averted was lowest among 40- and 50-year-old cohorts and cost per QALY saved lowest among 60-year cohorts in lifelong immunity model. The models were most sensitive to disease incidence, vaccine cost, and proportion of persons developing disease among infected. Age-based WNV vaccination program targeting those at higher risk for severe disease is more cost-effective than universal vaccination. Annual variation in WNV disease incidence, QALY weights, and vaccine costs impact the cost effectiveness ratios. Published by Elsevier Ltd.

Environmental and economic evaluation of selective non-catalytic reduction of nitrogen oxides

NASA Astrophysics Data System (ADS)

Parchevskii, V. M.; Shchederkina, T. E.; Proshina, A. O.

2017-11-01

There are two groups of atmosphere protecting measures: technology (primary) and treatment (secondary). When burning high-calorie low-volatile brands of coals in the furnaces with liquid slag removal to achieve emission standards required joint use of these two methods, for example, staged combustion and selective non-catalytic reduction recovery (SNCR). For the economically intelligent combination of these two methods it is necessary to have information not only about the environmental performance of each method, but also the operating costs per unit of reduced emission. The authors of this report are made an environmental-economic analysis of SNCR on boiler Π-50P Kashirskaya power station. The obtained results about the dependence of costs from the load of the boiler and the mass emissions of nitrogen oxides then approximates into empirical formulas, is named as environmental and economic characteristics, which is suitable for downloading into controllers and other control devices for subsequent implementation of optimal control of emissions to ensure compliance with environmental regulations at the lowest cost at any load of the boiler.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed

Desmond, Katherine A; Rice, Thomas H; Leibowitz, Arleen A

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

Progress report on a multi-service family planning mobile unit September, 1981.

PubMed

1981-12-01

In 1979, the National Family Planning Program's (NFPP) multiservice mobile unit pilot project was implemented to deliver a full complement of clinical and nonclinical family planning services to remote Thai villages by transporting nurses, physicians, and supplies by van. 15 provinces with the lowest family planning achievement in 1978 were selected to participate in the project for 1 year; one refused. Funding was allocated for mobile unit trips and promotional billboards. Implementation at the time of data analysis averaged 9.8 province-months, sufficient to reveal trends in project achievement. 9579 new acceptors were reported after 805 mobile trips in the 14 provinces, an average of 12 new acceptors/trip. New acceptor recruitment costs were estimated at $6.20/client. Based on Thai data for continuation rates, an estimated 18,238 couples years of protection (CYP) were achieved by the mobile unit. In comparison to other family planning services' mobile units, the multiservice unit had the lowest operating costs, but the most expensive cost/CYP. The effectiveness of the promotional billboards was assessed by comparing acceptor rates in provinces with and without billboards. Overall, the provinces with billboards showed less of an increase in new acceptors. When months of project implementation are controlled, a positive effect of the billboards is suggested. While demonstrating that all modern contraception can be delivered via mobile units to remote villages, there is inadequate acceptance of the highly effective family planning methods to justify the cost of transporting staff and equipment.

An economic comparison of different fermentation configurations to convert corn stover to ethanol using Z. mobilis and Saccharomyces.

PubMed

Dutta, Abhijit; Dowe, Nancy; Ibsen, Kelly N; Schell, Daniel J; Aden, Andy

2010-01-01

Numerous routes are being explored to lower the cost of cellulosic ethanol production and enable large-scale production. One critical area is the development of robust cofermentative organisms to convert the multiple, mixed sugars found in biomass feedstocks to ethanol at high yields and titers without the need for processing to remove inhibitors. Until such microorganisms are commercialized, the challenge is to design processes that exploit the current microorganisms' strengths. This study explored various process configurations tailored to take advantage of the specific capabilities of three microorganisms, Z. mobilis 8b, S. cerevisiae, and S. pastorianus. A technoeconomic study, based on bench-scale experimental data generated by integrated process testing, was completed to understand the resulting costs of the different process configurations. The configurations included whole slurry fermentation with a coculture, and separate cellulose simultaneous saccharification and fermentation (SSF) and xylose fermentations with none, some or all of the water to the SSF replaced with the fermented liquor from the xylose fermentation. The difference between the highest and lowest ethanol cost for the different experimental process configurations studied was $0.27 per gallon ethanol. Separate fermentation of solid and liquor streams with recycle of fermented liquor to dilute the solids gave the lowest ethanol cost, primarily because this option achieved the highest concentrations of ethanol after fermentation. Further studies, using methods similar to ones employed here, can help understand and improve the performance and hence the economics of integrated processes involving enzymes and fermentative microorganisms.

Cost effectiveness of facility-based care, home-based care and mobile clinics for provision of antiretroviral therapy in Uganda.

PubMed

Babigumira, Joseph B; Sethi, Ajay K; Smyth, Kathleen A; Singer, Mendel E

2009-01-01

Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years. Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses. FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost.

Techno-Economic Analysis of Biofuel Production from Macroalgae (Seaweed)

PubMed Central

Soleymani, Mohsen

2017-01-01

A techno-economic evaluation of bioenergy production from macroalgae was carried out in this study. Six different scenarios were examined for the production of different energy products and by-products. Seaweed was produced either via the longline method or the grid method. Final products of these scenarios were either ethanol from fermentation, or electricity from anaerobic digestion (AD). By-products were digestate for AD, and animal feed, or electricity and digestate, for the fermentation pathway. Bioenergy breakeven selling prices were investigated according to the cost components and the feedstock supply chain, while suggestions for potential optimization of costs were provided. The lowest production level of dry seaweed to meet 0.93 ($/L) for ethanol fuel and 0.07 $/kW-h for electricity was found to be 0.68 and 3.7 million tonnes (dry basis), respectively. At the moment, biofuel production from seaweed has been determined not to be economically feasible, but achieving economic production may be possible by lowering production costs and increasing the area under cultivation. PMID:29186857

Tradeoffs between costs and greenhouse gas emissions in the design of urban transit systems

NASA Astrophysics Data System (ADS)

Griswold, Julia B.; Madanat, Samer; Horvath, Arpad

2013-12-01

Recent investments in the transit sector to address greenhouse gas emissions have concentrated on purchasing efficient replacement vehicles and inducing mode shift from the private automobile. There has been little focus on the potential of network and operational improvements, such as changes in headways, route spacing, and stop spacing, to reduce transit emissions. Most models of transit system design consider user and agency cost while ignoring emissions and the potential environmental benefit of operational improvements. We use a model to evaluate the user and agency costs as well as greenhouse gas benefit of design and operational improvements to transit systems. We examine how the operational characteristics of urban transit systems affect both costs and greenhouse gas emissions. The research identifies the Pareto frontier for designing an idealized transit network. Modes considered include bus, bus rapid transit (BRT), light rail transit (LRT), and metro (heavy) rail, with cost and emissions parameters appropriate for the United States. Passenger demand follows a many-to-many travel pattern with uniformly distributed origins and destinations. The approaches described could be used to optimize the network design of existing bus service or help to select a mode and design attributes for a new transit system. The results show that BRT provides the lowest cost but not the lowest emissions for our large city scenarios. Bus and LRT systems have low costs and the lowest emissions for our small city scenarios. Relatively large reductions in emissions from the cost-optimal system can be achieved with only minor increases in user travel time.

A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia

PubMed Central

Lee, Jung-Seok

2017-01-01

Background Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. Methods/Principal findings A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. Conclusions/Significance The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run. PMID:29084220

Steady state numerical solutions for determining the location of MEMS on projectile

NASA Astrophysics Data System (ADS)

Abiprayu, K.; Abdigusna, M. F. F.; Gunawan, P. H.

2018-03-01

This paper is devoted to compare the numerical solutions for the steady and unsteady state heat distribution model on projectile. Here, the best location for installing of the MEMS on the projectile based on the surface temperature is investigated. Numerical iteration methods, Jacobi and Gauss-Seidel have been elaborated to solve the steady state heat distribution model on projectile. The results using Jacobi and Gauss-Seidel are shown identical but the discrepancy iteration cost for each methods is gained. Using Jacobi’s method, the iteration cost is 350 iterations. Meanwhile, using Gauss-Seidel 188 iterations are obtained, faster than the Jacobi’s method. The comparison of the simulation by steady state model and the unsteady state model by a reference is shown satisfying. Moreover, the best candidate for installing MEMS on projectile is observed at pointT(10, 0) which has the lowest temperature for the other points. The temperature using Jacobi and Gauss-Seidel for scenario 1 and 2 atT(10, 0) are 307 and 309 Kelvin respectively.

A comparison of entropy balance and probability weighting methods to generalize observational cohorts to a population: a simulation and empirical example.

PubMed

Harvey, Raymond A; Hayden, Jennifer D; Kamble, Pravin S; Bouchard, Jonathan R; Huang, Joanna C

2017-04-01

We compared methods to control bias and confounding in observational studies including inverse probability weighting (IPW) and stabilized IPW (sIPW). These methods often require iteration and post-calibration to achieve covariate balance. In comparison, entropy balance (EB) optimizes covariate balance a priori by calibrating weights using the target's moments as constraints. We measured covariate balance empirically and by simulation by using absolute standardized mean difference (ASMD), absolute bias (AB), and root mean square error (RMSE), investigating two scenarios: the size of the observed (exposed) cohort exceeds the target (unexposed) cohort and vice versa. The empirical application weighted a commercial health plan cohort to a nationally representative National Health and Nutrition Examination Survey target on the same covariates and compared average total health care cost estimates across methods. Entropy balance alone achieved balance (ASMD ≤ 0.10) on all covariates in simulation and empirically. In simulation scenario I, EB achieved the lowest AB and RMSE (13.64, 31.19) compared with IPW (263.05, 263.99) and sIPW (319.91, 320.71). In scenario II, EB outperformed IPW and sIPW with smaller AB and RMSE. In scenarios I and II, EB achieved the lowest mean estimate difference from the simulated population outcome ($490.05, $487.62) compared with IPW and sIPW, respectively. Empirically, only EB differed from the unweighted mean cost indicating IPW, and sIPW weighting was ineffective. Entropy balance demonstrated the bias-variance tradeoff achieving higher estimate accuracy, yet lower estimate precision, compared with IPW methods. EB weighting required no post-processing and effectively mitigated observed bias and confounding. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

[Economic impact of nosocomial bacteraemia. A comparison of three calculation methods].

PubMed

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Castells, Xavier; Knobel, Hernando; Cots, Francesc

2016-12-01

The excess cost associated with nosocomial bacteraemia (NB) is used as a measurement of the impact of these infections. However, some authors have suggested that traditional methods overestimate the incremental cost due to the presence of various types of bias. The aim of this study was to compare three assessment methods of NB incremental cost to correct biases in previous analyses. Patients who experienced an episode of NB between 2005 and 2007 were compared with patients grouped within the same All Patient Refined-Diagnosis-Related Group (APR-DRG) without NB. The causative organisms were grouped according to the Gram stain, and whether bacteraemia was caused by a single or multiple microorganisms, or by a fungus. Three assessment methods are compared: stratification by disease; econometric multivariate adjustment using a generalised linear model (GLM); and propensity score matching (PSM) was performed to control for biases in the econometric model. The analysis included 640 admissions with NB and 28,459 without NB. The observed mean cost was €24,515 for admissions with NB and €4,851.6 for controls (without NB). Mean incremental cost was estimated at €14,735 in stratified analysis. Gram positive microorganism had the lowest mean incremental cost, €10,051. In the GLM, mean incremental cost was estimated as €20,922, and adjusting with PSM, the mean incremental cost was €11,916. The three estimates showed important differences between groups of microorganisms. Using enhanced methodologies improves the adjustment in this type of study and increases the value of the results. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

TH-CD-201-11: Optimizing the Response and Cost of a DNA Double-Strand Break Dosimeter

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

Obeidat, M; Cline, K; Stathakis, S

Purpose: A DNA double-strand break (DSB) dosimeter was developed to measure the biological effect of radiation. The goal here is to refine the fabrication method of this dosimeter to reproducibly create a low coefficient of variation (CoV) and reduce the cost for the dosimeter. Methods: Our dosimeter consists of 4 kilo-base pair DNA strands (labeled on one end with biotin and on the other with fluorescein) attached to streptavidin magnetic beads. The final step of the DNA dosimeter fabrication is to suspend these attached beads in phosphate-buffered saline (PBS). The amount of PBS used to suspend the attached beads andmore » the relative volume of the DNA strands to the beads both affect the CoV and dosimeter cost. We diluted the beads attached with DNA in different volumes of PBS (100, 200, and 400 µL) to create different concentrations of the DNA dosimeter. Then we irradiated these dosimeters (50 µL samples) in a water-equivalent plastic phantom at 25 and 50 Gy (three samples per dose) and calculated the CoV for each dosimeter concentration. Also, we used different masses of DNA strands (1, 2, 8, 16, 24, and 32 µg) to attach to the same volume of magnetic beads (100 µL) to explore how this affects the cost of the dosimeter. Results: The lowest CoV was produced for the highest concentration of dosimeter (100 µL of PBS), which created CoV of 2.0 and 1.0% for 25 and 50 Gy, respectively. We found that the lowest production cost for the dosimeter occurs by attaching 16 µg of DNA strands with 100 µL of beads. Conclusion: : We optimized the fabrication of the DNA dosimeter to produce low CoV and cost, but we still need to explore ways to further improve the dosimeter for use at lower doses. This work was supported in part by Yarmouk University (Irbid, Jordan) and CPRIT (RP140105)« less

Direct Medical Costs of Dengue Fever in Vietnam: A Retrospective Study in a Tertiary Hospital

PubMed Central

VO, Nhung Thi Tuyet; PHAN, Trang Ngo Diem; VO, Trung Quang

2017-01-01

Background In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision. Methods This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies. Average cost per case and treatment cost across different age was calculated. Results In the study period, 1672 patients with dengue fever were hospitalised. The average age was 24.98 (SD = 14.10) years, and 47.5% were males (795 patients). Across age groups, the average cost per episode was USD 48.10 (SD = 3.22). The highest costs (USD 56.61, SD = 48.84) were incurred in the adult age group (> 15 years), and the lowest costs (USD 30.10, SD = 17.27) were incurred in the paediatric age group (< 15 years). Conclusion The direct medical costs of dengue-related hospitalisation place a severe economic burden on patients and their families. The probable economic value of dengue management in Vietnam is significant. PMID:28814934

A stochastic algorithm for global optimization and for best populations: A test case of side chains in proteins

PubMed Central

Glick, Meir; Rayan, Anwar; Goldblum, Amiram

2002-01-01

The problem of global optimization is pivotal in a variety of scientific fields. Here, we present a robust stochastic search method that is able to find the global minimum for a given cost function, as well as, in most cases, any number of best solutions for very large combinatorial “explosive” systems. The algorithm iteratively eliminates variable values that contribute consistently to the highest end of a cost function's spectrum of values for the full system. Values that have not been eliminated are retained for a full, exhaustive search, allowing the creation of an ordered population of best solutions, which includes the global minimum. We demonstrate the ability of the algorithm to explore the conformational space of side chains in eight proteins, with 54 to 263 residues, to reproduce a population of their low energy conformations. The 1,000 lowest energy solutions are identical in the stochastic (with two different seed numbers) and full, exhaustive searches for six of eight proteins. The others retain the lowest 141 and 213 (of 1,000) conformations, depending on the seed number, and the maximal difference between stochastic and exhaustive is only about 0.15 Kcal/mol. The energy gap between the lowest and highest of the 1,000 low-energy conformers in eight proteins is between 0.55 and 3.64 Kcal/mol. This algorithm offers real opportunities for solving problems of high complexity in structural biology and in other fields of science and technology. PMID:11792838

Optimization techniques applied to passive measures for in-orbit spacecraft survivability

NASA Technical Reports Server (NTRS)

Mog, Robert A.; Price, D. Marvin

1987-01-01

Optimization techniques applied to passive measures for in-orbit spacecraft survivability, is a six-month study, designed to evaluate the effectiveness of the geometric programming (GP) optimization technique in determining the optimal design of a meteoroid and space debris protection system for the Space Station Core Module configuration. Geometric Programming was found to be superior to other methods in that it provided maximum protection from impact problems at the lowest weight and cost.

7 CFR 1788.2 - General insurance requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... consistent with cost-effectiveness, reliability, safety, and expedition. It is recognized that Prudent... accomplish the desired result at the lowest reasonable cost consistent with cost-effectiveness, reliability... which is used or useful in the borrower's business and which shall be covered by insurance, unless each...

Study of process technology for GaAlAs/GaAs heteroface solar cells

NASA Technical Reports Server (NTRS)

Conway, E. J.; Walker, G. H.; Byvik, C. E.; Almgren, D. W.

1980-01-01

Two processes were considered: the infinite melt process and the finite melt process. The only technique that is developed to the point that 10,000 cells could be produced in one year is the infinite melt liquid phase epitaxy process. The lowest cost per cell was achieved with the advanced metal organic chemical vapor deposition process. Molecular beam epitaxy was limited by the slow growth rate. The lowest cost, an 18 percent efficient cell at air mass zero, was approximately $70 per watt.

Doing more for less: identifying opportunities to expand public sector access to safe abortion in South Africa through budget impact analysis.

PubMed

Lince-Deroche, Naomi; Harries, Jane; Constant, Deborah; Morroni, Chelsea; Pleaner, Melanie; Fetters, Tamara; Grossman, Daniel; Blanchard, Kelly; Sinanovic, Edina

2018-02-01

To estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. We conducted a budget impact analysis using public sector abortion statistics and published cost data. We estimated the total costs to the public health service over 10 years, starting in South Africa's financial year 2016/17, given four scenarios: (1) holding service provision constant, (2) expanding public sector provision, (3) changing the abortion technologies used (i.e. the method mix), and (4) expansion plus changing the method mix. The public sector performed an estimated 20% of the expected total number of abortions in 2016/17; 26% and 54% of all abortions were performed illegally or in the private sector respectively. Costs were lowest in scenarios where method mix shifting occurred. Holding the proportion of abortions performed in the public-sector constant, shifting to more cost-effective service provision (more first-trimester services with more medication abortion and using the combined regimen for medical induction in the second trimester) could result in savings of $28.1 million in the public health service over the 10-year period. Expanding public sector provision through elimination of unsafe abortions would require an additional $192.5 million. South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided. More research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions. South Africa can provide more safe abortions for less money in the public sector through shifting to more first-trimester methods, including more medication abortion, and shifting to a combined mifepristone plus misoprostol regimen for second trimester medical induction. Expanding access in addition to method mix changes would require additional funds. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparing the net cost of CSP-TES to PV deployed with battery storage

NASA Astrophysics Data System (ADS)

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

2016-05-01

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment.

PubMed

Kilian, Reinhold; Matschinger, Herbert; Löeffler, Walter; Roick, Christiane; Angermeyer, Matthias C

2002-03-01

Transformation of the dependent cost variable is often used to solve the problems of heteroscedasticity and skewness in linear ordinary least square regression of health service cost data. However, transformation may cause difficulties in the interpretation of regression coefficients and the retransformation of predicted values. The study compares the advantages and disadvantages of different methods to estimate regression based cost functions using data on the annual costs of schizophrenia treatment. Annual costs of psychiatric service use and clinical and socio-demographic characteristics of the patients were assessed for a sample of 254 patients with a diagnosis of schizophrenia (ICD-10 F 20.0) living in Leipzig. The clinical characteristics of the participants were assessed by means of the BPRS 4.0, the GAF, and the CAN for service needs. Quality of life was measured by WHOQOL-BREF. A linear OLS regression model with non-parametric standard errors, a log-transformed OLS model and a generalized linear model with a log-link and a gamma distribution were used to estimate service costs. For the estimation of robust non-parametric standard errors, the variance estimator by White and a bootstrap estimator based on 2000 replications were employed. Models were evaluated by the comparison of the R2 and the root mean squared error (RMSE). RMSE of the log-transformed OLS model was computed with three different methods of bias-correction. The 95% confidence intervals for the differences between the RMSE were computed by means of bootstrapping. A split-sample-cross-validation procedure was used to forecast the costs for the one half of the sample on the basis of a regression equation computed for the other half of the sample. All three methods showed significant positive influences of psychiatric symptoms and met psychiatric service needs on service costs. Only the log- transformed OLS model showed a significant negative impact of age, and only the GLM shows a significant negative influences of employment status and partnership on costs. All three models provided a R2 of about.31. The Residuals of the linear OLS model revealed significant deviances from normality and homoscedasticity. The residuals of the log-transformed model are normally distributed but still heteroscedastic. The linear OLS model provided the lowest prediction error and the best forecast of the dependent cost variable. The log-transformed model provided the lowest RMSE if the heteroscedastic bias correction was used. The RMSE of the GLM with a log link and a gamma distribution was higher than those of the linear OLS model and the log-transformed OLS model. The difference between the RMSE of the linear OLS model and that of the log-transformed OLS model without bias correction was significant at the 95% level. As result of the cross-validation procedure, the linear OLS model provided the lowest RMSE followed by the log-transformed OLS model with a heteroscedastic bias correction. The GLM showed the weakest model fit again. None of the differences between the RMSE resulting form the cross- validation procedure were found to be significant. The comparison of the fit indices of the different regression models revealed that the linear OLS model provided a better fit than the log-transformed model and the GLM, but the differences between the models RMSE were not significant. Due to the small number of cases in the study the lack of significance does not sufficiently proof that the differences between the RSME for the different models are zero and the superiority of the linear OLS model can not be generalized. The lack of significant differences among the alternative estimators may reflect a lack of sample size adequate to detect important differences among the estimators employed. Further studies with larger case number are necessary to confirm the results. Specification of an adequate regression models requires a careful examination of the characteristics of the data. Estimation of standard errors and confidence intervals by nonparametric methods which are robust against deviations from the normal distribution and the homoscedasticity of residuals are suitable alternatives to the transformation of the skew distributed dependent variable. Further studies with more adequate case numbers are needed to confirm the results.

Costs and Efficiency of Online and Offline Recruitment Methods: A Web-Based Cohort Study.

PubMed

Christensen, Tina; Riis, Anders H; Hatch, Elizabeth E; Wise, Lauren A; Nielsen, Marie G; Rothman, Kenneth J; Toft Sørensen, Henrik; Mikkelsen, Ellen M

2017-03-01

The Internet is widely used to conduct research studies on health issues. Many different methods are used to recruit participants for such studies, but little is known about how various recruitment methods compare in terms of efficiency and costs. The aim of our study was to compare online and offline recruitment methods for Internet-based studies in terms of efficiency (number of recruited participants) and costs per participant. We employed several online and offline recruitment methods to enroll 18- to 45-year-old women in an Internet-based Danish prospective cohort study on fertility. Offline methods included press releases, posters, and flyers. Online methods comprised advertisements placed on five different websites, including Facebook and Netdoktor.dk. We defined seven categories of mutually exclusive recruitment methods and used electronic tracking via unique Uniform Resource Locator (URL) and self-reported data to identify the recruitment method for each participant. For each method, we calculated the average cost per participant and efficiency, that is, the total number of recruited participants. We recruited 8252 study participants. Of these, 534 were excluded as they could not be assigned to a specific recruitment method. The final study population included 7724 participants, of whom 803 (10.4%) were recruited by offline methods, 3985 (51.6%) by online methods, 2382 (30.8%) by online methods not initiated by us, and 554 (7.2%) by other methods. Overall, the average cost per participant was €6.22 for online methods initiated by us versus €9.06 for offline methods. Costs per participant ranged from €2.74 to €105.53 for online methods and from €0 to €67.50 for offline methods. Lowest average costs per participant were for those recruited from Netdoktor.dk (€2.99) and from Facebook (€3.44). In our Internet-based cohort study, online recruitment methods were superior to offline methods in terms of efficiency (total number of participants enrolled). The average cost per recruited participant was also lower for online than for offline methods, although costs varied greatly among both online and offline recruitment methods. We observed a decrease in the efficiency of some online recruitment methods over time, suggesting that it may be optimal to adopt multiple online methods. ©Tina Christensen, Anders H Riis, Elizabeth E Hatch, Lauren A Wise, Marie G Nielsen, Kenneth J Rothman, Henrik Toft Sørensen, Ellen M Mikkelsen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.03.2017.

Establishment and comparison of three novel methods for the determination of the photodynamic therapy agent 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) in human serum.

PubMed

Chen, Lin; Xiao, Qingqing; Zhang, Xian; Yang, Jin

2016-03-20

2-[1-Hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) is a second-generation photosensitizer that has been applied in clinical studies of photodynamic therapy for a variety of malignant lesions. Based on the differences in selectivity and labour intensity, three novel methods - fluorescence detection coupled with high performance liquid chromatography (LC-FLD), LC-tandem mass spectrometry (LC-MS/MS) and fluorescence-based microplate reader methods - were developed for the determination of HPPH in human serum, which allowed comparison of fluorescence and MS platform for HPPH quantification. All three methods have been validated and successfully applied to support the clinical pharmacokinetic study of HPPH. The concentrations measured by LC-FLD matched those by LC-MS/MS with a correlation coefficient (r=0.994) and coefficient of determination (r(2)=0.989). Data consistency was also found between the measurements of microplate reader and LC-MS/MS with a correlation coefficient (r=0.999) and coefficient of determination (r(2)=0.998), indicating that fluorescence assay, the low cost alternative with a relatively poorer selectivity, is clearly suitable for the quantification of HPPH. Calibration curves in the methods of LC-FLD and microplate reader were linear (r˃0.998) over the concentration range from 50 to 5000 ng/mL, and linearity was obtained over the concentration range from 5 to 1000 ng/mL in the LC-MS/MS method. Compared with the other two methods, the fluorescence-based microplate reader method with proven high selectivity should be strongly recommended because of obvious advantages such as the lowest labour intensity, the lowest instrument cost, a better sensitivity than LC-FLD and the very rapid determination of large number of samples (24 samples/40 s). Copyright © 2015 Elsevier B.V. All rights reserved.

Renewable Portfolio Standards: Understanding Costs and Benefits | Energy

Science.gov Websites

considering the highest cost and lowest benefit outcomes. More Information: Fact Sheet Image of a report cover | Presentation Image of a report cover for A Survey of State-Level Cost and Benefit Estimates of Renewable Portfolio Standards: Understanding Costs and Benefits State policymakers, public utilities commissions, and

42 CFR 50.504 - Allowable cost of drugs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Allowable cost of drugs. 50.504 Section 50.504... APPLICABILITY Maximum Allowable Cost for Drugs § 50.504 Allowable cost of drugs. (a) The maximum amount which may be expended from program funds for the acquisition of any drug shall be the lowest of (1) The...

42 CFR 50.504 - Allowable cost of drugs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Allowable cost of drugs. 50.504 Section 50.504... APPLICABILITY Maximum Allowable Cost for Drugs § 50.504 Allowable cost of drugs. (a) The maximum amount which may be expended from program funds for the acquisition of any drug shall be the lowest of (1) The...

42 CFR 50.504 - Allowable cost of drugs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Allowable cost of drugs. 50.504 Section 50.504... APPLICABILITY Maximum Allowable Cost for Drugs § 50.504 Allowable cost of drugs. (a) The maximum amount which may be expended from program funds for the acquisition of any drug shall be the lowest of (1) The...

42 CFR 50.504 - Allowable cost of drugs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Allowable cost of drugs. 50.504 Section 50.504... APPLICABILITY Maximum Allowable Cost for Drugs § 50.504 Allowable cost of drugs. (a) The maximum amount which may be expended from program funds for the acquisition of any drug shall be the lowest of (1) The...

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

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs providesmore » a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.« less

Financial comparisons of fishing gear used in Kenya's coral reef lagoons.

PubMed

Mangi, Stephen C; Roberts, Callum M; Rodwell, Lynda D

2007-12-01

The cost of fishing and the income earned by fishers using small and large traps, gill nets, beach seines, hand lines, and spearguns were assessed in the multigear fishery of southern Kenya to establish a financial rationale for fishing gear use. Direct observations and key-informant interviews with fish leaders and boat captains were used to gather data on fish catch, cost of fishing gear, boats, and the price of fish. Among the fishing gear used, spearguns had the lowest monthly cost (USD 1 mo(-1)) while big traps had the highest (USD 13 mo(-1)). Income was highest among capital cost beach seine fishers (USD 183 mo(-1)) and lowest among noncapital cost beach seine fishers (USD 20 mo(-1)). There was a direct positive correlation between income earned and profitability of gear. Correlation of the financial measure for each gear to four categories of damage to fish and habitats showed that low cost fishing gear were associated with the highest environmental damage indicating a trade-off between cost of gear and environmental health.

Choose Wisely: the Quality of Massage Education in the United States

PubMed Central

Menard, Martha Brown

2014-01-01

Background Assessing the quality of postsecondary education remains a difficult task, despite many efforts to do so. No consensus or standard definition of educational quality has yet been agreed upon or developed. Purpose This study evaluated the quality of massage education in the United States using three closely-related questions to frame the evaluation: 1) Is accreditation improving the quality of education for massage therapy? If not, then what do we need to do to improve it? 2) Does accreditation by COMTA specifically improve quality of education compared to other vocational accrediting agencies that do not require curriculum competencies specific to massage? 3) Would adding competencies at an “advanced” level, or specific degree levels, be helpful in advancing massage therapy in the eyes of other health professions? Setting United States Participants Members of a national massage education organization, members affiliated with the educational arm of two national professional associations, and members of two national education organizations in complementary and integrative health care (CIHC). Research Design Mixed methods evaluation using three data sources: existing gainful employment data from the US Department of Education, analyzed by type of massage program and accreditation agency to determine average and relative value for cost; numbers of disciplinary actions against massage practitioners reported by state regulatory agencies, and a qualitatively developed survey administered to two different groups of educators. Results Average tuition cost across all reporting schools/programs was $13,605, with an average graduation rate of 71.9%. Of the schools and programs that reported student loan data, 84% of students received federal financial aid. Median loan amount was $8,052, with an average repayment rate of 43.4%. Programs in corporate-owned schools had the highest average cost, highest median loan amount, and lowest repayment rate, while community college programs had the lowest average cost, lowest graduation rate, and lowest median loan amount. Repayment rate data were not available for community colleges. Of the five states and the District of Columbia that require school accreditation, there were 208 disciplinary actions from 2009–2011. The remaining 28 regulated states that do not require school accreditation reported 1,702 disciplinary actions during the same period. Seventy-five percent of massage educators and 58% of CIHC educators stated that the current quality of massage education is inconsistent, with only 10% of massage educators and 8% of CIHC educators agreeing that current educational quality is adequate. Fifty-six percent of massage educators and 40% of CIHC educators agreed that educational quality needs to improve if massage therapists want to be considered comparable to other allied health professionals. Both groups suggested specific areas and means of improvement, including raising admission requirements and offering an academic degree. Conclusions Accreditation appears to improve the quality of massage education; however, more consistent methods for calculating tuition costs, educational outcomes, and classifying severity of disciplinary actions are needed. Both quantitative and qualitative evidence indicates that the current quality of massage education in the US is inconsistent and less than adequate. Specific areas of improvement needed for massage therapists to be perceived as comparable to other allied healthcare providers are described. PMID:25184011

Financing Strategies For A Nuclear Fuel Cycle Facility

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

David Shropshire; Sharon Chandler

2006-07-01

To help meet the nation’s energy needs, recycling of partially used nuclear fuel is required to close the nuclear fuel cycle, but implementing this step will require considerable investment. This report evaluates financing scenarios for integrating recycling facilities into the nuclear fuel cycle. A range of options from fully government owned to fully private owned were evaluated using DPL (Decision Programming Language 6.0), which can systematically optimize outcomes based on user-defined criteria (e.g., lowest lifecycle cost, lowest unit cost). This evaluation concludes that the lowest unit costs and lifetime costs are found for a fully government-owned financing strategy, due tomore » government forgiveness of debt as sunk costs. However, this does not mean that the facilities should necessarily be constructed and operated by the government. The costs for hybrid combinations of public and private (commercial) financed options can compete under some circumstances with the costs of the government option. This analysis shows that commercial operations have potential to be economical, but there is presently no incentive for private industry involvement. The Nuclear Waste Policy Act (NWPA) currently establishes government ownership of partially used commercial nuclear fuel. In addition, the recently announced Global Nuclear Energy Partnership (GNEP) suggests fuels from several countries will be recycled in the United States as part of an international governmental agreement; this also assumes government ownership. Overwhelmingly, uncertainty in annual facility capacity led to the greatest variations in unit costs necessary for recovery of operating and capital expenditures; the ability to determine annual capacity will be a driving factor in setting unit costs. For private ventures, the costs of capital, especially equity interest rates, dominate the balance sheet; and the annual operating costs, forgiveness of debt, and overnight costs dominate the costs computed for the government case. The uncertainty in operations, leading to lower than optimal processing rates (or annual plant throughput), is the most detrimental issue to achieving low unit costs. Conversely, lowering debt interest rates and the required return on investments can reduce costs for private industry.« less

CONSIDERATIONS IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which in...

CD-ROM versus Online.

ERIC Educational Resources Information Center

Wiedemer, John David; Boelio, David B.

1995-01-01

Compares compact discs (CD-ROMs) and online services in terms of cost of information delivery; system advantages and disadvantages; future possibilities; and role in the National Information Infrastructure. Analysis reveals that CD-ROMs have the lowest information delivery cost and are endorsed by the marketplace as a cost-effective way to deliver…

CONSIDERATION IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which involve ...

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

PubMed Central

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

2016-01-01

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

Yeast derivatives and wheat germ in the adult diet modulates fecundity in a tephritid pest.

PubMed

Goane, L; Pereyra, P M; Castro, F; Ruiz, M J; Juárez, M L; Segura, D F; Vera, M T

2018-05-22

Anastrepha fraterculus (Wiedemann), a pest of great economic importance in South America, needs urgently to be controlled by environmentally friendly methods such as the sterile insect technique for which mass rearing of insects is required. Because oogenesis takes place during the adult stage, mass-rearing facilities should provide the females a diet that maximizes egg production at the lowest cost. Accordingly, we investigated the effect of artificial protein sources in the adult diet (yeast derivatives of different cost but with similar amino acids profiles, and the addition of wheat germ) on fecundity. Additionally, we evaluated different ratios of yeast derivatives or wheat germ on ovary maturation, fecundity, and fertility as well as their association with the nutrient content of females. Females fed hydrolyzed yeast and yeast extract attained the highest fecundity level, and those fed brewer's yeast the lowest. Reducing the amount of hydrolyzed yeast, an expensive protein source, in the diet negatively affected fecundity and ovary maturation. Increasing the amount of brewer's yeast, a low-cost protein source, did not favor fecundity. The addition of wheat germ in the adult diet improved fecundity regardless of the yeast derivate considered. Percentage of egg hatch was not affected by the diet. Nutrient content of A. fraterculus females varied according to the adult diet provided and mating status. Our findings provide novel baseline information to understand the role of nutrition on reproductive performance of A. fraterculus females and are discussed in the context of resource allocation. They also provide valuable advances in the search for cost-effective adult diets at fruit fly mass rearing facilities.

Using Google AdWords for International Multilingual Recruitment to Health Research Websites

PubMed Central

Gross, Margaret S; Liu, Nancy H; Contreras, Omar; Muñoz, Ricardo F

2014-01-01

Background Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Objective Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Methods Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) “Unmanaged”, a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) “Managed”, a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. Results During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US $0.20 for Chinese ads to US $0.50 for English ads). Although Chinese speakers’ click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US $10.80 for Russian speakers to US $51.88 for English speakers. During the 7 weeks of “managed” recruitment, we attempted to improve AdWords’ performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Conclusions Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results. PMID:24446166

Cost-Effectiveness of Nitrogen Mitigation by Alternative ...

EPA Pesticide Factsheets

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. We seek to address two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes, and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets and neighborhood-scale blackwater digesters are also attractive options in some cases, particularly best-case nitrogen mitigation; innovative/advanced septic system

Cost-sensitive case-based reasoning using a genetic algorithm: application to medical diagnosis.

PubMed

Park, Yoon-Joo; Chun, Se-Hak; Kim, Byung-Chun

2011-02-01

The paper studies the new learning technique called cost-sensitive case-based reasoning (CSCBR) incorporating unequal misclassification cost into CBR model. Conventional CBR is now considered as a suitable technique for diagnosis, prognosis and prescription in medicine. However it lacks the ability to reflect asymmetric misclassification and often assumes that the cost of a positive diagnosis (an illness) as a negative one (no illness) is the same with that of the opposite situation. Thus, the objective of this research is to overcome the limitation of conventional CBR and encourage applying CBR to many real world medical cases associated with costs of asymmetric misclassification errors. The main idea involves adjusting the optimal cut-off classification point for classifying the absence or presence of diseases and the cut-off distance point for selecting optimal neighbors within search spaces based on similarity distribution. These steps are dynamically adapted to new target cases using a genetic algorithm. We apply this proposed method to five real medical datasets and compare the results with two other cost-sensitive learning methods-C5.0 and CART. Our finding shows that the total misclassification cost of CSCBR is lower than other cost-sensitive methods in many cases. Even though the genetic algorithm has limitations in terms of unstable results and over-fitting training data, CSCBR results with GA are better overall than those of other methods. Also the paired t-test results indicate that the total misclassification cost of CSCBR is significantly less than C5.0 and CART for several datasets. We have proposed a new CBR method called cost-sensitive case-based reasoning (CSCBR) that can incorporate unequal misclassification costs into CBR and optimize the number of neighbors dynamically using a genetic algorithm. It is meaningful not only for introducing the concept of cost-sensitive learning to CBR, but also for encouraging the use of CBR in the medical area. The result shows that the total misclassification costs of CSCBR do not increase in arithmetic progression as the cost of false absence increases arithmetically, thus it is cost-sensitive. We also show that total misclassification costs of CSCBR are the lowest among all methods in four datasets out of five and the result is statistically significant in many cases. The limitation of our proposed CSCBR is confined to classify binary cases for minimizing misclassification cost because our proposed CSCBR is originally designed to classify binary case. Our future work extends this method for multi-classification which can classify more than two groups. Copyright © 2010 Elsevier B.V. All rights reserved.

Modified conjugate gradient method for diagonalizing large matrices.

PubMed

Jie, Quanlin; Liu, Dunhuan

2003-11-01

We present an iterative method to diagonalize large matrices. The basic idea is the same as the conjugate gradient (CG) method, i.e, minimizing the Rayleigh quotient via its gradient and avoiding reintroducing errors to the directions of previous gradients. Each iteration step is to find lowest eigenvector of the matrix in a subspace spanned by the current trial vector and the corresponding gradient of the Rayleigh quotient, as well as some previous trial vectors. The gradient, together with the previous trial vectors, play a similar role as the conjugate gradient of the original CG algorithm. Our numeric tests indicate that this method converges significantly faster than the original CG method. And the computational cost of one iteration step is about the same as the original CG method. It is suitable for first principle calculations.

Combining an Analytic Hierarchy Process and TOPSIS for Selecting Postharvest Technology Method for Selayar Citrus in Indonesia

NASA Astrophysics Data System (ADS)

Dirpan, Andi

2018-05-01

This research was intended to select the best handling methods or postharvest technologies that can be used to maintain the quality of citrus fruit in Selayar, South Sulawesi, Indonesia among (1) modified atmosphere packaging (MAP (2) Controlled atmosphere storage (CAS) (3) coatings (4) hot water treatment (5) Hot Calcium Dip (HCD) by using combination between an analytic hierarchy process (AHP) and TOPSIS. Improving quality, applicability, increasing shelf life and reducing cost are used as the criteria to determine the best postharvest technologies. The results show that the most important criteria for selecting postharvest technology is improving quality followed by increasing shelf life, reducing cost and applicability. Furthermore, by using TOPSIS, it is clear that the postharvest technology that had the lowest rangking is modified atmosphere packaging (MAP), followed by controlled atmosphere storage (CAS), coatings, hot calcium dip (HCD) and hot water treatment (HWT). Therefore, it can be concluded that the best postharvest technology method for Selayar citrus is modified atmosphere packaging (MAP).

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

PubMed Central

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

Objective To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. Methods Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Findings The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day’s wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days’ wages for losartan. For originator brands, the costs rise to 1.2 days’ wages for salbutamol inhaler and 15.6 days’ wages for omeprazole. Conclusions The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions. PMID:23936471

Options for managing low grade cervical abnormalities detected at screening: cost effectiveness study.

PubMed

2009-07-28

To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening. Design Cost analysis within multicentre individually randomised controlled trial. Grampian, Tayside, and Nottingham. 4201 women with low grade abnormalities. Cytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance. Data on resource use collected from participants throughout the duration of the trial (36 months), enabling the estimation of both the direct (health care) and indirect (time and travel) costs of management. Quality of life assessed at recruitment and at 12, 18, 24, and 30 months, using the EQ-5D instrument. Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia (grade II or worse) detected, by trial arm, as confirmed at exit, and cost utility ratios (cost per quality adjusted life year (QALY) gained) for the three pairwise comparisons of trial arms. The mean three year discounted costs of surveillance, immediate treatment, and biopsy and recall were pound150.20 (euro177, $249), pound240.30 (euro283, $415), and pound241.10 (euro284, $4000), respectively, viewed from the health service perspective. From the social perspective, mean discounted costs were pound204.40 (euro241, $339), pound339.90 (euro440, $563), and pound327.50 (euro386, $543), respectively. Estimated at the means, the incremental cost effectiveness ratios indicated that immediate treatment was dominated by the other two management methods, although it did offer the lowest cost per case of cervical intraepithelial neoplasia detected and treated. The pronounced skews in the distributions indicated that probabilistic uncertainty analysis would offer more meaningful estimates of cost effectiveness. The observed differences in the cost effectiveness ratios between trial arms were not significant. Judged within the time frame of the TOMBOLA evaluation, there is no compelling economic reason to favour any one follow-up method over either of the others. ISRCTN 34841617.

48 CFR 52.247-59 - F.o.b. Origin-Carload and Truckload Shipments.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... origin contracts with shipments in carloads or truckloads. This will facilitate realistic freight cost... weight that will result in the lowest freight rate (or per car charge) on file or published in common... highest applicable minimum weight that will result in the lowest possible freight rate (or per car charge...

48 CFR 52.247-59 - F.o.b. Origin-Carload and Truckload Shipments.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... origin contracts with shipments in carloads or truckloads. This will facilitate realistic freight cost... weight that will result in the lowest freight rate (or per car charge) on file or published in common... highest applicable minimum weight that will result in the lowest possible freight rate (or per car charge...

48 CFR 52.247-59 - F.o.b. Origin-Carload and Truckload Shipments.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... origin contracts with shipments in carloads or truckloads. This will facilitate realistic freight cost... weight that will result in the lowest freight rate (or per car charge) on file or published in common... highest applicable minimum weight that will result in the lowest possible freight rate (or per car charge...

48 CFR 52.247-59 - F.o.b. Origin-Carload and Truckload Shipments.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... origin contracts with shipments in carloads or truckloads. This will facilitate realistic freight cost... weight that will result in the lowest freight rate (or per car charge) on file or published in common... highest applicable minimum weight that will result in the lowest possible freight rate (or per car charge...

Estimating cost of large-fire suppression for three Forest Service regions

Treesearch

Eric L. Smith; Gonz& aacute; lez-Cab& aacute; n Armando

1987-01-01

The annual costs attributable to large fire suppression in three Forest Service Regions (1970-1981) were estimated as a function of fire perimeters using linear regression. Costs calculated on a per chain of perimeterbasis were highest for the Pacific Northwest Region, next highest for the Northern Region, and lowest for the Intermountain Region. Recent costs in real...

Designing cost efficient buffer zone programs: An application of the FyrisSKZ tool in a Swedish catchment.

PubMed

Collentine, Dennis; Johnsson, Holger; Larsson, Peter; Markensten, Hampus; Persson, Kristian

2015-03-01

Riparian buffer zones are the only measure which has been used extensively in Sweden to reduce phosphorus losses from agricultural land. This paper describes how the FyrisSKZ web tool can be used to evaluate allocation scenarios using data from the Svärta River, an agricultural catchment located in central Sweden. Three scenarios are evaluated: a baseline, a uniform 6-m-wide buffer zone in each sub-catchment, and an allocation of areas of buffer zones to sub-catchments based on the average cost of reduction. The total P reduction increases by 30 % in the second scenario compared to the baseline scenario, and the average reduction per hectare increases by 90 % while total costs of the program fall by 32 %. In the third scenario, the average cost per unit of reduction (163 kg P(-1)) is the lowest of the three scenarios (58 % lower than the baseline) and has the lowest total program costs.

Investigating the relationship between worker demographics and nature of injury on Federal Department of Defense workers' compensation injury rates and costs from 2000 to 2008.

PubMed

Mallon, Timothy M; Cherry, Scott E

2015-03-01

This is the first study of workers' compensation injuries and costs in Department of Defense workers that examined whether any demographic factors including age, sex, occupation, and nature of injury altered the risks or costs of an injury or illness over time. Department of Defense Workers' Compensation claims for period 2000 to 2008 were analyzed (n = 142,115) using Defense Portal Analysis and Defense Manpower Data Center to calculate injury rates and costs. Regression analysis was done using SPSS to examine the change in the risk of injury or illness over time from 2000 to 2008. The age group of 30 to 34 years had the lowest costs per claim and highest claims rate, 332 per 10,000. The age group of 65 to 70 years had the lowest claims rate of 188 per 10,000 but the highest costs per claim. Claims cost increased $69 for each 5-year group, and older workers had a threefold increase in costs per claim. Younger workers get hurt more often, but older workers tend to have more expensive claims.

An effort to assess the relation between productivity loss costs and presenteeism at work.

PubMed

Vänni, Kimmo; Neupane, Subas; Nygård, Clas-Håkan

2017-03-01

This study assesses potential presenteeism costs and the association of these with a company's business figures. We conducted the questionnaire surveys in alternate years between 2003 and 2007 and linked them to sickness absence register data. Perceived work ability levels were assessed and converted into presenteeism days using the Presenteeism Scale tool. Sickness absence and presenteeism days were converted into monetary figures using median monthly salary information. The share of presenteeism costs was constant at about 1% of annual turnover and about 3.7% of personnel costs. The lowest annual presenteeism cost per employee was EUR 986 and the highest was EUR 1302. The lowest number of presenteeism days per employee in a year was 8.7 days and the highest number was 10.4 days. Estimated losses to a company due to sickness absences and presenteeism ranged from EUR 4.6 million to EUR 5.6 million annually. The potential presenteeism costs to the company and to Finnish society were vast. Presenteeism is a costly problem but more research is needed to reveal the connections between presenteeism and a company's turnover, personnel costs and profit.

Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam

PubMed Central

Van Minh, Hoang; Odaga, John; Rout, Swampa Sarit; Ngoc, Diep Nguyen Thi; Menezes, Lysander; Araujo, Maria Ana Mendoza; LaMontagne, D Scott

2013-01-01

Abstract Objective To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Methods Data were collected from a sample of facilities that participated in five demonstration projects for HPV vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. Findings The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). Conclusion The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services. PMID:23940406

Differences exist across insurance schemes in China post-consolidation

PubMed Central

Yi, Danhui; Wang, Xiaojun; Jiang, Yan; Wang, Yu; Liu, Xinchun

2017-01-01

Background In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance), URBMI (Urban Resident Basic Medical Insurance), and NCMS (New Cooperative Medical Scheme), across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation. Methods A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects’ characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket) cost, and insurance reimbursement rate. Results Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate. Conclusions Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences. PMID:29125837

Costing Principles in Higher Education and Their Application (First Revision).

ERIC Educational Resources Information Center

Sterns, A. A.

This document provides a reason for applying known cost-accounting methodology within the realm of higher education and attempts to make the known techniques viable for sets of objectives within the university environment. The plan developed here is applied to a department, the lowest level in the university hierarchy, and demonstrates costs in…

Economic evaluation of influenza pandemic mitigation strategies in the us using a stochastic microsimulation transmission model

PubMed Central

Sander, Beate; Nizam, Azhar; Garrison, Louis P.; Postma, Maarten J.; Halloran, M. Elizabeth; Longini, Ira M.

2013-01-01

Objectives To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States. Methods We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination. Results In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to full TAP or prevaccination further improves health outcomes, but increases total cost to society by approximately $2700 per capita. Conclusion Full targeted antiviral prophylaxis is an effective and cost-saving measure for mitigating pandemic influenza. PMID:18671770

Advanced electric propulsion system concept for electric vehicles. Addendum 1: Voltage considerations

NASA Technical Reports Server (NTRS)

Raynard, A. E.; Forbes, F. E.

1980-01-01

The two electric vehicle propulsion systems that best met cost and performance goals were examined to assess the effect of battery pack voltage on system performance and cost. A voltage range of 54 to 540 V was considered for a typical battery pack capacity of 24 k W-hr. The highest battery specific energy (W-hr/kg) and the lowest cost ($/kW-hr) were obtained at the minimum voltage level. The flywheel system traction motor is a dc, mechanically commutated with shunt field control, and due to the flywheel the traction motor and the battery are not subject to extreme peaks of power demand. The basic system uses a permanent-magnet motor with electronic commutation supplied by an ac power control unit. In both systems battery cost were the major factor in system voltage selection, and a battery pack with the minimum voltage of 54 V produced the lowest life-cycle cost. The minimum life-cycle cost for the basic system with lead-acid batteries was $0.057/km and for the flywheel system was $0.037/km.

Care fragmentation, quality, and costs among chronically ill patients.

PubMed

Frandsen, Brigham R; Joynt, Karen E; Rebitzer, James B; Jha, Ashish K

2015-05-01

To assess the relationship between care fragmentation and both quality and costs of care for commercially insured, chronically ill patients. We used claims data from 2004 to 2008 for 506,376 chronically ill, privately insured enrollees of a large commercial insurance company to construct measures of fragmentation. We included patients in the sample if they had chronic conditions in any of the following categories: cardiovascular disease, diabetes, asthma, arthritis, or migraine. We assigned each patient a fragmentation index based on the patterns of care of their primary care provider (PCP), with care patterns spread across a higher number of providers considered to be more fragmented. We used regression analysis to examine the relationship between fragmentation and both quality and cost outcomes. Patients of PCPs in the highest quartile of fragmentation had a higher chance of having a departure from clinical best practice (32.8%, vs 25.9% among patients of PCPs in the lowest quartile of fragmentation; P < .001). Similarly, patients of PCPs with high fragmentation had higher rates of preventable hospitalizations (9.1% in highest quartile vs 7.1% in lowest quartile; P < .001). High fragmentation was associated with $4542 higher healthcare spending ($10,396 in the highest quartile vs $5854 in the lowest quartile; P < .001). We found similar or larger effects on quality and costs among patients when we examined the most frequently occurring disease groups individually. Chronically ill patients whose primary care providers offer highly fragmented care more often experience lapses in care quality and incur greater healthcare costs.

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

Chatterton, Mike

The Recovery Act: Districtwide Geothermal Heating Conversion project performed by the Blaine County School District was part of a larger effort by the District to reduce operating costs, address deferred maintenance items, and to improve the learning environment of the students. This project evaluated three options for the ground source which were Open-Loop Extraction/Re-injection wells, Closed-Loop Vertical Boreholes, and Closed-Loop Horizontal Slinky approaches. In the end the Closed-Loop Horizontal Slinky approach had the lowest total cost of ownership but the majority of the sites associated with this project did not have enough available ground area to install the system somore » the second lowest option was used (Open-Loop). In addition to the ground source, this project looked at ways to retrofit existing HVAC systems with new high efficiency systems. The end result was the installation of distributed waterto- air heat pumps with water-to-water heat pumps installed to act as boilers/chillers for areas with a high ventilation demand such as they gymnasiums. A number of options were evaluated and the lowest total cost of ownership approach was implemented in the majority of the facilities. The facilities where the lowest total cost of ownership approaches was not selected were done to maintain consistency of the systems from facility to facility. This project had a number of other benefits to the Blaine County public. The project utilizes guaranteed energy savings to justify the levy funds expended. The project also developed an educational dashboard that can be used in the classrooms and to educate the community on the project and its performance. In addition, the majority of the installation work was performed by contractors local to Blaine County which acted as an economic stimulus to the area during a period of recession.« less

Cost of goods sold and total cost of delivery for oral and parenteral vaccine packaging formats.

PubMed

Sedita, Jeff; Perrella, Stefanie; Morio, Matt; Berbari, Michael; Hsu, Jui-Shan; Saxon, Eugene; Jarrahian, Courtney; Rein-Weston, Annie; Zehrung, Darin

2018-03-14

Despite limitations of glass packaging for vaccines, the industry has been slow to implement alternative formats. Polymer containers may address many of these limitations, such as breakage and delamination. However, the ability of polymer containers to achieve cost of goods sold (COGS) and total cost of delivery (TCOD) competitive with that of glass containers is unclear, especially for cost-sensitive low- and lower-middle-income countries. COGS and TCOD models for oral and parenteral vaccine packaging formats were developed based on information from subject matter experts, published literature, and Kenya's comprehensive multiyear plan for immunization. Rotavirus and inactivated poliovirus vaccines (IPV) were used as representative examples of oral and parenteral vaccines, respectively. Packaging technologies evaluated included glass vials, blow-fill-seal (BFS) containers, preformed polymer containers, and compact prefilled auto-disable (CPAD) devices in both BFS and preformed formats. For oral vaccine packaging, BFS multi-monodose (MMD) ampoules were the least expensive format, with a COGS of $0.12 per dose. In comparison, oral single-dose glass vials had a COGS of $0.40. BFS MMD ampoules had the lowest TCOD of oral vaccine containers at $1.19 per dose delivered, and ten-dose glass vials had a TCOD of $1.61 per dose delivered. For parenteral vaccines, the lowest COGS was achieved with ten-dose glass vials at $0.22 per dose. In contrast, preformed CPAD devices had the highest COGS at $0.60 per dose. Ten-dose glass vials achieved the lowest TCOD of the parenteral vaccine formats at $1.56 per dose delivered. Of the polymer containers for parenteral vaccines, BFS MMD ampoules achieved the lowest TCOD at $1.89 per dose delivered, whereas preformed CPAD devices remained the most expensive format, at $2.25 per dose delivered. Given their potential to address the limitations of glass and reduce COGS and TCOD, polymer containers deserve further consideration as alternative approaches for vaccine packaging. Copyright © 2018 PATH. Published by Elsevier Ltd.. All rights reserved.

Cost-effectiveness of Colorectal Cancer Screening and Treatment Methods: Mapping of Systematic Reviews.

PubMed

Abdolahi, Hossein Mashhadi; Asiabar, Ali Sarabi; Azami-Aghdash, Saber; Pournaghi-Azar, Fatemeh; Rezapour, Aziz

2018-01-01

Due to extensive literature on colorectal cancer and their heterogeneous results, this study aimed to summarize the systematic reviews which review the cost-effectiveness studies on different aspects of colorectal cancer. The required data were collected by searching the following key words according to MeSH: "colorectal cancer," "colorectal oncology," "colorectal carcinoma," "colorectal neoplasm," "colorectal tumors," "cost-effectiveness," "systematic review," and "meta-analysis." The following databases were searched: PubMed, Cochrane, Google Scholar, and Scopus. Two reviewers evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. Finally, eight systematic reviews were included in the study. The Drummond checklist was mostly used for assessing the quality of the articles. The main perspective was related to the payer and the least was relevant to the social. The majority of the cases referred to sensitivity analysis (in 76% of the cases) and the lowest point also was allocated to discounting (in 37% of cases). The Markov model was used most widely in the studies. Treatment methods examined in the studies were not cost-effective in comparison with the studied units. Among the screening methods, computerized tomographic colonography and fecal DNA were cost-effective. The average score of the articles' qualities was high (9.8 out of 11). The community perspective should be taken into consideration at large in the studies. It is necessary to pay more attention to discounting subject in studies. More frequent application of the Markov model is recommended.

Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study

PubMed Central

Lee, Kun Yun; Ong, Tiong Kiam; Low, Ee Vien; Liow, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng Bang; Ali, Rosli Mohd; Ismail, Omar; Ahmad, Wan Azman Wan; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

Objectives Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability. Design This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates. Setting Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions. Participants The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded. Primary and secondary outcome measures The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost. Results The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost. Conclusions Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations. Registration Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR). PMID:28552843

Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts >350 cells/uL in Rural Uganda

PubMed Central

Jain, Vivek; Chang, Wei; Byonanebye, Dathan M.; Owaraganise, Asiphas; Twinomuhwezi, Ellon; Amanyire, Gideon; Black, Douglas; Marseille, Elliot; Kamya, Moses R.; Havlir, Diane V.; Kahn, James G.

2015-01-01

Background Evidence favoring earlier HIV ART initiation at high CD4+ T-cell counts (CD4>350/uL) has grown, and guidelines now recommend earlier HIV treatment. However, the cost of providing ART to individuals with CD4>350 in Sub-Saharan Africa has not been well estimated. This remains a major barrier to optimal global cost projections for accelerating the scale-up of ART. Our objective was to compute costs of ART delivery to high CD4+count individuals in a typical rural Ugandan health center-based HIV clinic, and use these data to construct scenarios of efficient ART scale-up. Methods Within a clinical study evaluating streamlined ART delivery to 197 individuals with CD4+ cell counts >350 cells/uL (EARLI Study: NCT01479634) in Mbarara, Uganda, we performed a micro-costing analysis of administrative records, ART prices, and time-and-motion analysis of staff work patterns. We computed observed per-person-per-year (ppy) costs, and constructed models estimating costs under several increasingly efficient ART scale-up scenarios using local salaries, lowest drug prices, optimized patient loads, and inclusion of viral load (VL) testing. Findings Among 197 individuals enrolled in the EARLI Study, median pre-ART CD4+ cell count was 569/uL (IQR 451–716). Observed ART delivery cost was $628 ppy at steady state. Models using local salaries and only core laboratory tests estimated costs of $529/$445 ppy (+/-VL testing, respectively). Models with lower salaries, lowest ART prices, and optimized healthcare worker schedules reduced costs by $100–200 ppy. Costs in a maximally efficient scale-up model were $320/$236 ppy (+/- VL testing). This included $39 for personnel, $106 for ART, $130/$46 for laboratory tests, and $46 for administrative/other costs. A key limitation of this study is its derivation and extrapolation of costs from one large rural treatment program of high CD4+ count individuals. Conclusions In a Ugandan HIV clinic, ART delivery costs—including VL testing—for individuals with CD4>350 were similar to estimates from high-efficiency programs. In higher efficiency scale-up models, costs were substantially lower. These favorable costs may be achieved because high CD4+ count patients are often asymptomatic, facilitating more efficient streamlined ART delivery. Our work provides a framework for calculating costs of efficient ART scale-up models using accessible data from specific programs and regions. PMID:26632823

Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic.

PubMed

Takahashi, Hidetoshi; Satoh, Katsuhiko; Takagi, Akiyoshi; Iizuka, Hajime

2017-09-01

Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12-month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions. © 2017 Japanese Dermatological Association.

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

PubMed

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

2012-08-21

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

Medicare Part D Roulette: Potential Implications of Random Assignment and Plan Restrictions

PubMed Central

Patel, Rajul A.; Walberg, Mark P.; Woelfel, Joseph A.; Amaral, Michelle M.; Varu, Paresh

2013-01-01

Background Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. Objective We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. Methods Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan. Results Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. Conclusions Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance. PMID:24753963

Air Force KC-X Tanker Aircraft Program: Background and Issues for Congress

DTIC Science & Technology

2009-10-05

General ..................................................................................................................... 12 Best Value vs . Lowest...Druyan was a single “bad apple ” and that her actions did not negate the merits of leasing Boeing 767s for use as tankers. In February 2005, however...Force KC-X Tanker Aircraft Program: Background and Issues for Congress Congressional Research Service 17 Best Value vs . Lowest Cost The question of

Estimating the global costs of vitamin A capsule supplementation: a review of the literature.

PubMed

Neidecker-Gonzales, Oscar; Nestel, Penelope; Bouis, Howarth

2007-09-01

Vitamin A supplementation reduces child mortality. It is estimated that 500 million vitamin A capsules are distributed annually. Policy recommendations have assumed that the supplementation programs offer a proven technology at a relatively low cost of around US$0.10 per capsule. To review data on costs of vitamin A supplementation to analyze the key factors that determine program costs, and to attempt to model these costs as a function of per capita income figures. Using data from detailed cost studies in seven countries, this study generated comparable cost categories for analysis, and then used the correlation between national incomes and wage rates to postulate a simple model where costs of vitamin A supplementation are regressed on per capita incomes. Costs vary substantially by country and depend principally on the cost of labor, which is highly correlated with per capita income. Two other factors driving costs are whether the program is implemented in conjunction with other health programs, such as National Immunization Days (which lowers costs), and coverage in rural areas (which increases costs). Labor accounts for 70% of total costs, both for paid staff and for volunteers, while the capsules account for less than 5%. Marketing, training, and administration account for the remaining 25%. Total costs are lowest (roughly US$0.50 per capsule) in Africa, where wages and incomes are lowest, US$1 in developing countries in Asia, and US$1.50 in Latin America. Overall, this study derives a much higher global estimate of costs of around US$1 per capsule.

The costs of hepatitis A infections in South Korea

PubMed Central

Kim, Kyohyun; Jeong, Baek-Geun; Ki, Moran; Park, Mira; Park, Jin Kyung; Choi, Bo Youl; Yoo, Weon-Seob

2014-01-01

OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate. PMID:25139060

Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis.

PubMed

Hall, Bradley R; Armijo, Priscila R; Krause, Crystal; Burnett, Tyler; Oleynikov, Dmitry

2018-07-01

The role of percutaneous cholecystostomy (PC) is undefined in patients with multiple comorbidities presenting with emergent calculous cholecystitis (CC). This study compared outcomes between PC, laparoscopic (LC), and open cholecystectomy (OC). The Vizient UHC database was queried for high-risk patients with CC who underwent PC, LC, OC, or laparoscopic converted to open cholecystectomy (CONV). Demographics, outcomes, mortality, length of stay (LOS), and direct cost were compared between the groups. LC was the most common approach with the lowest risk of death, complications, LOS, and cost. Complication risk was highest in OC. Nearly 20% of patients underwent PC. Complication rate, LOS, infection, aspiration pneumonia, and mortality were higher in PC. Direct cost was lowest in LC, followed by CONV, PC, and OC. Emergent cholecystectomy for CC in high-risk patients is safer and more cost effective than PC and this study supports the use of cholecystectomy as the primary treatment approach in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

New Buildings Design | Climate Neutral Research Campuses | NREL

Science.gov Websites

over a building's lifetime, energy efficiency represents the lowest cost strategy for reducing energy (ft2*yr) to $16/ft2*yr. This means that if you are designing a new 100,000-ft2 building, it could cost as much as $1.6 million per year to operate. Given this baseline, life cycle cost calculations are

A computer program for analysis of fuelwood harvesting costs

Treesearch

George B. Harpole; Giuseppe Rensi

1985-01-01

The fuelwood harvesting computer program (FHP) is written in FORTRAN 60 and designed to select a collection of harvest units and systems from among alternatives to satisfy specified energy requirements at a lowest cost per million Btu's as recovered in a boiler, or thousand pounds of H2O evaporative capacity kiln drying. Computed energy costs are used as a...

Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm.

PubMed

Jacobson, Sheldon H; Karnani, Tamana; Sewell, Edward C

2004-06-02

Pediatric immunization is an important factor in providing protection against numerous common preventable diseases. The success of the pharmaceutical industry in developing new pediatric vaccines has resulted in a crowded recommended immunization schedule requiring several clinic visits over the first 12 years of life. Operations research models have been developed and used to make economically sound procurement choices from among a growing number of competing vaccine products. One factor that has not been incorporated into such models is the economic impact of wastage on such decisions. This paper reports results obtained from a vaccine selection algorithm that incorporates vaccine wastage data. The lowest overall cost formularies comparing no wastage costs with wastage costs are presented. A sensitivity analysis of the vaccine formulary with respect to the wastage rates associated with each available vaccine is provided. The maximum permissible wastage rate for each vaccine is determined for which the vaccine earns a place in the lowest overall cost formulary. This research provides health maintenance organizations and healthcare providers information that can be used to gain a better understanding of wastage and its impact on pediatric formulary costs.

Cost-effectiveness of Secukinumab as First Biologic Treatment, Compared with Other Biologics, for Moderate to Severe Psoriasis in Germany.

PubMed

Augustin, Matthias; McBride, Doreen; Gilloteau, Isabelle; O'Neill, Caitriona; Neidhardt, Katja; Graham, Christopher N

2018-05-05

Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A, has demonstrated strong and sustained efficacy in adults with moderate to severe psoriasis in clinical trials. This analysis compared the cost per responder of secukinumab as first biologic treatment of moderate to severe psoriasis, with adalimumab, infliximab, etanercept, and ustekinumab in Germany. A 52-week decision-tree model was developed. Response to treatment was assessed based on the likelihood of achieving a predefined Psoriasis Area and Severity Index (PASI) response to separate the cohort into responders (PASI ≥75), partial responders (PASI 50 to 74), and non-responders (PASI <50). Responders at week 16 continued initial treatment, whereas partial responders and non-responders were switched to standard of care, which included methotrexate, cyclosporine, phototherapy, and topical corticosteroids. Sustained response was defined as 16-week response maintained at week 52. A German health care system perspective was adopted. Clinical efficacy data was obtained from a mixed-treatment comparison; 2016 resource unit costs from national sources; and adverse events and discontinuation rates from the literature. We calculated cost per PASI 90 responder over week 16 and week 52, as well as cost per sustained responder between weeks 16 and 52. Secukinumab had the lowest cost per PASI 90 responder over 16 weeks (€18,026) compared with ustekinumab (€18,080), adalimumab (€23,499), infliximab (€29,599), and etanercept (€34,037). Over 52 weeks, costs per PASI 90 responder ranged from €42,409 (secukinumab) to €70,363 (etanercept). Likewise, secukinumab had the lowest cost per sustained 52-week PASI 90 responder (€22,690) compared with other biologic treatments. Sensitivity analyses, excluding patient copayments, showed similar results. First biologic treatment with secukinumab for moderate to severe psoriasis is cost-effective, with lowest cost per responder compared with other biologic treatments in Germany. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Using Google AdWords for international multilingual recruitment to health research websites.

PubMed

Gross, Margaret S; Liu, Nancy H; Contreras, Omar; Muñoz, Ricardo F; Leykin, Yan

2014-01-20

Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) "Unmanaged", a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) "Managed", a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US $0.20 for Chinese ads to US $0.50 for English ads). Although Chinese speakers' click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US $10.80 for Russian speakers to US $51.88 for English speakers. During the 7 weeks of "managed" recruitment, we attempted to improve AdWords' performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results.

[Direct and indirect costs of luteinising hormone-releasing hormone analogues in the treatment of locally advanced or metastatic prostate cancer in Italy].

PubMed

Fadda, Valeria; Maratea, Dario

2015-12-01

When analyzing the use of luteinizing hormone-releasing hormone (LHRH) analogues for different clinical indications, current available evidence does not support a presumed drug class effect among the various LHRH in the treatment of prostate cancer. The following search key words were entered in the PubMed database and the NICE and FDA websites: “LHRH agonist AND prostatic cancer”, “androgen deprivation therapy”, “androgen suppression”, “buserelin”, “leuprorelin”, “goserelin”,“triptorelin”, “degarelix”. The direct costs included the following items: follow-up visits, diagnostic exams (e.g. prostate-specific antigen PSA) and drug costs. The indirect costs included working days lost by the patient. With intermittent therapy as a reference, leuprorelin injectable solution of 22,25 mg was associated with the lowest cost and degarelix with the highest cost. However, given the mandatory presence of a nurse for drug injection, the buserelin depot formulation was associated with the lowest cost. If the costs for hospital visits were added to drug costs, differences between the various therapeutic strategies were less remarkable. Our study showed how various factors (e.g. route of administration, frequency of administration, presence of a nurse for drug reconstitution and injection) should be taken into account by decision makers in addition to the price of drugs.

Cost-effectiveness of Colorectal Cancer Screening and Treatment Methods: Mapping of Systematic Reviews

PubMed Central

Abdolahi, Hossein Mashhadi; Asiabar, Ali Sarabi; Azami-Aghdash, Saber; Pournaghi-Azar, Fatemeh; Rezapour, Aziz

2018-01-01

Objective: Due to extensive literature on colorectal cancer and their heterogeneous results, this study aimed to summarize the systematic reviews which review the cost-effectiveness studies on different aspects of colorectal cancer. Methods: The required data were collected by searching the following key words according to MeSH: “colorectal cancer,” “colorectal oncology,” “colorectal carcinoma,” “colorectal neoplasm,” “colorectal tumors,” “cost-effectiveness,” “systematic review,” and “meta-analysis.” The following databases were searched: PubMed, Cochrane, Google Scholar, and Scopus. Two reviewers evaluated the articles according to the checklist of “assessment of multiple systematic reviews” (AMSTAR) tool. Results: Finally, eight systematic reviews were included in the study. The Drummond checklist was mostly used for assessing the quality of the articles. The main perspective was related to the payer and the least was relevant to the social. The majority of the cases referred to sensitivity analysis (in 76% of the cases) and the lowest point also was allocated to discounting (in 37% of cases). The Markov model was used most widely in the studies. Treatment methods examined in the studies were not cost-effective in comparison with the studied units. Among the screening methods, computerized tomographic colonography and fecal DNA were cost-effective. The average score of the articles’ qualities was high (9.8 out of 11). Conclusions: The community perspective should be taken into consideration at large in the studies. It is necessary to pay more attention to discounting subject in studies. More frequent application of the Markov model is recommended. PMID:29379836

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers

PubMed Central

2009-01-01

Background Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Methods Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. Results A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. Conclusion The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies. PMID:19604408

Detection limits and cost comparisons of human- and gull-associated conventional and quantitative PCR assays in artificial and environmental waters.

PubMed

Riedel, Timothy E; Zimmer-Faust, Amity G; Thulsiraj, Vanessa; Madi, Tania; Hanley, Kaitlyn T; Ebentier, Darcy L; Byappanahalli, Muruleedhara; Layton, Blythe; Raith, Meredith; Boehm, Alexandria B; Griffith, John F; Holden, Patricia A; Shanks, Orin C; Weisberg, Stephen B; Jay, Jennifer A

2014-04-01

Some molecular methods for tracking fecal pollution in environmental waters have both PCR and quantitative PCR (qPCR) assays available for use. To assist managers in deciding whether to implement newer qPCR techniques in routine monitoring programs, we compared detection limits (LODs) and costs of PCR and qPCR assays with identical targets that are relevant to beach water quality assessment. For human-associated assays targeting Bacteroidales HF183 genetic marker, qPCR LODs were 70 times lower and there was no effect of target matrix (artificial freshwater, environmental creek water, and environmental marine water) on PCR or qPCR LODs. The PCR startup and annual costs were the lowest, while the per reaction cost was 62% lower than the Taqman based qPCR and 180% higher than the SYBR based qPCR. For gull-associated assays, there was no significant difference between PCR and qPCR LODs, target matrix did not effect PCR or qPCR LODs, and PCR startup, annual, and per reaction costs were lower. Upgrading to qPCR involves greater startup and annual costs, but this increase may be justified in the case of the human-associated assays with lower detection limits and reduced cost per sample. Copyright © 2014 Elsevier Ltd. All rights reserved.

Detection limits and cost comparisons of human- and gull-associated conventional and quantitative PCR assays in artificial and environmental waters

USGS Publications Warehouse

Riedel, Timothy E.; Zimmer-Faust, Amity G.; Thulsiraj, Vanessa; Madi, Tania; Hanley, Kaitlyn T.; Ebentier, Darcy L.; Byappanahalli, Muruleedhara N.; Layton, Blythe; Raith, Meredith; Boehm, Alexandria B.; Griffith, John F.; Holden, Patricia A.; Shanks, Orin C.; Weisberg, Stephen B.; Jay, Jennifer A.

2014-01-01

Some molecular methods for tracking fecal pollution in environmental waters have both PCR and quantitative PCR (qPCR) assays available for use. To assist managers in deciding whether to implement newer qPCR techniques in routine monitoring programs, we compared detection limits (LODs) and costs of PCR and qPCR assays with identical targets that are relevant to beach water quality assessment. For human-associated assays targeting Bacteroidales HF183 genetic marker, qPCR LODs were 70 times lower and there was no effect of target matrix (artificial freshwater, environmental creek water, and environmental marine water) on PCR or qPCR LODs. The PCR startup and annual costs were the lowest, while the per reaction cost was 62% lower than the Taqman based qPCR and 180% higher than the SYBR based qPCR. For gull-associated assays, there was no significant difference between PCR and qPCR LODs, target matrix did not effect PCR or qPCR LODs, and PCR startup, annual, and per reaction costs were lower. Upgrading to qPCR involves greater startup and annual costs, but this increase may be justified in the case of the human-associated assays with lower detection limits and reduced cost per sample.

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

PubMed

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

2017-07-01

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

Surgical follow-up costs disproportionately impact low-income patients.

PubMed

Scott, Aaron R; Rush, Augustus J; Naik, Aanand D; Berger, David H; Suliburk, James W

2015-11-01

Surgical procedures have significant costs at the national level, but the financial burden on patients is equally important. Patients' out-of-pocket costs for surgery and surgical care include not only direct medical costs but also the indirect cost of lost wages and direct nonmedical costs including transportation and childcare. We hypothesized that the nonmedical costs of routine postoperative clinic visits disproportionately impact low-income patients. This was a cross-sectional study performed in the postoperative acute care surgery clinic at a large, urban county hospital. A survey containing items about social, demographic, and financial data was collected from ambulatory patients. Nonmedical costs were calculated as the sum of transportation, childcare, and lost wages. Costs and cost to income ratios were compared between income strata. Ninety-seven patients responded to the survey of which 59 reported all items needed for cost calculations. The median calculated cost of a clinic visit was $27 (interquartile range $18-59). Components of this cost were $16 ($14-$20) for travel, $22 ($17-$50) for childcare among patients requiring childcare, and $0 ($0-$30) in lost wages. Low-income patients had significantly higher (P = 0.0001) calculated cost to income ratios, spending nearly 10% of their monthly income on these costs. The financial burden of routine postoperative clinic visits is significant. Consistent with our hypothesis, the lowest income patients are disproportionately impacted, spending nearly 10% of their monthly income on costs associated with the clinic visit. Future cost-containment efforts should examine alternative, lower cost methods of follow-up, which reduce financial burden. Copyright © 2015 Elsevier Inc. All rights reserved.

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers.

PubMed

Rodrigo, Shelly; Sinclair, Martha; Cunliffe, David; Leder, Karin

2009-07-16

Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.

Costs and benefits of different methods of esophagectomy for esophageal cancer.

PubMed

Yanasoot, Alongkorn; Yolsuriyanwong, Kamtorn; Ruangsin, Sakchai; Laohawiriyakamol, Supparerk; Sunpaweravong, Somkiat

2017-01-01

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.

PubMed

Tosteson, Anna N A; Burge, Russel T; Marshall, Deborah A; Lindsay, Robert

2008-09-01

To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women. Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model. No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture. Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings. Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.

Environmental and economic life cycle assessment for sewage sludge treatment processes in Japan.

PubMed

Hong, Jinglan; Hong, Jingmin; Otaki, Masahiro; Jolliet, Olivier

2009-02-01

Life cycle assessment for sewage sludge treatment was carried out by estimating the environmental and economic impacts of the six alternative scenarios most often used in Japan: dewatering, composting, drying, incineration, incinerated ash melting and dewatered sludge melting, each with or without digestion. Three end-of-life treatments were also studied: landfilling, agricultural application and building material application. The results demonstrate that sewage sludge digestion can reduce the environmental load and cost through reduced dry matter volume. The global warming potential (GWP) generated from incineration and melting processes can be significantly reduced through the reuse of waste heat for electricity and/or heat generation. Equipment production in scenarios except dewatering has an important effect on GWP, whereas the contribution of construction is negligible. In addition, the results show that the dewatering scenario has the highest impact on land use and cost, the drying scenario has the highest impact on GWP and acidification, and the incinerated ash melting scenario has the highest impact on human toxicity due to re-emissions of heavy metals from incinerated ash in the melting unit process. On the contrary, the dewatering, composting and incineration scenarios generate the lowest impact on human toxicity, land use and acidification, respectively, and the incinerated ash melting scenario has the lowest impact on GWP and cost. Heavy metals released from atmospheric effluents generated the highest human toxicity impact, with the effect of dioxin emissions being significantly lower. This study proved that the dewatered sludge melting scenario is an environmentally optimal and economically affordable method.

The hepatitis C genotype 1 paradox: cost per treatment is increasing, but cost per cure is decreasing.

PubMed

Shafran, Stephen D

2015-01-01

Significant attention has been focused on the perceived increase in the cost of antiviral treatment for hepatitis C genotype 1 infection since the approval of the first direct-acting antiviral agents in 2011. Using Canadian list prices, the present analysis points out a paradox: while the cost per antiviral regimen is increasing, the cost per cure is decreasing, especially with interferon-free therapy. In a publicly funded health care system, the lowest cost per cure is a more valuable measure of value for public money than the cost per regimen.

Mass-flow-rate-controlled fluid flow in nanochannels by particle insertion and deletion.

PubMed

Barclay, Paul L; Lukes, Jennifer R

2016-12-01

A nonequilibrium molecular dynamics method to induce fluid flow in nanochannels, the insertion-deletion method (IDM), is introduced. IDM inserts and deletes particles within distinct regions in the domain, creating locally high and low pressures. The benefits of IDM are that it directly controls a physically meaningful quantity, the mass flow rate, allows for pressure and density gradients to develop in the direction of flow, and permits treatment of complex aperiodic geometries. Validation of IDM is performed, yielding good agreement with the analytical solution of Poiseuille flow in a planar channel. Comparison of IDM to existing methods indicates that it is best suited for gases, both because it intrinsically accounts for compressibility effects on the flow and because the computational cost of particle insertion is lowest for low-density fluids.

Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs.

PubMed

Lo, Yuan-Ting C; Wahlqvist, Mark L; Huang, Yi-Chen; Lee, Meei-Shyuan

2016-03-14

A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65-79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30%) and total medical costs (19%), whereas those in the highest animal-derived group had a higher number of hospital days (28%) and costs (83%) as well as total medical costs (38%). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38,600) as well as the lowest total medical costs (NT$75,800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies.

Cost and greenhouse gas emission tradeoffs of alternative uses of lignin for second generation ethanol

NASA Astrophysics Data System (ADS)

Pourhashem, Ghasideh; Adler, Paul R.; McAloon, Andrew J.; Spatari, Sabrina

2013-06-01

Second generation ethanol bioconversion technologies are under demonstration-scale development for the production of lignocellulosic fuels to meet the US federal Renewable Fuel Standards (RFS2). Bioconversion technology utilizes the fermentable sugars generated from the cellulosic fraction of the feedstock, and most commonly assumes that the lignin fraction may be used as a source of thermal and electrical energy. We examine the life cycle greenhouse gas (GHG) emission and techno-economic cost tradeoffs for alternative uses of the lignin fraction of agricultural residues (corn stover, and wheat and barley straw) produced within a 2000 dry metric ton per day ethanol biorefinery in three locations in the United States. We compare three scenarios in which the lignin is (1) used as a land amendment to replace soil organic carbon (SOC); (2) separated, dried and sold as a coal substitute to produce electricity; and (3) used to produce electricity onsite at the biorefinery. Results from this analysis indicate that for life cycle GHG intensity, amending the lignin to land is lowest among the three ethanol production options (-25 to -2 g CO2e MJ-1), substituting coal with lignin is second lowest (4-32 g CO2e MJ-1), and onsite power generation is highest (36-41 g CO2e MJ-1). Moreover, the onsite power generation case may not meet RFS2 cellulosic fuel requirements given the uncertainty in electricity substitution. Options that use lignin for energy do so at the expense of SOC loss. The lignin-land amendment option has the lowest capital cost among the three options due to lower equipment costs for the biorefinery’s thermal energy needs and use of biogas generated onsite. The need to purchase electricity and uncertain market value of the lignin-land amendment could raise its cost compared to onsite power generation and electricity co-production. However, assuming a market value (50-100/dry Mg) for nutrient and soil carbon replacement in agricultural soils, and potentially economy of scale residue collection prices at higher collection volumes associated with low SOC loss, the lignin-land amendment option is economically and environmentally preferable, with the lowest GHG abatement costs relative to gasoline among the three lignin co-product options we consider.

Size-guided multi-seed heuristic method for geometry optimization of clusters: Application to benzene clusters.

PubMed

Takeuchi, Hiroshi

2018-05-08

Since searching for the global minimum on the potential energy surface of a cluster is very difficult, many geometry optimization methods have been proposed, in which initial geometries are randomly generated and subsequently improved with different algorithms. In this study, a size-guided multi-seed heuristic method is developed and applied to benzene clusters. It produces initial configurations of the cluster with n molecules from the lowest-energy configurations of the cluster with n - 1 molecules (seeds). The initial geometries are further optimized with the geometrical perturbations previously used for molecular clusters. These steps are repeated until the size n satisfies a predefined one. The method locates putative global minima of benzene clusters with up to 65 molecules. The performance of the method is discussed using the computational cost, rates to locate the global minima, and energies of initial geometries. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study.

PubMed

Lee, Kun Yun; Ong, Tiong Kiam; Low, Ee Vien; Liow, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng Bang; Ali, Rosli Mohd; Ismail, Omar; Ahmad, Wan Azman Wan; Said, Mas Ayu; Dahlui, Maznah

2017-05-28

Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability. This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates. Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions. The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded. The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost. The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost. Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations. Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Staging Options for the Air Force’s Electronic Combat Test Capability: a Cost Analysis

DTIC Science & Technology

1990-09-01

strategic in nature and completely different than daily operating decisions (20:6). Horngren , in his book Cost Accounting : A Managerial Emphasis...AFIT/GCA/LSY/90S-3 DTTC S E-191 J) C, STAGING OPTIONS FOR THE AIR FORCE’S ELECTRONIC COMBAT TEST CAPABILITY: A COST ANALYSIS THESIS Joseph J. Landino...Alternative Costs ......... 56 v AFIT/GCA/LSY/90S-3 Abstract This study’s purpose was to identify the lowest cost aircraft staging base( s ) for the Air

Preliminary engineering analysis for clothes washers

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

Biermayer, Peter J.

1996-10-01

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

Cost comparison of three kinds of compression therapy in venous ulcer*

PubMed Central

Pereira, Bruno Emmanuel de Medeiros; de Sousa, Alana Tamar Oliveira; França, Jael Rúbia Figueiredo de Sá; Soares, Maria Júlia Guimarães Oliveira

2016-01-01

Evolution and cost of three types of compression therapy (single layer, multilayer and Unna boot) in patients with venous ulceration were compared. The evaluation lasted two months and used photographic records and instrument based on pressure ulcer scale for healing (PUSH). Treatment with monolayer compression therapy presented the lowest cost and more efficacy of the three types, with 82% savings compared with the multilayer therapy. PMID:27579760

Cost optimisation and minimisation of the environmental impact through life cycle analysis of the waste water treatment plant of Bree (Belgium).

PubMed

De Gussem, K; Wambecq, T; Roels, J; Fenu, A; De Gueldre, G; Van De Steene, B

2011-01-01

An ASM2da model of the full-scale waste water plant of Bree (Belgium) has been made. It showed very good correlation with reference operational data. This basic model has been extended to include an accurate calculation of environmental footprint and operational costs (energy consumption, dosing of chemicals and sludge treatment). Two optimisation strategies were compared: lowest cost meeting the effluent consent versus lowest environmental footprint. Six optimisation scenarios have been studied, namely (i) implementation of an online control system based on ammonium and nitrate sensors, (ii) implementation of a control on MLSS concentration, (iii) evaluation of internal recirculation flow, (iv) oxygen set point, (v) installation of mixing in the aeration tank, and (vi) evaluation of nitrate setpoint for post denitrification. Both an environmental impact or Life Cycle Assessment (LCA) based approach for optimisation are able to significantly lower the cost and environmental footprint. However, the LCA approach has some advantages over cost minimisation of an existing full-scale plant. LCA tends to chose control settings that are more logic: it results in a safer operation of the plant with less risks regarding the consents. It results in a better effluent at a slightly increased cost.

Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1

PubMed Central

Morgan, Jake R.; Pho, Mai T.; Leff, Jared A.; Schackman, Bruce R.; Horsburgh, C. Robert; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Freedberg, Kenneth A.; Kim, Arthur Y.

2017-01-01

Abstract Background. Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity. Methods. We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios. Results. We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients. Conclusions. Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred. PMID:28480259

Medical savings accounts make waves.

PubMed

Gardner, J

1995-02-27

MSAs: the theory. Medical savings account legislation would allow consumers to set aside pre-tax dollars to pay for day-to-day healthcare costs. The accounts are to be backed up by a catastropic policy with a deductible roughly equal to the maximum amount allowed in the MSA. The aim is to reduce healthcare cost inflation by making consumers more aware of the costs of healthcare than they are under comprehensive policies and enabling them to shop for the lowest-cost, highest-quality care.

Optimum dry-cooling sub-systems for a solar air conditioner

NASA Technical Reports Server (NTRS)

Chen, J. L. S.; Namkoong, D.

1978-01-01

Dry-cooling sub-systems for residential solar powered Rankine compression air conditioners were economically optimized and compared with the cost of a wet cooling tower. Results in terms of yearly incremental busbar cost due to the use of dry-cooling were presented for Philadelphia and Miami. With input data corresponding to local weather, energy rate and capital costs, condenser surface designs and performance, the computerized optimization program yields design specifications of the sub-system which has the lowest annual incremental cost.

Psychosocial Costs of Racism to Whites: Exploring Patterns through Cluster Analysis

ERIC Educational Resources Information Center

Spanierman, Lisa B.; Poteat, V. Paul; Beer, Amanda M.; Armstrong, Patrick Ian

2006-01-01

Participants (230 White college students) completed the Psychosocial Costs of Racism to Whites (PCRW) Scale. Using cluster analysis, we identified 5 distinct cluster groups on the basis of PCRW subscale scores: the unempathic and unaware cluster contained the lowest empathy scores; the insensitive and afraid cluster consisted of low empathy and…

A passive optical fibre hydrophone array utilising fibre Bragg grating sensors

NASA Astrophysics Data System (ADS)

Karas, Andrew R.; Papageorgiou, Anthony W.; Cook, Peter R.; Arkwright, John W.

2018-02-01

Many current high performance hydrophones use piezo-electric technology to measure sound pressure in water. These hydrophones are sensitive enough to detect any sound above the lowest ambient ocean acoustic noise, however cost of manufacture, weight and storage volume of the array as well as deployment and maintenance costs can limit their largescale application. Piezo-electric systems also have issues with electro-magnetic interference and the signature of the electrical cabling required in a large array. A fibre optic hydrophone array has advantages over the piezo-electric technology in these areas. This paper presents the operating principle of a passive optical fibre hydrophone array utilising Fibre Bragg Gratings (FBGs). The multiple FBG sensors are interrogated using a single solid state spectrometer which further reduces the cost of the deployed system. A noise equivalent power (NEP) comparison of the developed FBG hydrophone versus an existing piezo-electric hydrophone is presented as well as a comparison to the lowest ambient ocean acoustic noise (sea state zero). This research provides an important first step towards a cost effective multi sensor hydrophone array using FBGs.

Evaluation of food waste disposal options by LCC analysis from the perspective of global warming: Jungnang case, South Korea.

PubMed

Kim, Mi-Hyung; Song, Yul-Eum; Song, Han-Byul; Kim, Jung-Wk; Hwang, Sun-Jin

2011-01-01

The costs associated with eight food waste disposal options, dry feeding, wet feeding, composting, anaerobic digestion, co-digestion with sewage sludge, food waste disposer, incineration, and landfilling, were evaluated in the perspective of global warming and energy and/or resource recovery. An expanded system boundary was employed to compare by-products. Life cycle cost was analyzed through the entire disposal process, which included discharge, separate collection, transportation, treatment, and final disposal stages, all of which were included in the system boundary. Costs and benefits were estimated by an avoided impact. Environmental benefits of each system per 1 tonne of food waste management were estimated using carbon prices resulting from CO(2) reduction by avoided impact, as well as the prices of by-products such as animal feed, compost, and electricity. We found that the cost of landfilling was the lowest, followed by co-digestion. The benefits of wet feeding systems were the highest and landfilling the lowest. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Effect of Health Plan Characteristics on Medicare+Choice Enrollment

PubMed Central

Dowd, Bryan E; Feldman, Roger; Coulam, Robert

2003-01-01

Objective To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans. Data Sources/Study Setting The data represent the population of all Medicare+Choice (M+C) plans offered to Medicare beneficiaries in the United States in 1999. Study Design The dependent variable is the log of the ratio of the market share of the jth health plan to the lowest cost plan in the beneficiary's county of residence. The explanatory variables are measures of premiums and benefits in the jth health plan relative to the premiums and benefits in the lowest cost plan. Data Collection Methods The data are from the 1999 Medicare Compare database, and M+C enrollment data from the Centers for Medicare and Medicaid Services (CMS). Principal Findings A $10 increase in an M+C plan's out-of-pocket premium, relative to its competitors, is associated with a decrease of four percentage points in the jth plan's market share (i.e., from 25 to 21 percent), holding the premiums of competing plans constant. Conclusions Although our price elasticity estimates are low, the market share losses associated with small changes in a health plan's premium, relative to its competitors, may be sufficient to discipline premiums in a competitive market. Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion. PMID:12650384

Simulation and Evaluation of Low Impact Development of Urban Residential District Based on SWMM and GIS

NASA Astrophysics Data System (ADS)

Huang, Tielan; Wang, Yunpeng; Zhang, Jinlan

2017-07-01

In this study, simulation and evaluation of low impact development in resident district was carried out based on Storm Water Management Model (SWMM) and GIS method. In the evaluation model, we added 3 kinds of low impact development facilities, namely permeable pavement, rainwater garden, and green roof. These facilities are used alone or in combination. The model was run under five different rainfall reappearing periods. The simulation results using low impact development facilities were compared with simulation results under the current situation and undeveloped state. The results show that the total amount of runoff was greatly reduced by using various types of low impact development facilities in the urban residential district. The maximum reduction rate was using permeable pavement, reached 29.9%, followed was using rainwater garden, and the worst was using green roof. The lowest cost of reduction of the total amount of runoff was using permeable pavement, the followed was using rainwater garden, and the highest was using green roof. The combination scheme of various low impact development facilities has the highest efficiency of reducing total amount of runoff, and the lowest cost, which considering of the actual situation of the study area. The study indicated that application of low impact development facilities can reduce surface runoff effectively, which should be a useful way for prevention of urban waterlogging.

Optimizing biomass feedstock blends with respect to cost, supply, and quality for catalyzed and uncatalyzed fast pyrolysis applications

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

Thompson, Vicki S.; Aston, John E.; Lacey, Jeffrey A.

Here, biomass cost, quality and quantity are important parameters to consider when choosing feedstocks and locations for biorefineries. Biomass cost is dependent upon type, location, quantities available in a given area and logistics costs as well the quality needed for the biorefinery. Biomass quality depends upon type, growth conditions, weather, harvesting methods, storage conditions as well as any preprocessing methods used to improve quality. Biomass quantity depends heavily on location as well as growth conditions, weather, harvesting methods and storage conditions. This study examines how all three of these parameters affect the biomass mixture that is needed in a biomassmore » depot or biorefinery to achieve the lowest cost with the highest quality and at the quantities needed for biorefinery operation. Four biomass depots were proposed in South Carolina that would each process the predominant type of biomass available in that area and each produce 200,000 tons of feedstock per year. These depots would then feed a centrally located 800,000 ton biorefinery that would convert the feedstocks to pyrolysis oil using either catalyzed or uncatalyzed fast pyrolysis. The four depots each needed to produce different blends of biomass based upon the quantities available to them but still meet the minimum quality requirements for the biorefinery. Costs were minimized by using waste biomass resources such as construction and demolition waste, logging residues and forest residuals. Depending upon the quality specification required by the biorefinery, it was necessary to utilize preprocessing methods such as air classification and acid leaching to upgrade biomass quality. In the case of uncatalyzed fast pyrolysis, all four depots could produce biomass blends that were lower cost than the the preferred pyrolysis feedstock, clean pine, and meet quality and quantity specifications. For catalyzed fast pyrolysis, three of the four depots were able to produce blends that met both quality and quantity specifications at minimum cost. The fourth depot would not be able to produce a blend meeting specifications without increasing the supply radius for the depot.« less

Optimizing biomass feedstock blends with respect to cost, supply, and quality for catalyzed and uncatalyzed fast pyrolysis applications

DOE PAGES

Thompson, Vicki S.; Aston, John E.; Lacey, Jeffrey A.; ...

2017-05-24

Here, biomass cost, quality and quantity are important parameters to consider when choosing feedstocks and locations for biorefineries. Biomass cost is dependent upon type, location, quantities available in a given area and logistics costs as well the quality needed for the biorefinery. Biomass quality depends upon type, growth conditions, weather, harvesting methods, storage conditions as well as any preprocessing methods used to improve quality. Biomass quantity depends heavily on location as well as growth conditions, weather, harvesting methods and storage conditions. This study examines how all three of these parameters affect the biomass mixture that is needed in a biomassmore » depot or biorefinery to achieve the lowest cost with the highest quality and at the quantities needed for biorefinery operation. Four biomass depots were proposed in South Carolina that would each process the predominant type of biomass available in that area and each produce 200,000 tons of feedstock per year. These depots would then feed a centrally located 800,000 ton biorefinery that would convert the feedstocks to pyrolysis oil using either catalyzed or uncatalyzed fast pyrolysis. The four depots each needed to produce different blends of biomass based upon the quantities available to them but still meet the minimum quality requirements for the biorefinery. Costs were minimized by using waste biomass resources such as construction and demolition waste, logging residues and forest residuals. Depending upon the quality specification required by the biorefinery, it was necessary to utilize preprocessing methods such as air classification and acid leaching to upgrade biomass quality. In the case of uncatalyzed fast pyrolysis, all four depots could produce biomass blends that were lower cost than the the preferred pyrolysis feedstock, clean pine, and meet quality and quantity specifications. For catalyzed fast pyrolysis, three of the four depots were able to produce blends that met both quality and quantity specifications at minimum cost. The fourth depot would not be able to produce a blend meeting specifications without increasing the supply radius for the depot.« less

Quantifying opportunities for hospital cost control: medical device purchasing and patient discharge planning.

PubMed

Robinson, James C; Brown, Timothy T

2014-09-01

To quantify the potential reduction in hospital costs from adoption of best local practices in supply chain management and discharge planning. We performed multivariate statistical analyses of the association between total variable cost per procedure and medical device price and length of stay, controlling for patient and hospital characteristics. Ten hospitals in 1 major metropolitan area supplied patient-level administrative data on 9778 patients undergoing joint replacement, spine fusion, or cardiac rhythm management (CRM) procedures in 2008 and 2010. The impact on each hospital of matching lowest local market device prices and lowest patient length of stay (LOS) was calculated using multivariate regression analysis controlling for patient demographics, diagnoses, comorbidities, and implications. Average variable costs ranged from $11,315 for joint replacement to $16,087 for CRM and $18,413 for spine fusion. Implantable medical devices accounted for a large share of each procedure's variable costs: 44% for joint replacement, 39% for spine fusion, and 59% for CRM. Device prices and patient length-of-stay exhibited wide variation across hospitals. Total potential hospital cost savings from achieving best local practices in device prices and patient length of stay are 14.5% for joint replacement, 18.8% for spine fusion;,and 29.1% for CRM. Hospitals have opportunities for cost reduction from adoption of best local practices in supply chain management and discharge planning.

The Impact Of Multimode Fiber Chromatic Dispersion On Data Communications

NASA Astrophysics Data System (ADS)

Hackert, Michael J.

1990-01-01

Capability for the lowest cost is the goal of contemporary communications managers. With all of the competitive pressures that modern businesses are experiencing these days, communications needs must be met with the most information carrying capacity for the lowest cost. Optical fiber communication systems meet these requirements while providing reliability, system integrity, and potential future upgradability. Consequently, optical fiber is finding numerous applications in addition to its traditional telephony plant. Fiber based systems are meeting these requirements in building networks and computer interconnects at a lower cost than copper based systems. A fiber type being chosen by industry to meet these needs in standard systems such as FDDI, is multimode fiber. Multimode fiber systems offer cost advantages over single-mode fiber through lower fiber connection costs. Also, system designers can gain savings by using low cost, high reliability, wide spectral width sources such as LEDs instead of lasers and by operating at higher bit rates than used for multimode systems in the past. However, in order to maximize the cost savings while ensuring the system will operate as intended, the chromatic dispersion of the fiber must be taken into account. This paper explains how to do that and shows how to calculate multimode chromatic dispersion for each of the standard fiber sizes (50 μm, 62.5 μm, 85 μm, and 100μm core diameter).

Costs of measuring leaf area index of corn

NASA Technical Reports Server (NTRS)

Daughtry, C. S. T.; Hollinger, S. E.

1984-01-01

The magnitude of plant-to-plant variability of leaf area of corn plants selected from uniform plots was examined and four representative methods for measuring leaf area index (LAI) were evaluated. The number of plants required and the relative costs for each sampling method were calculated to detect 10, 20, and 50% differences in LAI using 0.05 and 0.01 tests of significance and a 90% probability of success (beta = 0.1). The natural variability of leaf area per corn plant was nearly 10%. Additional variability or experimental error may be introduced by the measurement technique employed and by nonuniformity within the plot. Direct measurement of leaf area with an electronic area meter had the lowest CV, required that the fewest plants be sampled, but required approximately the same amount of time as the leaf area/weight ratio method to detect comparable differences. Indirect methods based on measurements of length and width of leaves required more plants but less total time than the direct method. Unless the coefficients for converting length and width to area are verified frequently, the indirect methods may be biased. When true differences in LAI among treatments exceed 50% of mean, all four methods are equal. The method of choice depends on the resources available, the differences to be detected, and what additional information, such as leaf weight or stalk weight, is also desired.

Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam.

PubMed

Levin, Carol E; Van Minh, Hoang; Odaga, John; Rout, Swampa Sarit; Ngoc, Diep Nguyen Thi; Menezes, Lysander; Araujo, Maria Ana Mendoza; LaMontagne, D Scott

2013-08-01

To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Data were collected from a sample of facilities that participated in five demonstration projects for hpv vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services.

Development of a patient-specific anatomical foot model from structured light scan data.

PubMed

Lochner, Samuel J; Huissoon, Jan P; Bedi, Sanjeev S

2014-01-01

The use of anatomically accurate finite element (FE) models of the human foot in research studies has increased rapidly in recent years. Uses for FE foot models include advancing knowledge of orthotic design, shoe design, ankle-foot orthoses, pathomechanics, locomotion, plantar pressure, tissue mechanics, plantar fasciitis, joint stress and surgical interventions. Similar applications but for clinical use on a per-patient basis would also be on the rise if it were not for the high costs associated with developing patient-specific anatomical foot models. High costs arise primarily from the expense and challenges of acquiring anatomical data via magnetic resonance imaging (MRI) or computed tomography (CT) and reconstructing the three-dimensional models. The proposed solution morphs detailed anatomy from skin surface geometry and anatomical landmarks of a generic foot model (developed from CT or MRI) to surface geometry and anatomical landmarks acquired from an inexpensive structured light scan of a foot. The method yields a patient-specific anatomical foot model at a fraction of the cost of standard methods. Average error for bone surfaces was 2.53 mm for the six experiments completed. Highest accuracy occurred in the mid-foot and lowest in the forefoot due to the small, irregular bones of the toes. The method must be validated in the intended application to determine if the resulting errors are acceptable.

An International Study of the Ability and Cost-Effectiveness of Advertising Methods to Facilitate Study Participant Self-Enrolment Into a Pilot Pharmacovigilance Study During Early Pregnancy

PubMed Central

2016-01-01

Background Knowledge of the fetal effects of maternal medication use in pregnancy is often inadequate and current pregnancy pharmacovigilance (PV) surveillance methods have important limitations. Patient self-reporting may be able to mitigate some of these limitations, providing an adequately sized study sample can be recruited. Objective To compare the ability and cost-effectiveness of several direct-to-participant advertising methods for the recruitment of pregnant participants into a study of self-reported gestational exposures and pregnancy outcomes. Methods The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) pregnancy study is a non-interventional, prospective pilot study of self-reported medication use and obstetric outcomes provided by a cohort of pregnant women that was conducted in Denmark, the Netherlands, Poland, and the United Kingdom. Direct-to-participant advertisements were provided via websites, emails, leaflets, television, and social media platforms. Results Over a 70-week recruitment period direct-to-participant advertisements engaged 43,234 individuals with the study website or telephone system; 4.78% (2065/43,234) of which were successfully enrolled and provided study data. Of these 90.4% (1867/2065) were recruited via paid advertising methods, 23.0% (475/2065) of whom were in the first trimester of pregnancy. The overall costs per active recruited participant were lowest for email (€23.24) and website (€24.41) advertisements and highest for leaflet (€83.14) and television (€100.89). Website adverts were substantially superior in their ability to recruit participants during their first trimester of pregnancy (317/668, 47.5%) in comparison with other advertising methods (P<.001). However, we identified international variations in both the cost-effectiveness of the various advertisement methods used and in their ability to recruit participants in early pregnancy. Conclusions Recruitment of a pregnant cohort using direct-to-participant advertisement methods is feasible, but the total costs incurred are not insubstantial. Future research is needed to identify advertising strategies capable of recruiting large numbers of demographically representative pregnant women, preferentially in early pregnancy. PMID:27227148

A simulation based approach to optimize inventory replenishment with RAND algorithm: An extended study of corrected demand using Holt's method for textile industry

NASA Astrophysics Data System (ADS)

Morshed, Mohammad Sarwar; Kamal, Mostafa Mashnoon; Khan, Somaiya Islam

2016-07-01

Inventory has been a major concern in supply chain and numerous researches have been done lately on inventory control which brought forth a number of methods that efficiently manage inventory and related overheads by reducing cost of replenishment. This research is aimed towards providing a better replenishment policy in case of multi-product, single supplier situations for chemical raw materials of textile industries in Bangladesh. It is assumed that industries currently pursue individual replenishment system. The purpose is to find out the optimum ideal cycle time and individual replenishment cycle time of each product for replenishment that will cause lowest annual holding and ordering cost, and also find the optimum ordering quantity. In this paper indirect grouping strategy has been used. It is suggested that indirect grouping Strategy outperforms direct grouping strategy when major cost is high. An algorithm by Kaspi and Rosenblatt (1991) called RAND is exercised for its simplicity and ease of application. RAND provides an ideal cycle time (T) for replenishment and integer multiplier (ki) for individual items. Thus the replenishment cycle time for each product is found as T×ki. Firstly, based on data, a comparison between currently prevailing (individual) process and RAND is provided that uses the actual demands which presents 49% improvement in total cost of replenishment. Secondly, discrepancies in demand is corrected by using Holt's method. However, demands can only be forecasted one or two months into the future because of the demand pattern of the industry under consideration. Evidently, application of RAND with corrected demand display even greater improvement. The results of this study demonstrates that cost of replenishment can be significantly reduced by applying RAND algorithm and exponential smoothing models.

Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis

PubMed Central

Hill, Andrew; Redd, Christopher; Gotham, Dzintars; Erbacher, Isabelle; Meldrum, Jonathan; Harada, Ryo

2017-01-01

Objectives The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs. Setting This research was carried out in a non-clinical research setting using secondary data. Participants There were no human participants in the study. Four drugs were selected for the study: bortezomib, dasatinib, everolimus and gefitinib. These medications were selected according to their clinical importance, novel pharmaceutical actions and the availability of generic price data. Primary and secondary outcome measures Target costs for treatment were to be generated for each indication for each treatment. The primary outcome measure was the target cost according to a production cost calculation algorithm. The secondary outcome measure was the target cost as the lowest available generic price; this was necessary where export data were not available to generate an estimate from our cost calculation algorithm. Other outcomes included patent expiry dates and total eligible treatment populations. Results Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74–99.6%. Patent expiry dates were bortezomib 2014–22, dasatinib 2020–26, everolimus 2019–25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736. Conclusions Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research. PMID:28110283

Probabilistic Methodology for Estimation of Number and Economic Loss (Cost) of Future Landslides in the San Francisco Bay Region, California

USGS Publications Warehouse

Crovelli, Robert A.; Coe, Jeffrey A.

2008-01-01

The Probabilistic Landslide Assessment Cost Estimation System (PLACES) presented in this report estimates the number and economic loss (cost) of landslides during a specified future time in individual areas, and then calculates the sum of those estimates. The analytic probabilistic methodology is based upon conditional probability theory and laws of expectation and variance. The probabilistic methodology is expressed in the form of a Microsoft Excel computer spreadsheet program. Using historical records, the PLACES spreadsheet is used to estimate the number of future damaging landslides and total damage, as economic loss, from future landslides caused by rainstorms in 10 counties of the San Francisco Bay region in California. Estimates are made for any future 5-year period of time. The estimated total number of future damaging landslides for the entire 10-county region during any future 5-year period of time is about 330. Santa Cruz County has the highest estimated number of damaging landslides (about 90), whereas Napa, San Francisco, and Solano Counties have the lowest estimated number of damaging landslides (5?6 each). Estimated direct costs from future damaging landslides for the entire 10-county region for any future 5-year period are about US $76 million (year 2000 dollars). San Mateo County has the highest estimated costs ($16.62 million), and Solano County has the lowest estimated costs (about $0.90 million). Estimated direct costs are also subdivided into public and private costs.

Economic burden of stroke: a systematic review on post-stroke care.

PubMed

Rajsic, S; Gothe, H; Borba, H H; Sroczynski, G; Vujicic, J; Toell, T; Siebert, Uwe

2018-06-16

Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.

Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp

PubMed Central

Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K.; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M.; Thirumurthy, Harsha

2015-01-01

Background: Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Methods: Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. Results: The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. Conclusions: EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization. PMID:26017658

Automatic Mrf-Based Registration of High Resolution Satellite Video Data

NASA Astrophysics Data System (ADS)

Platias, C.; Vakalopoulou, M.; Karantzalos, K.

2016-06-01

In this paper we propose a deformable registration framework for high resolution satellite video data able to automatically and accurately co-register satellite video frames and/or register them to a reference map/image. The proposed approach performs non-rigid registration, formulates a Markov Random Fields (MRF) model, while efficient linear programming is employed for reaching the lowest potential of the cost function. The developed approach has been applied and validated on satellite video sequences from Skybox Imaging and compared with a rigid, descriptor-based registration method. Regarding the computational performance, both the MRF-based and the descriptor-based methods were quite efficient, with the first one converging in some minutes and the second in some seconds. Regarding the registration accuracy the proposed MRF-based method significantly outperformed the descriptor-based one in all the performing experiments.

Engineered cost-effective growth of Co-based nanoflakes as a sustainable water oxidation electrocatalyst

NASA Astrophysics Data System (ADS)

Pourreza, M.; Naseri, N.

2017-11-01

Developing low-cost, scalable and reproducible synthesis methods for water oxidation reaction (WOR) catalysts is highly desirable and also challenging in energy, environmental and industrial applications. In this context, electrochemical deposition is known as an easy and cost-effective technique in nanomaterial growth. Herein, cobalt-based nanoflakes were grown on a flexible and commercially available steel mesh substrate by electrodeposition approach with a crystalline structure as a mixture of oxide, hydroxide and oxyhydroxide phases. For the first time, the correlation between electrodeposition parameters, time and current density, and morphological characteristics of the grown nanoflakes (density and aspect ratio based on SEM results) has been derived. According to a comprehensive study of the flakes’ electrocatalytic performance in WOR, the optimized sample fabricated with a moderate electrodeposition current density (7 mA cm-2) and duration time (2000 s) revealed the highest density (7.6  ×  108 cm-2) and aspect ratio (7.1) as well as the lowest values for overpotential (OP  =  324 mV) and charge transfer resistance (14 Ω). This designed array of Co-based nanoflakes also showed the lowest value of overpotential for bare cobalt-based WOR electrocatalysts reported yet. High and low values for deposition current density and/or deposition time had a negative effect on the sample surface, leaving some areas without any flakes or with incomplete and inefficient formation of nanoflakes with low densities and aspect ratios. A similar effect was observed for annealed samples in the range of 200-400 °C. Based on recorded overpotentials and extracted surface morphological parameters, a linear and logarithmic behavior in overpotential-flake density dependency was proposed for current density and time controlled systems, respectively.

Anharmonic Vibrational Analyses of Pentapeptide Conformations Explored with Enhanced Sampling Simulations.

PubMed

Otaki, Hiroki; Yagi, Kiyoshi; Ishiuchi, Shun-Ichi; Fujii, Masaaki; Sugita, Yuji

2016-10-06

An accurate theoretical prediction of the vibrational spectrum of polypeptides remains to be a challenge due to (1) their conformational flexibility and (2) non-negligible anharmonic effects. The former makes the search for conformers that contribute to the spectrum difficult, and the latter requires an expensive, quantum mechanical calculation for both electrons and vibrations. Here, we propose a new theoretical approach, which implements an enhanced conformational sampling by the replica-exchange molecular dynamics method, a structural clustering to identify distinct conformations, and a vibrational structure calculation by the second-order vibrational quasi-degenerate perturbation theory (VQDPT2). A systematic mode-selection scheme is developed to reduce the cost of VQDPT2 and the generation of a potential energy surface by the electronic structure calculation. The proposed method is applied to a pentapeptide, SIVSF-NH 2 , for which the infrared spectrum has recently been measured in the gas phase with high resolution in the OH and NH stretching region. The theoretical spectrum of the lowest energy conformer is obtained with a mean absolute deviation of 11.2 cm -1 from the experimental spectrum. Furthermore, the NH stretching frequencies of the five lowest energy conformers are found to be consistent with the literature values measured for small peptides with a similar secondary structure. Therefore, the proposed method is a promising way to analyze the vibrational spectrum of polypeptides.

Shuttle payload vibroacoustic test plan evaluation

NASA Technical Reports Server (NTRS)

Stahle, C. V.; Gongloff, H. R.; Young, J. P.; Keegan, W. B.

1977-01-01

Statistical decision theory is used to evaluate seven alternate vibro-acoustic test plans for Space Shuttle payloads; test plans include component, subassembly and payload testing and combinations of component and assembly testing. The optimum test levels and the expected cost are determined for each test plan. By including all of the direct cost associated with each test plan and the probabilistic costs due to ground test and flight failures, the test plans which minimize project cost are determined. The lowest cost approach eliminates component testing and maintains flight vibration reliability by performing subassembly tests at a relatively high acoustic level.

The Influence of Varying Cost Formats on Preferences

PubMed Central

Jiang, Charles Changchuan; Fraenkel, Liana

2016-01-01

Background Numerous studies have found that cost strongly influences patients’ decision-making. The objective of this study was to explore the impact of varying cost formats on patients’ preferences. Methods Mechanical Turk workers completed a choice based conjoint (CBC) analysis survey. The CBC survey was designed to examine stated preferences for second line agents used to treat diabetes using five attributes: route of administration, efficacy, risk of low blood sugar, frequency of checking blood sugar levels and cost. We developed seven versions of the CBC survey which were identical except for the cost attribute. We described cost in terms of: Affordability, Monthly co-pay, Dollar Sign Rating, How Expensive or How Cheap compared to other medications, Monthly Co-pay, Working Hours Equivalent (per month) and Percent of Monthly Income. The resulting part-worth utilities were used to calculate the relative importance of cost and to estimate treatment preferences for a sulfonylurea, exenatide and insulin. Results The relative impact of cost varied significantly across the seven formats. Cost had the greatest influence on participants’ decisions when framed in terms of Affordability [mean (SD) relative importance = 37.3 (0.9)] and the lowest influence when framed in terms of How Cheap (compared to other drugs) [mean (SD) relative importance= 12.1 (0.9)]. A sulfonylurea was strongly preferred across four of the seven formats. Preference for insulin, the most effective, albeit riskiest option, was low across all cost formats. Conclusions The format used to describe cost influences how this attribute impacts patients’ preferences. Individuals are most cost-sensitive when cost is framed in terms of affordability and least cost-sensitive when cost is described in terms of how cheap the medication is compared to others. PMID:27856826

Cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia.

PubMed

Kazerooni, Rashid; Broadhead, Christine

2015-02-15

A cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia (CD) was conducted. A cost-utility analysis of botulinum toxin type A products was conducted from the U.S. government perspective using a decision-analysis model with a one-year time horizon. Probabilities of the model were taken from several studies using the three botulinum type A products approved by the Food and Drug Administration for the treatment of CD: onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), and incobotulinumtoxinA (Xeomin). The main outcome measurement was successful treatment response with botulinum toxin type A, measured in quality-adjusted life years (QALYs). Response was defined as a patient who experienced improvement of CD symptoms without a severe adverse event. Probabilistic sensitivity analysis was conducted to test robustness of the base-case results. All three botulinum toxin type A agents were cost-effective at a willingness-to-pay threshold of $100,000 per QALY. Xeomin was the most cost-effective with a cost-effectiveness ratio of $27,548 per QALY. Xeomin was dominant over the alternative agents with equivalent efficacy outcomes and lower costs. Dysport had the second lowest cost-effectiveness ratio ($36,678), followed by Botox ($49,337). The probabilistic sensitivity analysis supported the results of the base-case analysis. Dysport was associated with the lowest wastage (2.2%), followed by Xeomin (10%) and Botox (22.9%). A cost-utility analysis found that Xeomin was the more cost-effective botulinum toxin type A product compared with Botox and Dysport for the treatment of CD. Wastage associated with the respective products may have a large effect on the cost-effectiveness of the agents. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

National-level infrastructure and economic effects of switchgrass cofiring with coal in existing power plants for carbon mitigation.

PubMed

Morrow, William R; Griffin, W Michael; Matthews, H Scott

2008-05-15

We update a previously presented Linear Programming (LP) methodology for estimating state level costs for reducing CO2 emissions from existing coal-fired power plants by cofiring switchgrass, a biomass energy crop, and coal. This paper presents national level results of applying the methodology to the entire portion of the United States in which switchgrass could be grown without irrigation. We present incremental switchgrass and coal cofiring carbon cost of mitigation curves along with a presentation of regionally specific cofiring economics and policy issues. The results show that cofiring 189 million dry short tons of switchgrass with coal in the existing U.S. coal-fired electricity generation fleet can mitigate approximately 256 million short tons of carbon-dioxide (CO2) per year, representing a 9% reduction of 2005 electricity sector CO2 emissions. Total marginal costs, including capital, labor, feedstock, and transportation, range from $20 to $86/ton CO2 mitigated,with average costs ranging from $20 to $45/ton. If some existing power plants upgrade to boilers designed for combusting switchgrass, an additional 54 million tons of switchgrass can be cofired. In this case, total marginal costs range from $26 to $100/ton CO2 mitigated, with average costs ranging from $20 to $60/ton. Costs for states east of the Mississippi River are largely unaffected by boiler replacement; Atlantic seaboard states represent the lowest cofiring cost of carbon mitigation. The central plains states west of the Mississippi River are most affected by the boiler replacement option and, in general, go from one of the lowest cofiring cost of carbon mitigation regions to the highest. We explain the variation in transportation expenses and highlight regional cost of mitigation variations as transportation overwhelms other cofiring costs.

Effect of type of cognitive task and walking speed on cognitive-motor interference during dual-task walking.

PubMed

Patel, P; Lamar, M; Bhatt, T

2014-02-28

We aimed to determine the effect of distinctly different cognitive tasks and walking speed on cognitive-motor interference of dual-task walking. Fifteen healthy adults performed four cognitive tasks: visuomotor reaction time (VMRT) task, word list generation (WLG) task, serial subtraction (SS) task, and the Stroop (STR) task while sitting and during walking at preferred-speed (dual-task normal walking) and slow-speed (dual-task slow-speed walking). Gait speed was recorded to determine effect on walking. Motor and cognitive costs were measured. Dual-task walking had a significant effect on motor and cognitive parameters. At preferred-speed, the motor cost was lowest for the VMRT task and highest for the STR task. In contrast, the cognitive cost was highest for the VMRT task and lowest for the STR task. Dual-task slow walking resulted in increased motor cost and decreased cognitive cost only for the STR task. Results show that the motor and cognitive cost of dual-task walking depends heavily on the type and perceived complexity of the cognitive task being performed. Cognitive cost for the STR task was low irrespective of walking speed, suggesting that at preferred-speed individuals prioritize complex cognitive tasks requiring higher attentional and processing resources over walking. While performing VMRT task, individuals preferred to prioritize more complex walking task over VMRT task resulting in lesser motor cost and increased cognitive cost for VMRT task. Furthermore, slow walking can assist in diverting greater attention towards complex cognitive tasks, improving its performance while walking. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

What linear programming contributes: world food programme experience with the "cost of the diet" tool.

PubMed

Frega, Romeo; Lanfranco, Jose Guerra; De Greve, Sam; Bernardini, Sara; Geniez, Perrine; Grede, Nils; Bloem, Martin; de Pee, Saskia

2012-09-01

Linear programming has been used for analyzing children's complementary feeding diets, for optimizing nutrient adequacy of dietary recommendations for a population, and for estimating the economic value of fortified foods. To describe and apply a linear programming tool ("Cost of the Diet") with data from Mozambique to determine what could be cost-effective fortification strategies. Based on locally assessed average household dietary needs, seasonal market prices of available food products, and food composition data, the tool estimates the lowest-cost diet that meets almost all nutrient needs. The results were compared with expenditure data from Mozambique to establish the affordability of this diet by quintiles of the population. Three different applications were illustrated: identifying likely "limiting nutrients," comparing cost effectiveness of different fortification interventions at the household level, and assessing economic access to nutritious foods. The analysis identified iron, vitamin B2, and pantothenic acid as "limiting nutrients." Under the Mozambique conditions, vegetable oil was estimated as a more cost-efficient vehicle for vitamin A fortification than sugar; maize flour may also be an effective vehicle to provide other constraining micronutrients. Multiple micronutrient fortification of maize flour could reduce the cost of the "lowest-cost nutritious diet" by 18%, but even this diet can be afforded by only 20% of the Mozambican population. Within the context of fortification, linear programming can be a useful tool for identifying likely nutrient inadequacies, for comparing fortification options in terms of cost effectiveness, and for illustrating the potential benefit of fortification for improving household access to a nutritious diet.

Cost-Effective Strategies for Rural Community Outreach, Hawaii, 2010–2011

PubMed Central

Barbato, Anna; Holuby, R. Scott; Ciarleglio, Anita E.; Taniguchi, Ronald

2014-01-01

Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members. PMID:25496555

Cost-effective strategies for rural community outreach, Hawaii, 2010-2011.

PubMed

Pellegrin, Karen L; Barbato, Anna; Holuby, R Scott; Ciarleglio, Anita E; Taniguchi, Ronald

2014-12-11

Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members.

Microinsurance: innovations in low-cost health insurance.

PubMed

Dror, David M; Radermacher, Ralf; Khadilkar, Shrikant B; Schout, Petra; Hay, François-Xavier; Singh, Arbind; Koren, Ruth

2009-01-01

Microinsurance--low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements-can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits--both designed to keep these arrangements in business--perversely limited these schemes' ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest.

Normal mode-guided transition pathway generation in proteins

PubMed Central

Lee, Byung Ho; Seo, Sangjae; Kim, Min Hyeok; Kim, Youngjin; Jo, Soojin; Choi, Moon-ki; Lee, Hoomin; Choi, Jae Boong

2017-01-01

The biological function of proteins is closely related to its structural motion. For instance, structurally misfolded proteins do not function properly. Although we are able to experimentally obtain structural information on proteins, it is still challenging to capture their dynamics, such as transition processes. Therefore, we need a simulation method to predict the transition pathways of a protein in order to understand and study large functional deformations. Here, we present a new simulation method called normal mode-guided elastic network interpolation (NGENI) that performs normal modes analysis iteratively to predict transition pathways of proteins. To be more specific, NGENI obtains displacement vectors that determine intermediate structures by interpolating the distance between two end-point conformations, similar to a morphing method called elastic network interpolation. However, the displacement vector is regarded as a linear combination of the normal mode vectors of each intermediate structure, in order to enhance the physical sense of the proposed pathways. As a result, we can generate more reasonable transition pathways geometrically and thermodynamically. By using not only all normal modes, but also in part using only the lowest normal modes, NGENI can still generate reasonable pathways for large deformations in proteins. This study shows that global protein transitions are dominated by collective motion, which means that a few lowest normal modes play an important role in this process. NGENI has considerable merit in terms of computational cost because it is possible to generate transition pathways by partial degrees of freedom, while conventional methods are not capable of this. PMID:29020017

A method for the analysis of perfluorinated compounds in environmental and drinking waters and the determination of their lowest concentration minimal reporting levels.

PubMed

Boone, J Scott; Guan, Bing; Vigo, Craig; Boone, Tripp; Byrne, Christian; Ferrario, Joseph

2014-06-06

A trace analytical method was developed for the determination of seventeen specific perfluorinated chemicals (PFCs) in environmental and drinking waters. The objectives were to optimize an isotope-dilution method to increase the precision and accuracy of the analysis of the PFCs and to eliminate the need for matrix-matched standards. A 250 mL sample of environmental or drinking water was buffered to a pH of 4, spiked with labeled surrogate standards, extracted through solid phase extraction cartridges, and eluted with ammonium hydroxide in methyl tert-butyl ether: methanol solution. The sample eluents were concentrated to volume and analyzed by liquid chromatography/tandem mass spectrometry (LC-MS/MS). The lowest concentration minimal reporting levels (LCMRLs) for the seventeen PFCs were calculated and ranged from 0.034 to 0.600 ng/L for surface water and from 0.033 to 0.640 ng/L for drinking water. The relative standard deviations (RSDs) for all compounds were <20% for all concentrations above the LCMRL. The method proved effective and cost efficient and addressed the problems with the recovery of perfluorobutanoic acid (PFBA) and other short chain PFCs. Various surface water and drinking water samples were used during method development to optimize this method. The method was used to evaluate samples from the Mississippi River at New Orleans and drinking water samples from a private residence in that same city. The method was also used to determine PFC contamination in well water samples from a fire training area where perfluorinated foams were used in training to extinguish fires. Published by Elsevier B.V.

An Evaluation of Web- and Print-Based Methods to Attract People to a Physical Activity Intervention

PubMed Central

Jennings, Cally; Plotnikoff, Ronald C; Vandelanotte, Corneel

2016-01-01

Background Cost-effective and efficient methods to attract people to Web-based health behavior interventions need to be identified. Traditional print methods including leaflets, posters, and newspaper advertisements remain popular despite the expanding range of Web-based advertising options that have the potential to reach larger numbers at lower cost. Objective This study evaluated the effectiveness of multiple Web-based and print-based methods to attract people to a Web-based physical activity intervention. Methods A range of print-based (newspaper advertisements, newspaper articles, letterboxing, leaflets, and posters) and Web-based (Facebook advertisements, Google AdWords, and community calendars) methods were applied to attract participants to a Web-based physical activity intervention in Australia. The time investment, cost, number of first time website visits, the number of completed sign-up questionnaires, and the demographics of participants were recorded for each advertising method. Results A total of 278 people signed up to participate in the physical activity program. Of the print-based methods, newspaper advertisements totaled AUD $145, letterboxing AUD $135, leaflets AUD $66, posters AUD $52, and newspaper article AUD $3 per sign-up. Of the Web-based methods, Google AdWords totaled AUD $495, non-targeted Facebook advertisements AUD $68, targeted Facebook advertisements AUD $42, and community calendars AUD $12 per sign-up. Although the newspaper article and community calendars cost the least per sign-up, they resulted in only 17 and 6 sign-ups respectively. The targeted Facebook advertisements were the next most cost-effective method and reached a large number of sign-ups (n=184). The newspaper article and the targeted Facebook advertisements required the lowest time investment per sign-up (5 and 7 minutes respectively). People reached through the targeted Facebook advertisements were on average older (60 years vs 50 years, P<.001) and had a higher body mass index (32 vs 30, P<.05) than people reached through the other methods. Conclusions Overall, our results demonstrate that targeted Facebook advertising is the most cost-effective and efficient method at attracting moderate numbers to physical activity interventions in comparison to the other methods tested. Newspaper advertisements, letterboxing, and Google AdWords were not effective. The community calendars and newspaper articles may be effective for small community interventions. ClinicalTrial Australian New Zealand Clinical Trials Registry: ACTRN12614000339651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363570&isReview=true (Archived by WebCite at http://www.webcitation.org/6hMnFTvBt) PMID:27235075

An International Study of the Ability and Cost-Effectiveness of Advertising Methods to Facilitate Study Participant Self-Enrolment Into a Pilot Pharmacovigilance Study During Early Pregnancy.

PubMed

Richardson, Jonathan Luke; Stephens, Sally; Thomas, Simon Hugh Lynton; Jamry-Dziurla, Anna; de Jong-van den Berg, Lolkje; Zetstra-van der Woude, Priscilla; Laursen, Maja; Hliva, Valerie; Mt-Isa, Shahrul; Bourke, Alison; Dreyer, Nancy A; Blackburn, Stella Cf

2016-01-01

Knowledge of the fetal effects of maternal medication use in pregnancy is often inadequate and current pregnancy pharmacovigilance (PV) surveillance methods have important limitations. Patient self-reporting may be able to mitigate some of these limitations, providing an adequately sized study sample can be recruited. To compare the ability and cost-effectiveness of several direct-to-participant advertising methods for the recruitment of pregnant participants into a study of self-reported gestational exposures and pregnancy outcomes. The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) pregnancy study is a non-interventional, prospective pilot study of self-reported medication use and obstetric outcomes provided by a cohort of pregnant women that was conducted in Denmark, the Netherlands, Poland, and the United Kingdom. Direct-to-participant advertisements were provided via websites, emails, leaflets, television, and social media platforms. Over a 70-week recruitment period direct-to-participant advertisements engaged 43,234 individuals with the study website or telephone system; 4.78% (2065/43,234) of which were successfully enrolled and provided study data. Of these 90.4% (1867/2065) were recruited via paid advertising methods, 23.0% (475/2065) of whom were in the first trimester of pregnancy. The overall costs per active recruited participant were lowest for email (€23.24) and website (€24.41) advertisements and highest for leaflet (€83.14) and television (€100.89). Website adverts were substantially superior in their ability to recruit participants during their first trimester of pregnancy (317/668, 47.5%) in comparison with other advertising methods (P<.001). However, we identified international variations in both the cost-effectiveness of the various advertisement methods used and in their ability to recruit participants in early pregnancy. Recruitment of a pregnant cohort using direct-to-participant advertisement methods is feasible, but the total costs incurred are not insubstantial. Future research is needed to identify advertising strategies capable of recruiting large numbers of demographically representative pregnant women, preferentially in early pregnancy.

CC2 oscillator strengths within the local framework for calculating excitation energies (LoFEx).

PubMed

Baudin, Pablo; Kjærgaard, Thomas; Kristensen, Kasper

2017-04-14

In a recent work [P. Baudin and K. Kristensen, J. Chem. Phys. 144, 224106 (2016)], we introduced a local framework for calculating excitation energies (LoFEx), based on second-order approximated coupled cluster (CC2) linear-response theory. LoFEx is a black-box method in which a reduced excitation orbital space (XOS) is optimized to provide coupled cluster (CC) excitation energies at a reduced computational cost. In this article, we present an extension of the LoFEx algorithm to the calculation of CC2 oscillator strengths. Two different strategies are suggested, in which the size of the XOS is determined based on the excitation energy or the oscillator strength of the targeted transitions. The two strategies are applied to a set of medium-sized organic molecules in order to assess both the accuracy and the computational cost of the methods. The results show that CC2 excitation energies and oscillator strengths can be calculated at a reduced computational cost, provided that the targeted transitions are local compared to the size of the molecule. To illustrate the potential of LoFEx for large molecules, both strategies have been successfully applied to the lowest transition of the bivalirudin molecule (4255 basis functions) and compared with time-dependent density functional theory.

Competitive bidding for health insurance contracts.

PubMed

Keijser, G M; Kirkman-Liff, B L

1992-05-01

The determination of the payment or premium to be paid to the insurer by a large purchaser of care must accurately represent the risk of the enrolled persons. One approach is a risk-adjusted payment established by a mathematical formula, which estimates the effect of many variables on total care costs, and for different groups of persons determine an average cost. This method has several problems, and an alternative is competitive bidding. Market forces pressure providers to offer the lowest possible bids while attempting to remain fiscally viable and provide high-quality services. Research from the U.S. demonstrates that competitive contracting effectively lowered the costs of health care for those sectors of the health care system that used this strategy. Bidding by area gave far more equitable results than could have been obtained with a state-wide system with crude adjustments for each area. It is an alternative which can create strong incentives for innovation and cost-containment, and at the same time allows insurers to take into account local variation in supply and demand of care. As a potential alternative to a regulatory system, competitive bidding should be considered for regional experimentation in health insurer payment.

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

Chen, Dafen; Jiang, Jiuchun; Kim, Gi-Heon

Choosing a proper cooling method for a lithium-ion (Li-ion) battery pack for electric drive vehicles (EDVs) and making an optimal cooling control strategy to keep the temperature at a optimal range of 15 degrees C to 35 degrees C is essential to increasing safety, extending the pack service life, and reducing costs. When choosing a cooling method and developing strategies, trade-offs need to be made among many facets such as costs, complexity, weight, cooling effects, temperature uniformity, and parasitic power. This paper considers four cell-cooling methods: air cooling, direct liquid cooling, indirect liquid cooling, and fin cooling. To evaluate theirmore » effectiveness, these methods are assessed using a typical large capacity Li-ion pouch cell designed for EDVs from the perspective of coolant parasitic power consumption, maximum temperature rise, temperature difference in a cell, and additional weight used for the cooling system. We use a state-of-the-art Li-ion battery electro-chemical thermal model. The results show that under our assumption an air-cooling system needs 2 to 3 more energy than other methods to keep the same average temperature; an indirect liquid cooling system has the lowest maximum temperature rise; and a fin cooling system adds about 40% extra weight of cell, which weighs most, when the four kinds cooling methods have the same volume. Indirect liquid cooling is a more practical form than direct liquid cooling though it has slightly lower cooling performance.« less

Potential Savings of Harmonising Hospital and Community Formularies for Chronic Disease Medications Initiated in Hospital

PubMed Central

Lapointe-Shaw, Lauren; Fischer, Hadas D.; Newman, Alice; John-Baptiste, Ava; Anderson, Geoffrey M.; Rochon, Paula A.; Bell, Chaim M.

2012-01-01

Background Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. Methods We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1st 2008-March 31st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. Results The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge. Interpretation In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs. PMID:22761882

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

Feibel, C.E.

This study uses multiple data collection and research methods including in depth interviews, 271 surveys of shared taxi and minibus operators, participant observation, secondary sources, and the literature on public transport from low, medium, and high-income countries. Extensive use is also made of a survey administered in Istanbul in 1976 to 1935 paratransit operators. Primary findings are that private buses are more efficient than public buses on a cost per passenger-km basis, and that private minibuses are as efficient as public buses. In terms of energy efficiency, minibuses are almost as efficient as public and private buses using actual-occupancy levels.more » Large shared taxis are twice as cost and energy efficient as cars, and small shared taxis 50% more efficient. In terms of investment cost per seat, large shared taxis have the lowest cost followed by smaller shared taxis, minibuses, and buses. Considering actual occupancy levels, minibuses are only slightly less effective in terms of congestion than buses, and large and small shared taxis are twice as effective as cars. It is also shown that minibuses and shared taxis have better service quality than buses because of higher frequencies and speeds, and because they provide a much higher probability of getting a seat than buses. Analysis of regulation and policy suggests that there are many unintended cost of public-transport regulations.« less

A novel automatic segmentation workflow of axial breast DCE-MRI

NASA Astrophysics Data System (ADS)

Besbes, Feten; Gargouri, Norhene; Damak, Alima; Sellami, Dorra

2018-04-01

In this paper we propose a novel process of a fully automatic breast tissue segmentation which is independent from expert calibration and contrast. The proposed algorithm is composed by two major steps. The first step consists in the detection of breast boundaries. It is based on image content analysis and Moore-Neighbour tracing algorithm. As a processing step, Otsu thresholding and neighbors algorithm are applied. Then, the external area of breast is removed to get an approximated breast region. The second preprocessing step is the delineation of the chest wall which is considered as the lowest cost path linking three key points; These points are located automatically at the breast. They are respectively, the left and right boundary points and the middle upper point placed at the sternum region using statistical method. For the minimum cost path search problem, we resolve it through Dijkstra algorithm. Evaluation results reveal the robustness of our process face to different breast densities, complex forms and challenging cases. In fact, the mean overlap between manual segmentation and automatic segmentation through our method is 96.5%. A comparative study shows that our proposed process is competitive and faster than existing methods. The segmentation of 120 slices with our method is achieved at least in 20.57+/-5.2s.

An Evaluation of Web- and Print-Based Methods to Attract People to a Physical Activity Intervention.

PubMed

Alley, Stephanie; Jennings, Cally; Plotnikoff, Ronald C; Vandelanotte, Corneel

2016-05-27

Cost-effective and efficient methods to attract people to Web-based health behavior interventions need to be identified. Traditional print methods including leaflets, posters, and newspaper advertisements remain popular despite the expanding range of Web-based advertising options that have the potential to reach larger numbers at lower cost. This study evaluated the effectiveness of multiple Web-based and print-based methods to attract people to a Web-based physical activity intervention. A range of print-based (newspaper advertisements, newspaper articles, letterboxing, leaflets, and posters) and Web-based (Facebook advertisements, Google AdWords, and community calendars) methods were applied to attract participants to a Web-based physical activity intervention in Australia. The time investment, cost, number of first time website visits, the number of completed sign-up questionnaires, and the demographics of participants were recorded for each advertising method. A total of 278 people signed up to participate in the physical activity program. Of the print-based methods, newspaper advertisements totaled AUD $145, letterboxing AUD $135, leaflets AUD $66, posters AUD $52, and newspaper article AUD $3 per sign-up. Of the Web-based methods, Google AdWords totaled AUD $495, non-targeted Facebook advertisements AUD $68, targeted Facebook advertisements AUD $42, and community calendars AUD $12 per sign-up. Although the newspaper article and community calendars cost the least per sign-up, they resulted in only 17 and 6 sign-ups respectively. The targeted Facebook advertisements were the next most cost-effective method and reached a large number of sign-ups (n=184). The newspaper article and the targeted Facebook advertisements required the lowest time investment per sign-up (5 and 7 minutes respectively). People reached through the targeted Facebook advertisements were on average older (60 years vs 50 years, P<.001) and had a higher body mass index (32 vs 30, P<.05) than people reached through the other methods. Overall, our results demonstrate that targeted Facebook advertising is the most cost-effective and efficient method at attracting moderate numbers to physical activity interventions in comparison to the other methods tested. Newspaper advertisements, letterboxing, and Google AdWords were not effective. The community calendars and newspaper articles may be effective for small community interventions. Australian New Zealand Clinical Trials Registry: ACTRN12614000339651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363570&isReview=true (Archived by WebCite at http://www.webcitation.org/6hMnFTvBt).

Economic Burden of Pediatric Asthma: Annual Cost of Disease in Iran

PubMed Central

SHARIFI, Laleh; DASHTI, Raheleh; POURPAK, Zahra; FAZLOLLAHI, Mohammad Reza; MOVAHEDI, Masoud; CHAVOSHZADEH, Zahra; SOHEILI, Habib; BOKAIE, Saied; KAZEMNEJAD, Anoushiravan; MOIN, Mostafa

2018-01-01

Background: Asthma is the first cause of children hospitalization and need for emergency and impose high economic burden on the families and governments. We aimed to investigate the economic burden of pediatric asthma and its contribution to family health budget in Iran. Methods: Overall, 283 pediatric asthmatic patients, who referred to two tertiary pediatric referral centers in Tehran capital of Iran, included from 2010–2012. Direct and indirect asthma-related costs were recorded during one-year period. Data were statistically analyzed for finding association between the costs and factors that affect this cost (demographic variables, tobacco smoke exposure, control status of asthma and asthma concomitant diseases). Results: Ninety-two (32.5%) females and 191(67.5%) males with the age range of 1–16 yr old were included. We found the annual total pediatrics asthma related costs were 367.97±23.06 USD. The highest cost belonged to the medications (69%) and the lowest one to the emergency (2%). We noticed a significant increasing in boys’ total costs (P=0.011), and 7–11 yr old age group (P=0.018). In addition, we found significant association between total asthma costs and asthma control status (P=0.011). Conclusion: The presence of an asthmatic child can consume nearly half of the health budget of a family. Our results emphasis on improving asthma management programs, which leads to successful control status of the disease and reduction in economic burden of pediatric asthma. PMID:29445636

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

PubMed Central

Booth, Neill; Jula, Antti; Aronen, Pasi; Kaila, Minna; Klaukka, Timo; Kukkonen-Harjula, Katriina; Reunanen, Antti; Rissanen, Pekka; Sintonen, Harri; Mäkelä, Marjukka

2007-01-01

Background Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario). Methods A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole. Results The impact of the use of the ACCG scenario in subgroups (aged 40–80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective. Conclusion The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall. PMID:17958883

Cost effectiveness of response-guided therapy with peginterferon in the treatment of chronic hepatitis B.

PubMed

Lo, Angeline Oi-Shan; Wong, Vincent Wai-Sun; Wong, Grace Lai-Hung; Chan, Henry Lik-Yuen; Dan, Yock-Young

2015-02-01

The high prevalence of chronic hepatitis B in Asian countries produces a substantial economic burden. Peginterferon has immunomodulatory effects and a finite course for treatment of hepatitis B, but also a high cost and side effects. The recent introduction of a 12-week stopping rule (stopping treatment after 12 weeks) has increased its appeal as a first-line treatment for hepatitis B. We aimed to determine the cost effectiveness of the 12-week stopping rule for peginterferon in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. We used Markov modeling, with data from the Hong Kong population, to compare the cost effectiveness of peginterferon therapy with a 12-week stopping rule vs conventional therapy (48 weeks) and with other antiviral agents. For HBeAg-positive patients, stopping peginterferon therapy after 12 weeks had the lowest cost-effectiveness ratio (CER), of $9501/quality-adjusted life-year (QALY), compared with no treatment, making it the most cost-effective option. Conventional (48-week) peginterferon treatment had a CER of $9664/QALY. For HBeAg-negative patients, entecavir had the lowest CER ($34,310/QALY). Entecavir was more cost effective than either peginterferon strategies (CERs of $37,423/QALY for 12 weeks of peginterferon and $38,474/QALY for 48 weeks of treatment). The 12-week stopping rule increases the cost effectiveness of peginterferon therapy, and is the most cost-effective treatment for HBeAg-positive patients. The need for long-term antiviral therapy for HBeAg-negative patients makes entecavir the most cost-effective strategy. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

What Analytic Method Should Clinicians Use to Derive Spine T-scores and Predict Incident Fractures in Men? Results from the MrOS study

PubMed Central

Hansen, Karen E; Blank, Robert D; Palermo, Lisa; Fink, Howard A; Orwoll, Eric S

2014-01-01

Summary In this study, the area under the curve was highest when using the lowest vertebral body T-score to diagnose osteoporosis. In men for whom hip imaging is not possible, the lowest vertebral body T-score improves ability to diagnose osteoporosis in men who are likely to have an incident fragility fracture. Purpose Spine T-scores have limited ability to predict fragility fracture. We hypothesized that using lowest vertebral body T-score to diagnose osteoporosis would better predict fracture. Methods Among men enrolled in the Osteoporotic Fractures in Men Study, we identified cases with incident clinical fracture (n=484) and controls without fracture (n=1,516). We analyzed the lumbar spine BMD in cases and controls (n=2,000) to record the L1-L4 (referent), the lowest vertebral body and ISCD-determined T-scores using a male normative database, and the L1-L4 T-score using a female normative database. We compared the ability of method to diagnose osteoporosis and therefore predict incident clinical fragility fracture, using area under the receiver operator curves (AUC) and the net reclassification index (NCI) as measures of diagnostic accuracy. ISCD-determined T-scores were determined in only 60% of participants (n=1205). Results Among 1,205 men, the AUC to predict incident clinical fracture was 0.546 for L1-L4 male, 0.542 for the L1-L4 female, 0.585 for lowest vertebral body and 0.559 for ISCD-determined T-score. The lowest vertebral body AUC was the only method significantly different from the referent method (p=0.002). Likewise, a diagnosis of osteoporosis based on the lowest vertebral body T-score demonstrated a significantly better NRI than the referent method (net NRI +0.077, p=0.005). By contrast, the net NRI for other methods of analysis did not differ from the referent method. Conclusion Our study suggests that in men, the lowest vertebral body T-score is an acceptable method by which to estimate fracture risk. PMID:24850381

The techno-economic optimization of a 100MWe CSP-desalination plant in Arandis, Namibia

NASA Astrophysics Data System (ADS)

Dall, Ernest P.; Hoffmann, Jaap E.

2017-06-01

Energy is a key factor responsible for a country's economic growth and prosperity. It is closely related to the main global challenges namely: poverty mitigation, global environmental change and food and water security [1.]. Concentrating solar power (CSP) is steadily gaining more market acceptance as the cost of electricity from CSP power plants progressively declines. The cogeneration of electricity and water is an attractive prospect for future CSP developments as the simultaneous production of power and potable water can have positive economic implications towards increasing the feasibility of CSP plant developments [2.]. The highest concentrations of direct normal irradiation are located relatively close to Western coastal and Middle-Eastern North-African regions. It is for this reason worthwhile investigating the possibility of CSP-desalination (CSP+D) plants as a future sustainable method for providing both electricity and water with significantly reduced carbon emissions and potential cost reductions. This study investigates the techno-economic feasibility of integrating a low-temperature thermal desalination plant to serve as the condenser as opposed to a conventional dry-cooled CSP plant in Arandis, Namibia. It outlines the possible benefits of the integration CSP+D in terms of overall cost of water and electricity. The high capital costs of thermal desalination heat exchangers as well as the pumping of seawater far inland is the most significant barrier in making this approach competitive against more conventional desalination methods such as reverse osmosis. The compromise between the lowest levelized cost of electricity and water depends on the sizing and the top brine temperature of the desalination plant.

Differences exist across insurance schemes in China post-consolidation.

PubMed

Li, Yang; Zhao, Yinjun; Yi, Danhui; Wang, Xiaojun; Jiang, Yan; Wang, Yu; Liu, Xinchun; Ma, Shuangge

2017-01-01

In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance), URBMI (Urban Resident Basic Medical Insurance), and NCMS (New Cooperative Medical Scheme), across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation. A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects' characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket) cost, and insurance reimbursement rate. Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate. Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences.

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the traditional FFS model, despite higher primary care costs in some models.

Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.

PubMed

Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R

2014-06-01

The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

Detection of knockdown resistance (kdr) mutations in Anopheles gambiae: a comparison of two new high-throughput assays with existing methods

PubMed Central

Bass, Chris; Nikou, Dimitra; Donnelly, Martin J; Williamson, Martin S; Ranson, Hilary; Ball, Amanda; Vontas, John; Field, Linda M

2007-01-01

Background Knockdown resistance (kdr) is a well-characterized mechanism of resistance to pyrethroid insecticides in many insect species and is caused by point mutations of the pyrethroid target site the para-type sodium channel. The presence of kdr mutations in Anopheles gambiae, the most important malaria vector in Africa, has been monitored using a variety of molecular techniques. However, there are few reports comparing the performance of these different assays. In this study, two new high-throughput assays were developed and compared with four established techniques. Methods Fluorescence-based assays based on 1) TaqMan probes and 2) high resolution melt (HRM) analysis were developed to detect kdr alleles in An. gambiae. Four previously reported techniques for kdr detection, Allele Specific Polymerase Chain Reaction (AS-PCR), Heated Oligonucleotide Ligation Assay (HOLA), Sequence Specific Oligonucleotide Probe – Enzyme-Linked ImmunoSorbent Assay (SSOP-ELISA) and PCR-Dot Blot were also optimized. The sensitivity and specificity of all six assays was then compared in a blind genotyping trial of 96 single insect samples that included a variety of kdr genotypes and African Anopheline species. The relative merits of each assay was assessed based on the performance in the genotyping trial, the length/difficulty of each protocol, cost (both capital outlay and consumable cost), and safety (requirement for hazardous chemicals). Results The real-time TaqMan assay was both the most sensitive (with the lowest number of failed reactions) and the most specific (with the lowest number of incorrect scores). Adapting the TaqMan assay to use a PCR machine and endpoint measurement with a fluorimeter showed a slight reduction in sensitivity and specificity. HRM initially gave promising results but was more sensitive to both DNA quality and quantity and consequently showed a higher rate of failure and incorrect scores. The sensitivity and specificity of AS-PCR, SSOP-ELISA, PCR Dot Blot and HOLA was fairly similar with a small number of failures and incorrect scores. Conclusion The results of blind genotyping trials of each assay indicate that where maximum sensitivity and specificity are required the TaqMan real-time assay is the preferred method. However, the cost of this assay, particularly in terms of initial capital outlay, is higher than that of some of the other methods. TaqMan assays using a PCR machine and fluorimeter are nearly as sensitive as real-time assays and provide a cost saving in capital expenditure. If price is a primary factor in assay choice then the AS-PCR, SSOP-ELISA, and HOLA are all reasonable alternatives with the SSOP-ELISA approach having the highest throughput. PMID:17697325

Design-Tradeoff Model For Space Station

NASA Technical Reports Server (NTRS)

Chamberlain, Robert G.; Smith, Jeffrey L.; Borden, Chester S.; Deshpande, Govind K.; Fox, George; Duquette, William H.; Dilullo, Larry A.; Seeley, Larry; Shishko, Robert

1990-01-01

System Design Tradeoff Model (SDTM) computer program produces information which helps to enforce consistency of design objectives throughout system. Mathematical model of set of possible designs for Space Station Freedom. Program finds particular design enabling station to provide specified amounts of resources to users at lowest total (or life-cycle) cost. Compares alternative design concepts by changing set of possible designs, while holding specified services to users constant, and then comparing costs. Finally, both costs and services varied simultaneously when comparing different designs. Written in Turbo C 2.0.

Is Accelerated Partner Therapy (APT) a cost-effective alternative to routine patient referral partner notification in the UK? Preliminary cost-consequence analysis of an exploratory trial.

PubMed

Roberts, Tracy E; Tsourapas, Angelos; Sutcliffe, Lorna; Cassell, Jackie; Estcourt, Claudia

2012-02-01

To undertake a cost-consequence analysis to assess two new models of partner notification (PN), known as Accelerated Partner Therapy (APT Hotline and APT Pharmacy), as compared with routine patient referral PN, for sex partners of people with chlamydia, gonorrhoea and non-gonococcal urethritis. Comparison of costs and outcomes alongside an exploratory trial involving two genitourinary medicine clinics and six community pharmacies. Index patients selected the PN method (APT Hotline, APT Pharmacy or routine PN) for their partners. Clinics and pharmacies recorded cost and resource use data including duration of consultation and uptake of treatment pack. Cost data were collected prospectively for two out of three interventions, and data were synthesised and compared in terms of effectiveness and costs. Routine PN had the lowest average cost per partner treated (approximately £46) compared with either APT Hotline (approximately £54) or APT Pharmacy (approximately £53) strategies. The cost-consequence analysis revealed that APT strategies were more costly but also more effective at treating partners compared to routine PN. The hotline strategy costs more than both the alternative PN strategies. If we accept that strategies which identify and treat partners the fastest are likely to be the most effective in reducing reinfection and onward transmission, then APT Hotline appears an effective PN strategy by treating the highest number of partners in the shortest duration. Whether the additional benefit is worth the additional cost cannot be determined in this preliminary analysis. These data will be useful for informing development of future randomised controlled trials of APT.

Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

PubMed Central

Ekwunife, Obinna I.

2017-01-01

Background Diarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the ‘no treatment’ approach (NT); the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI); and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI). Methods Markov cohort model conducted from the payer’s perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state). Disability adjusted life years (DALYs) averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER) served as measure of cost-effectiveness. Results Based on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita), all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation. Conclusion Rotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria. PMID:29261649

The evolution of the surgical treatment of chronic pancreatitis.

PubMed

Andersen, Dana K; Frey, Charles F

2010-01-01

To establish the current status of surgical therapy for chronic pancreatitis, recent published reports are examined in the context of the historical advances in the field. The basis for decompression (drainage), denervation, and resection strategies for the treatment of pain caused by chronic pancreatitis is reviewed. These divergent approaches have finally coalesced as the head of the pancreas has become apparent as the nidus of chronic inflammation. The recent developments in surgical methods to treat the complications of chronic pancreatitis and the results of recent prospective randomized trials of operative approaches were reviewed to establish the current best practices. Local resection of the pancreatic head, with or without duct drainage, and duodenum-preserving pancreatic head resection offer outcomes as effective as pancreaticoduodenectomy, with lowered morbidity and mortality. Local resection or excavation of the pancreatic head offers the advantage of lowest cost and morbidity and early prevention of postoperative diabetes. The late incidences of recurrent pain, diabetes, and exocrine insufficiency are equivalent for all 3 surgical approaches. Local resection of the pancreatic head appears to offer best outcomes and lowest risk for the management of the pain of chronic pancreatitis.

Simplified approach to the mixed time-averaging semiclassical initial value representation for the calculation of dense vibrational spectra

NASA Astrophysics Data System (ADS)

Buchholz, Max; Grossmann, Frank; Ceotto, Michele

2018-03-01

We present and test an approximate method for the semiclassical calculation of vibrational spectra. The approach is based on the mixed time-averaging semiclassical initial value representation method, which is simplified to a form that contains a filter to remove contributions from approximately harmonic environmental degrees of freedom. This filter comes at no additional numerical cost, and it has no negative effect on the accuracy of peaks from the anharmonic system of interest. The method is successfully tested for a model Hamiltonian and then applied to the study of the frequency shift of iodine in a krypton matrix. Using a hierarchic model with up to 108 normal modes included in the calculation, we show how the dynamical interaction between iodine and krypton yields results for the lowest excited iodine peaks that reproduce experimental findings to a high degree of accuracy.

Shuttle payload minimum cost vibroacoustic tests

NASA Technical Reports Server (NTRS)

Stahle, C. V.; Gongloff, H. R.; Young, J. P.; Keegan, W. B.

1977-01-01

This paper is directed toward the development of the methodology needed to evaluate cost effective vibroacoustic test plans for Shuttle Spacelab payloads. Statistical decision theory is used to quantitatively evaluate seven alternate test plans by deriving optimum test levels and the expected cost for each multiple mission payload considered. The results indicate that minimum costs can vary by as much as $6 million for the various test plans. The lowest cost approach eliminates component testing and maintains flight vibration reliability by performing subassembly tests at a relatively high acoustic level. Test plans using system testing or combinations of component and assembly level testing are attractive alternatives. Component testing alone is shown not to be cost effective.

Space Radiation Transport Methods Development

NASA Technical Reports Server (NTRS)

Wilson, J. W.; Tripathi, R. K.; Qualls, G. D.; Cucinotta, F. A.; Prael, R. E.; Norbury, J. W.; Heinbockel, J. H.; Tweed, J.

2002-01-01

Improved spacecraft shield design requires early entry of radiation constraints into the design process to maximize performance and minimize costs. As a result, we have been investigating high-speed computational procedures to allow shield analysis from the preliminary design concepts to the final design. In particular, we will discuss the progress towards a full three-dimensional and computationally efficient deterministic code for which the current HZETRN evaluates the lowest order asymptotic term. HZETRN is the first deterministic solution to the Boltzmann equation allowing field mapping within the International Space Station (ISS) in tens of minutes using standard Finite Element Method (FEM) geometry common to engineering design practice enabling development of integrated multidisciplinary design optimization methods. A single ray trace in ISS FEM geometry requires 14 milliseconds and severely limits application of Monte Carlo methods to such engineering models. A potential means of improving the Monte Carlo efficiency in coupling to spacecraft geometry is given in terms of reconfigurable computing and could be utilized in the final design as verification of the deterministic method optimized design.

A novel method to value real options in health care: the case of a multicohort human papillomavirus vaccination strategy.

PubMed

Favato, Giampiero; Baio, Gianluca; Capone, Alessandro; Marcellusi, Andrea; Saverio Mennini, Francesco

2013-07-01

A large number of economic evaluations have already confirmed the cost-effectiveness of different human papillomavirus (HPV) vaccination strategies. Standard analyses might not capture the full economic value of novel vaccination programs because the cost-effectiveness paradigm fails to take into account the value of active management. Management decisions can be seen as real options, a term used to refer to the application of option pricing theory to the valuation of investments in nonfinancial assets in which much of the value is attributable to flexibility and learning over time. The aim of this article was to discuss the potential advantages shown by using the payoff method in the valuation of the cost-effectiveness of competing HPV immunization programs. This was the first study, to the best of our knowledge, to use the payoff method to determine the real option values of 4 different HPV vaccination strategies targeting female subjects aged 12, 15, 18, and 25 years. The payoff method derives the real option value from the triangular payoff distribution of the project's net present value, which is treated as a triangular fuzzy number. To inform the real option model, cost-effectiveness data were derived from an empirically calibrated Bayesian model designed to assess the cost-effectiveness of a multicohort HPV vaccination strategy in the context of the current cervical cancer screening program in Italy. A net health benefit approach was used to calculate the expected fuzzy net present value for each of the 4 vaccination strategies evaluated. Costs per quality-adjusted life-year gained seemed to be related to the number of cohorts targeted: a single cohort of girls aged 12 years (€10,955 [95% CI, -1,021 to 28,212]) revealed the lowest cost among the 4 alternative strategies evaluated. The real option valuation challenged the cost-effectiveness dominance of a single cohort of 12-year-old girls. The simultaneous vaccination of 2 cohorts of girls aged 12 and 15 years yielded a real option value (€17,723) equivalent to that attributed to a single cohort of 12-year-old girls (€17,460). The payoff method showed distinctive advantages in the valuation of the cost-effectiveness of competing health care interventions, essentially determined by the replacement of the nonfuzzy numbers that are commonly used in cost-effectiveness analysis models, with fuzzy numbers as an input to inform the real option pricing method. The real option approach to value uncertainty makes policy making in health care an evolutionary process and creates a new "space" for decision-making choices. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

The use of integer programming to select bulls across breeding companies with volume price discounts.

PubMed

McConnel, M B; Galligan, D T

2004-10-01

Optimization programs are currently used to aid in the selection of bulls to be used in herd breeding programs. While these programs offer a systematic approach to the problem of semen selection, they ignore the impact of volume discounts. Volume discounts are discounts that vary depending on the number of straws purchased. The dynamic nature of volume discounts means that, in order to be adequately accounted for, they must be considered in the optimization routine. Failing to do this creates a missed economic opportunity because the potential benefits of optimally selecting and combining breeding company discount opportunities are not captured. To address these issues, an integer program was created which used binary decision variables to incorporate the effects of quantity discounts into the optimization program. A consistent set of trait criteria was used to select a group of bulls from 3 sample breeding companies. Three different selection programs were used to select the bulls, 2 traditional methods and the integer method. After the discounts were applied using each method, the integer program resulted in the lowest cost portfolio of bulls. A sensitivity analysis showed that the integer program also resulted in a low cost portfolio when the genetic trait goals were changed to be more or less stringent. In the sample application, a net benefit of the new approach over the traditional approaches was a 12.3 to 20.0% savings in semen cost.

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time‐driven activity‐based costing

PubMed Central

Odhiambo, J.; Riviello, R.; Lin, Y.; Nkurunziza, T.; Shrime, M.; Maine, R.; Omondi, J. M.; Mpirimbanyi, C.; de la Paix Sebakarane, J.; Hagugimana, P.; Rusangwa, C.; Hedt‐Gauthier, B.

2018-01-01

Background In low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings. Methods This costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices. Results Of 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent). Conclusion The intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

A deterministic aggregate production planning model considering quality of products

NASA Astrophysics Data System (ADS)

Madadi, Najmeh; Yew Wong, Kuan

2013-06-01

Aggregate Production Planning (APP) is a medium-term planning which is concerned with the lowest-cost method of production planning to meet customers' requirements and to satisfy fluctuating demand over a planning time horizon. APP problem has been studied widely since it was introduced and formulated in 1950s. However, in several conducted studies in the APP area, most of the researchers have concentrated on some common objectives such as minimization of cost, fluctuation in the number of workers, and inventory level. Specifically, maintaining quality at the desirable level as an objective while minimizing cost has not been considered in previous studies. In this study, an attempt has been made to develop a multi-objective mixed integer linear programming model that serves those companies aiming to incur the minimum level of operational cost while maintaining quality at an acceptable level. In order to obtain the solution to the multi-objective model, the Fuzzy Goal Programming approach and max-min operator of Bellman-Zadeh were applied to the model. At the final step, IBM ILOG CPLEX Optimization Studio software was used to obtain the experimental results based on the data collected from an automotive parts manufacturing company. The results show that incorporating quality in the model imposes some costs, however a trade-off should be done between the cost resulting from producing products with higher quality and the cost that the firm may incur due to customer dissatisfaction and sale losses.

Ablative heat shield design for space shuttle

NASA Technical Reports Server (NTRS)

Seiferth, R. W.

1973-01-01

Ablator heat shield configuration optimization studies were conducted for the orbiter. Ablator and reusable surface insulation (RSI) trajectories for design studies were shaped to take advantage of the low conductance of ceramic RSI and high temperature capability of ablators. Comparative weights were established for the RSI system and for direct bond and mechanically attached ablator systems. Ablator system costs were determined for fabrication, installation and refurbishment. Cost penalties were assigned for payload weight penalties, if any. The direct bond ablator is lowest in weight and cost. A mechanically attached ablator using a magnesium subpanel is highly competitive for both weight and cost.

An Advanced Programming Technique for a Cost-Effective Hardware-Independent Realization of Naval Software Systems. Final Technical Report, Part II.

ERIC Educational Resources Information Center

Computer Symbolic, Inc., Washington, DC.

A pseudo assembly language, PAL, was developed and specified for use as the lowest level in a general, multilevel programing system for the realization of cost-effective, hardware-independent Naval software. The language was developed as part of the system called FIRMS (Fast Iterative Recursive Macro System) and is sufficiently general to allow…

Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

PubMed

Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

2015-03-01

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

HIV-1 and HCV viral load cost models for bDNA: 440 Molecular System versus real-time PCR AmpliPrep/TaqMan test.

PubMed

Elbeik, Tarek; Dalessandro, Ralph; Loftus, Richard A; Beringer, Scott

2007-11-01

Comparative cost models were developed to assess cost-per-reportable result and annual costs for HIV-1 and HCV bDNA and AmpliPrep/TaqMan Test (PCR). Model cost components included kit, disposables, platform and related equipment, equipment service plan, equipment maintenance, equipment footprint, waste and labor. Model assessment was most cost-effective when run by bDNA with 36 or more clinical samples and PCR with 30 or fewer clinical samples. Lower costs are attained with maximum samples (84-168) run daily. Highest cost contributors include kit, platform and PCR proprietary disposables. Understanding component costs and the most economic use of HIV-1 and HCV viral load will aid in attaining lowest costs through selection of the appropriate assay and effective negotiations.

VARIATIONS IN RECRUITMENT YIELD, COSTS, SPEED AND PARTICIPANT DIVERSITY ACROSS INTERNET PLATFORMS IN A GLOBAL STUDY EXAMINING THE EFFICACY OF AN HIV/AIDS AND HIV TESTING ANIMATED AND LIVE-ACTION VIDEO AMONG ENGLISH- OR SPANISH-SPEAKING INTERNET OR SOCIAL MEDIA USERS

PubMed Central

Shao, Winnie; Guan, Wentao; Clark, Melissa A.; Liu, Tao; Santelices, Claudia; Cortés, Dharma E.; Merchant, Roland C.

2016-01-01

For a world-wide, Internet-based study on HIV/AIDS and HIV testing knowledge, we compared the yields, speed and costs of recruitment and participant diversity across free postings on 13 Internet or social media platforms, paid advertising or postings on 3 platforms, and separate free postings and paid advertisements on Facebook. Platforms were compared by study completions (yield), time to completion, completion to enrollment ratios (CERs), and costs/ completion; and by participants’ demographic characteristics, HIV testing history, and health literacy levels. Of the 482 English-speaking participants, Amazon Mechanical Turk yielded the most participants, recruited participants at the fastest rate and had the highest CER (0.78) and lowest costs / completion. Of the 335 Spanish-speaking participants, Facebook yielded the most participants and recruited participants at the fastest rate, although Amazon Mechanical Turk had the highest CER (0.72) and lowest costs/completion. Across platforms participants differed substantially according to their demographic characteristics, HIV testing history and health literay skills. The study results highlight the need for researchers to strongly consider choice of Internet or social media plaforms when conducting Internet-based research. Because of the sample specifications and cost restraints of studies, specific Internet/ social media or participant selection plaforms will be much more effective or appropriate than others. PMID:27330570

VARIATIONS IN RECRUITMENT YIELD, COSTS, SPEED AND PARTICIPANT DIVERSITY ACROSS INTERNET PLATFORMS IN A GLOBAL STUDY EXAMINING THE EFFICACY OF AN HIV/AIDS AND HIV TESTING ANIMATED AND LIVE-ACTION VIDEO AMONG ENGLISH- OR SPANISH-SPEAKING INTERNET OR SOCIAL MEDIA USERS.

PubMed

Shao, Winnie; Guan, Wentao; Clark, Melissa A; Liu, Tao; Santelices, Claudia; Cortés, Dharma E; Merchant, Roland C

For a world-wide, Internet-based study on HIV/AIDS and HIV testing knowledge, we compared the yields, speed and costs of recruitment and participant diversity across free postings on 13 Internet or social media platforms, paid advertising or postings on 3 platforms, and separate free postings and paid advertisements on Facebook. Platforms were compared by study completions (yield), time to completion, completion to enrollment ratios (CERs), and costs/ completion; and by participants' demographic characteristics, HIV testing history, and health literacy levels. Of the 482 English-speaking participants, Amazon Mechanical Turk yielded the most participants, recruited participants at the fastest rate and had the highest CER (0.78) and lowest costs / completion. Of the 335 Spanish-speaking participants, Facebook yielded the most participants and recruited participants at the fastest rate, although Amazon Mechanical Turk had the highest CER (0.72) and lowest costs/completion. Across platforms participants differed substantially according to their demographic characteristics, HIV testing history and health literay skills. The study results highlight the need for researchers to strongly consider choice of Internet or social media plaforms when conducting Internet-based research. Because of the sample specifications and cost restraints of studies, specific Internet/ social media or participant selection plaforms will be much more effective or appropriate than others.

Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis.

PubMed

Hill, Andrew; Redd, Christopher; Gotham, Dzintars; Erbacher, Isabelle; Meldrum, Jonathan; Harada, Ryo

2017-01-20

The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs. This research was carried out in a non-clinical research setting using secondary data. There were no human participants in the study. Four drugs were selected for the study: bortezomib, dasatinib, everolimus and gefitinib. These medications were selected according to their clinical importance, novel pharmaceutical actions and the availability of generic price data. Target costs for treatment were to be generated for each indication for each treatment. The primary outcome measure was the target cost according to a production cost calculation algorithm. The secondary outcome measure was the target cost as the lowest available generic price; this was necessary where export data were not available to generate an estimate from our cost calculation algorithm. Other outcomes included patent expiry dates and total eligible treatment populations. Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74-99.6%. Patent expiry dates were bortezomib 2014-22, dasatinib 2020-26, everolimus 2019-25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736. Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Uptake of Hepatitis C Screening, Characteristics of Patients Tested, and Intervention Costs in the BEST-C Study

PubMed Central

Brady, Joanne E.; Liffmann, Danielle K.; Yartel, Anthony; Kil, Natalie; Federman, Alex D.; Kannry, Joseph; Jordan, Cynthia; Massoud, Omar I.; Nerenz, David R; Brown, Kimberly A.; Smith, Bryce D.; Vellozzi, Claudia; Rein, David B.

2017-01-01

Background From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. Rationale To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945–1965 birth-cohort (BC). Main Results Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7–38.2] for repeated-mailing, 13.2 [95% CI 3.6–48.6] for BPA, and 32.9 [95% CI 19.3–56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691). Conclusion HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions. PMID:27770543

Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study.

PubMed

Brady, Joanne E; Liffmann, Danielle K; Yartel, Anthony; Kil, Natalie; Federman, Alex D; Kannry, Joseph; Jordan, Cynthia; Massoud, Omar I; Nerenz, David R; Brown, Kimberly A; Smith, Bryce D; Vellozzi, Claudia; Rein, David B

2017-01-01

From December 2012 to March 2014, three randomized trials, each implementing a unique intervention in primary care settings (repeated mailing, an electronic health record best practice alert [BPA], and patient solicitation), evaluated hepatitis C virus (HCV) antibody testing, diagnosis, and costs for each of the interventions compared with standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. The goal of this study was to estimate the effects of interventions conducted as part of the Birth-Cohort Evaluation to Advance Screening and Testing for Hepatitis C study on HCV testing and costs among persons of the 1945-1965 birth cohort (BC). Intervention resulted in substantially higher HCV testing rates compared with standard-of-care testing (26.9% versus 1.4% for repeated mailing, 30.9% versus 3.6% for BPA, and 63.5% versus 2.0% for patient solicitation) and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% confidence interval (CI), 9.7-38.2] for repeated mailing, 13.2 [95% CI, 3.6-48.6] for BPA, and 32.9 [95% CI, 19.3-56.1] for patient solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1691). HCV testing interventions resulted in an increase in BC testing compared with standard-of-care testing but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared with the other interventions. (Hepatology 2017;65:44-53). © 2016 by the American Association for the Study of Liver Diseases.

New optimization strategies of pavement maintenance: A case study for national road network in Indonesia using integrated road management system

NASA Astrophysics Data System (ADS)

Hamdi, Hadiwardoyo, Sigit P.; Correia, A. Gomes; Pereira, Paulo

2017-06-01

A road network requires timely maintenance to keep the road surface in good condition onward better services to improve accessibility and mobility. Strategies and maintenance techniques must be chosen in order to maximize road service level through cost-effective interventions. This approach requires an updated database, which the road network in Indonesia is supported by a manual and visual survey, also using NAASRA profiler. Furthermore, in this paper, the deterministic model of deterioration was used. This optimization model uses life cycle cost analysis (LCCA), applied in an integrated manner, using IRI indicator, and allows determining the priority of treatment, type of treatment and its relation to the cost. The purpose of this paper was focussed on the aspects of road maintenance management, i.e., maintenance optimization models for different levels of traffic and various initial of road distress conditions on the national road network in Indonesia. The implementation of Integrated Road Management System (IRMS) can provide a solution to the problem of cost constraints in the maintenance of the national road network. The results from this study found that as the lowest as agency cost, it will affect the increasing of user cost. With the achievement of the target plan scenario Pl000 with initial value IRI 2, it was found that the routine management throughout the year and in early reconstruction and periodic maintenance with a 30 mm thick overlay, will simultaneously provide a higher net benefit value and has the lowest total cost of transportation.

The Cost of Providing Combined Prevention and Treatment Services, Including ART, to Female Sex Workers in Burkina Faso

PubMed Central

Cianci, Fiona; Sweeney, Sedona; Konate, Issouf; Nagot, Nicolas; Low, Andrea; Mayaud, Philippe; Vickerman, Peter

2014-01-01

Background Female Sex workers (FSW) are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART), for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups. Methods Field-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules. Results Using the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505–US$1117), primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505. Conclusion Whilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to other population groups in Africa. PMID:24950185

[Effects, safety and cost-benefit analysis of Down syndrome screening in first trimester].

PubMed

Shengmou, Lin; Min, Chen; Chenhong, Wang; Shengli, Li; Jiansheng, Xie; Hui, Yuan; Dinghao, Lin; Xiaoxia, Wu; Wei, Wang; Hongyun, Zhang; Haiyan, Tang

2014-05-01

To investigate the effects, safety and cost-benefit analysis of Down syndrome screening in first trimester. From January 2009 to December 2012, 43 729 pregnant women undergoing 3 methods of Down syndrome traditional screening strategies in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively, including in 17 502 cases in pregnancy associated plasma protein A (PAPP-A) and free β-hCG measured biochemistry screening, 14 080 cases in nuchal translucency (NT) screening and 12 147 cases in combined screening, meanwhile, 7 389 cases on non-invasive fetal trisomy test (NIFTY) were performed in Huada Gene Research Institute(BGI). The effects and safety of four screening strategies were assessed throughout a decision tree. The economical characters of each screening strategy were compared by cost-effectiveness analysis as well as cost-benefit analysis. (1) The effects of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (2) The safety of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (3) Cost-effectiveness analysis and cost-benefit analysis:the biochemistry screening has lowest cost-effectiveness ratio (CER) and highest cost-benefit ratio (CBR), which performed a better economical efficiency. The incremental CER of three traditional screening strategies are all less than the economical burden of Down syndrome.NIFTY has highest CER and negative net present value (NPV), NPV would be positive and CBR would be more than 1 if the price of NIFTY reduce to 1 434 Yuan. Combined screening possess best screening efficiency, while biochemistry screening was demonstrated more economical in traditional screening.NIFTY is the future of Down syndrome screening.

The Clinical Impact and Cost-Effectiveness of Routine, Voluntary HIV Screening in South Africa

PubMed Central

Walensky, Rochelle P.; Wood, Robin; Fofana, Mariam O.; Martinson, Neil A.; Losina, Elena; April, Michael D.; Bassett, Ingrid V.; Morris, Bethany L.; Freedberg, Kenneth A.; Paltiel, A. David

2010-01-01

Background Although 900,000 HIV-infected South Africans receive antiretroviral therapy (ART), the majority of South Africans with HIV remain undiagnosed. Methods We use a published simulation model of HIV case detection and treatment to examine three HIV screening scenarios, in addition to current practice: 1) one-time; 2) every five years; and 3) annually. South African model input data include: 16.9% HIV prevalence, 1.3% annual incidence, 49% test acceptance rate, HIV testing costs of $6.49/patient, and a 47% linkage-to-care rate (including two sequential ART regimens) for identified cases. Outcomes include life expectancy, direct medical costs, and incremental cost-effectiveness. Results HIV screening one-time, every five years, and annually increase HIV-infected quality-adjusted life expectancy (mean age 33 years) from 180.6 months (current practice) to 184.9, 187.6 and 197.2 months. The incremental cost-effectiveness of one-time screening is dominated by screening every five years. Screening every five years and annually each have incremental cost-effectiveness ratios of $1,570/quality-adjusted life year (QALY) and $1,720/QALY. Screening annually is very cost-effective even in settings with the lowest incidence/prevalence, with test acceptance and linkage rates both as low as 20%, or when accounting for a stigma impact at least four-fold that of the base case. Conclusions In South Africa, annual voluntary HIV screening offers substantial clinical benefit and is very cost-effective, even with highly constrained access to care and treatment. PMID:21068674

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

PubMed Central

Tetens, Inge; Dejgård Jensen, Jørgen; Smed, Sinne; Gabrijelčič Blenkuš, Mojca; Rayner, Mike; Darmon, Nicole; Robertson, Aileen

2016-01-01

Background Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Methods Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. Results The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Conclusion Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable. PMID:27760131

Costs and difficulties of recruiting patients to provide e-health support: pilot study in one primary care trust.

PubMed

Jones, Ray B; O'Connor, Anita; Brelsford, Jade; Parsons, Neil; Skirton, Heather

2012-03-29

Better use of e-health services by patients could improve outcomes and reduce costs but there are concerns about inequalities of access. Previous research in outpatients suggested that anonymous personal email support may help patients with long term conditions to use e-health, but recruiting earlier in their 'journey' may benefit patients more. This pilot study explored the feasibility and cost of recruiting patients for an e-health intervention in one primary care trust. The sample comprised 46 practices with total patient population of 250,000. We approached all practices using various methods, seeking collaboration to recruit patients via methods agreed with each practice. A detailed research diary was kept of time spent recruiting practices and patients. Researcher time was used to estimate costs. Patients who consented to participate were offered email support for their use of the Internet for health. Eighteen practices agreed to take part; we recruited 27 patients, most (23/27) from five practices. Practices agreed to recruit patients for an e-health intervention via waiting room leaflets (16), posters (16), practice nurses (15), doctors giving patients leaflets (5), a study website link (7), inclusion in planned mailshots (2), and a special mailshot to patients selected from practice computers (1). After low recruitment response we also recruited directly in five practices through research assistants giving leaflets to patients in waiting rooms. Ten practices recruited no patients. Those practices that were more difficult to recruit were less likely to recruit patients. Leaving leaflets for practice staff to distribute and placing posters in the practice were not effective in recruiting patients. Leaflets handed out by practice nurses and website links were more successful. The practice with lowest costs per patient recruited (£70) used a special mailshot to selected patients. Recruitment via general practice was not successful and was therefore expensive. Direct to consumer methods and recruitment of patients in outpatients to offer email support may be more cost effective. If recruitment in general practice is required, contacting practices by letter and email, not following up non-responding practices, and recruiting patients with selected conditions by special mailshot may be the most cost-effective approach.

High-Altitude Air Mass Zero Calibration of Solar Cells

NASA Technical Reports Server (NTRS)

Woodyard, James R.; Snyder, David B.

2005-01-01

Air mass zero calibration of solar cells has been carried out for several years by NASA Glenn Research Center using a Lear-25 aircraft and Langley plots. The calibration flights are carried out during early fall and late winter when the tropopause is at the lowest altitude. Measurements are made starting at about 50,000 feet and continue down to the tropopause. A joint NASA/Wayne State University program called Suntracker is underway to explore the use of weather balloon and communication technologies to characterize solar cells at elevations up to about 100 kft. The balloon flights are low-cost and can be carried out any time of the year. AMO solar cell characterization employing the mountaintop, aircraft and balloon methods are reviewed. Results of cell characterization with the Suntracker are reported and compared with the NASA Glenn Research Center aircraft method.

Highly selective colorimetric bacteria sensing based on protein-capped nanoparticles.

PubMed

Qiu, Suyan; Lin, Zhenyu; Zhou, Yaomin; Wang, Donggen; Yuan, Lijuan; Wei, Yihua; Dai, Tingcan; Luo, Linguang; Chen, Guonan

2015-02-21

A rapid and cost-effective colorimetric sensor has been developed for the detection of bacteria (Bacillus subtilis was selected as an example). The sensor was designed to rely on lysozyme-capped AuNPs with the advantages of effective amplification and high specificity. In the sensing system, lysozyme was able to bind strongly to Bacillus subtilis, which effectively induced a color change of the solution from light purple to purplish red. The lowest concentration of Bacillus subtilis detectable by the naked eye was 4.5 × 10(3) colony-forming units (CFU) mL(-1). Similar results were discernable from UV-Vis absorption measurements. A good specificity was observed through a statistical analysis method using the SPSS software (version 17.0). This simple colorimetric sensor may therefore be a rapid and specific method for a bacterial detection assay in complex samples.

Optical characterization of nonimaging dish concentrator for the application of dense-array concentrator photovoltaic system.

PubMed

Tan, Ming-Hui; Chong, Kok-Keong; Wong, Chee-Woon

2014-01-20

Optimization of the design of a nonimaging dish concentrator (NIDC) for a dense-array concentrator photovoltaic system is presented. A new algorithm has been developed to determine configuration of facet mirrors in a NIDC. Analytical formulas were derived to analyze the optical performance of a NIDC and then compared with a simulated result obtained from a numerical method. Comprehensive analysis of optical performance via analytical method has been carried out based on facet dimension and focal distance of the concentrator with a total reflective area of 120 m2. The result shows that a facet dimension of 49.8 cm, focal distance of 8 m, and solar concentration ratio of 411.8 suns is the most optimized design for the lowest cost-per-output power, which is US$1.93 per watt.

A cost-effectiveness analysis of diagnostic strategies for symptomatic patients with ileal pouch-anal anastomosis.

PubMed

Shen, Bo; Shermock, Kenneth M; Fazio, Victor W; Achkar, Jean-Paul; Brzezinski, Aaron; Bevins, Charles L; Bambrick, Marlene L; Remzi, Feza H; Lashner, Bret A

2003-11-01

Pouchitis is often diagnosed based on symptoms and empirically treated with antibiotics (treat-first strategy). However, symptom assessment alone is not reliable for diagnosis, and an initial evaluation with pouch endoscopy (test-first strategy) has been shown to be more accurate. Cost-effectiveness of these strategies has not been compared. The aim of this study was to compare cost-effectiveness of different clinical approaches for patients with symptoms suggestive of pouchitis. Pouchitis was defined as pouchitis disease activity index scores > or =7. The frequency of pouchitis in symptomatic patients with ileal pouch was estimated to be 51%; the efficacy for initial therapy with metronidazole (MTZ) and ciprofloxacin (CIP) was 75% and 85%, respectively. Cost estimates were obtained from Medicare reimbursement data. Six competing strategies (MTZ trial, CIP trial, MTZ-then-CIP trial, CIP-then-MTZ trial, pouch endoscopy with biopsy, and pouch endoscopy without biopsy) were modeled in a decision tree. Costs per correct diagnosis with appropriate treatment were $194 for MTZ trial, $279 for CIP trial, $208 for MTZ-then-CIP trial, $261 for CIP-then-MTZ trial, $352 for pouch endoscopy with biopsy, and $243 for pouch endoscopy without biopsy. Of the two strategies with the lowest cost, the pouch endoscopy without biopsy strategy costs $50 more per patient than the MTZ trial strategy but results in an additional 15 days for early diagnosis and thus initiation of appropriate treatment (incremental cost-effectiveness ratio $3 per additional day gained). The results of base-case analysis were robust in sensitivity analyses. Although the MTZ-trial strategy had the lowest cost, the pouch endoscopy without biopsy strategy was most cost-effective. Therefore, based on its relatively low cost and the avoidance of both diagnostic delay and adverse effects associated with unnecessary antibiotics, pouch endoscopy without biopsy is the recommended strategy among those tested for the diagnosis of pouchitis.

24 CFR 941.101 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... housing residents over the long term and have the lowest possible life cycle costs, taking into account.... [61 FR 38016, July 22, 1996, as amended at 64 FR 13511, Mar. 19, 1999] Effective Date Note: At 61 FR...

24 CFR 941.101 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... housing residents over the long term and have the lowest possible life cycle costs, taking into account.... [61 FR 38016, July 22, 1996, as amended at 64 FR 13511, Mar. 19, 1999] Effective Date Note: At 61 FR...

24 CFR 941.101 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... housing residents over the long term and have the lowest possible life cycle costs, taking into account.... [61 FR 38016, July 22, 1996, as amended at 64 FR 13511, Mar. 19, 1999] Effective Date Note: At 61 FR...

Making Tax-Exempt Capital Financing Work.

ERIC Educational Resources Information Center

Kavanagh, Richard E.

1985-01-01

Large and small businesses have long financed capital projects through tax-exempt financing. Colleges that need large sums of money to retrofit campuses with energy-efficient equipment can achieve the lowest borrowing cost available through bond insurance. (Author/MSE)

Convergence of decision rules for value-based pricing of new innovative drugs.

PubMed

Gandjour, Afschin

2015-04-01

Given the high costs of innovative new drugs, most European countries have introduced policies for price control, in particular value-based pricing (VBP) and international reference pricing. The purpose of this study is to describe how profit-maximizing manufacturers would optimally adjust their launch sequence to these policies and how VBP countries may best respond. To decide about the launching sequence, a manufacturer must consider a tradeoff between price and sales volume in any given country as well as the effect of price in a VBP country on the price in international reference pricing countries. Based on the manufacturer's rationale, it is best for VBP countries in Europe to implicitly collude in the long term and set cost-effectiveness thresholds at the level of the lowest acceptable VBP country. This way, international reference pricing countries would also converge towards the lowest acceptable threshold in Europe.

Transforming high-dimensional potential energy surfaces into sum-of-products form using Monte Carlo methods

NASA Astrophysics Data System (ADS)

Schröder, Markus; Meyer, Hans-Dieter

2017-08-01

We propose a Monte Carlo method, "Monte Carlo Potfit," for transforming high-dimensional potential energy surfaces evaluated on discrete grid points into a sum-of-products form, more precisely into a Tucker form. To this end we use a variational ansatz in which we replace numerically exact integrals with Monte Carlo integrals. This largely reduces the numerical cost by avoiding the evaluation of the potential on all grid points and allows a treatment of surfaces up to 15-18 degrees of freedom. We furthermore show that the error made with this ansatz can be controlled and vanishes in certain limits. We present calculations on the potential of HFCO to demonstrate the features of the algorithm. To demonstrate the power of the method, we transformed a 15D potential of the protonated water dimer (Zundel cation) in a sum-of-products form and calculated the ground and lowest 26 vibrationally excited states of the Zundel cation with the multi-configuration time-dependent Hartree method.

Economic burden of illness of acute coronary syndromes: medical and productivity costs

PubMed Central

2011-01-01

Background The significant economic burden associated with acute coronary syndromes (ACS) provides a need to evaluate both medical costs and productivity costs, according to evolving guideline-driven ACS treatment strategies, medical management (MM), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). Methods Commercially insured individuals, aged 18-64, with an emergency room (ER) visit or hospitalization accompanied by an ACS diagnosis (index event) were identified from a large claims database between 01/2004 and 12/2005 with a 1-year follow-up period. Patients who had an ACS diagnosis in the 12 months prior to their index event were excluded. Patients were divided into 3 groups according to treatment strategies during the index event: MM, PCI, or CABG. A subset of patients was identified for the productivity cost analysis exploring short-term disability and absenteeism costs. Multivariate generalized linear models were performed to examine the ACS costs by 3 different treatment strategies. Results A total of 10,487 patients were identified for the medical cost analysis. The total 1-year medical costs (index event costs plus the 1-year follow-up costs) were lowest for MM patients ($34,087), followed by PCI patients ($52,673) and CABG patients ($86,914). Of the 3,080 patients in the productivity costs analysis, 2,454 patients were identified in the short-term disability cohort and 626 patients were identified in the absenteeism cohort. Both the estimated mean total 1-year short-term disability and absenteeism costs were highest for CABG patients ($17,335, $14,960, respectively) compared to MM patients ($6,048, $9,826, respectively) and PCI patients ($9,221, $9,460, respectively). Conclusions Both total 1-year medical costs and 1-year productivity costs are substantial for working-aged individuals with ACS. These costs differ according to the type of treatment strategy, with CABG having higher costs compared to either PCI or MM. PMID:21314995

Economics of the solid rocket booster for space shuttle

NASA Technical Reports Server (NTRS)

Rice, W. C.

1979-01-01

The paper examines economics of the solid rocket booster for the Space Shuttle. Costs have been held down by adapting existing technology to the 146 in. SRB selected, with NASA reducing the cost of expendables and reusing the expensive nonexpendable hardware. Drop tests of Titan III motor cases and nozzles proved that boosters can survive water impact at vertical velocities of 100 ft/sec so that SRB components can be reused. The cost of expendables was minimized by selecting proven propellants, insulation, and nozzle ablatives of known costs; the propellant has the lowest available cost formulation, and low cost ablatives, such as pitch carbon fibers, will be used when available. Thus, the use of proven technology and low cost expendables will make the SRB an economical booster for the Space Shuttle.

Diagnostic value and cost utility analysis for urine Gram stain and urine microscopic examination as screening tests for urinary tract infection.

PubMed

Wiwanitkit, Viroj; Udomsantisuk, Nibhond; Boonchalermvichian, Chaiyaporn

2005-06-01

The aim of this study was to evaluate the diagnostic properties of urine Gram stain and urine microscopic examination for screening for urinary tract infection (UTI), and to perform an additional cost utility analysis. This descriptive study was performed on 95 urine samples sent for urine culture to the Department of Microbiology, Faculty of Medicine, Chulalongkorn University. The first part of the study was to determine the diagnostic properties of two screening tests (urine Gram stain and urine microscopic examination). Urine culture was set as the gold standard and the results from both methods were compared to this. The second part of this study was to perform a cost utility analysis. The sensitivity of urine Gram stain was 96.2%, the specificity 93.0%, the positive predictive value 94.3% and the negative predictive value 95.2%. False positives occurred with a frequency of 7.0% and false negatives 3.8%. For the microscopic examination, the sensitivity was 65.4%, specificity 74.4%, positive predictive value 75.6% and negative predictive value 64.0%. False positives occurred with a frequency of 25.6% and false negatives 34.6%. Combining urine Gram stain and urine microscopic examination, the sensitivity was 98.1%, specificity 74.4%, positive predictive value 82.3% and negative predictive value 97.0%. False positives occurred with a frequency of 25.6% and false negatives 1.9%. However, the cost per utility of the combined method was higher than either urine microscopic examination or urine Gram stain alone. Urine Gram stain provided the lowest cost per utility. Economically, urine Gram stain is the proper screening tool for presumptive diagnosis of UTI.

Optimization study of small-scale solar membrane distillation desalination systems (s-SMDDS).

PubMed

Chang, Hsuan; Chang, Cheng-Liang; Hung, Chen-Yu; Cheng, Tung-Wen; Ho, Chii-Dong

2014-11-24

Membrane distillation (MD), which can utilize low-grade thermal energy, has been extensively studied for desalination. By incorporating solar thermal energy, the solar membrane distillation desalination system (SMDDS) is a potential technology for resolving energy and water resource problems. Small-scale SMDDS (s-SMDDS) is an attractive and viable option for the production of fresh water for small communities in remote arid areas. The minimum cost design and operation of s-SMDDS are determined by a systematic method, which involves a pseudo-steady-state approach for equipment sizing and dynamic optimization using overall system mathematical models. Two s-SMDDS employing an air gap membrane distillation module with membrane areas of 11.5 m(2) and 23 m(2) are analyzed. The lowest water production costs are $5.92/m(3) and $5.16/m(3) for water production rates of 500 kg/day and 1000 kg/day, respectively. For these two optimal cases, the performance ratios are 0.85 and 0.91; the recovery ratios are 4.07% and 4.57%. The effect of membrane characteristics on the production cost is investigated. For the commercial membrane employed in this study, the increase of the membrane mass transfer coefficient up to two times is beneficial for cost reduction.

Optimization Study of Small-Scale Solar Membrane Distillation Desalination Systems (s-SMDDS)

PubMed Central

Chang, Hsuan; Chang, Cheng-Liang; Hung, Chen-Yu; Cheng, Tung-Wen; Ho, Chii-Dong

2014-01-01

Membrane distillation (MD), which can utilize low-grade thermal energy, has been extensively studied for desalination. By incorporating solar thermal energy, the solar membrane distillation desalination system (SMDDS) is a potential technology for resolving energy and water resource problems. Small-scale SMDDS (s-SMDDS) is an attractive and viable option for the production of fresh water for small communities in remote arid areas. The minimum cost design and operation of s-SMDDS are determined by a systematic method, which involves a pseudo-steady-state approach for equipment sizing and dynamic optimization using overall system mathematical models. Two s-SMDDS employing an air gap membrane distillation module with membrane areas of 11.5 m2 and 23 m2 are analyzed. The lowest water production costs are $5.92/m3 and $5.16/m3 for water production rates of 500 kg/day and 1000 kg/day, respectively. For these two optimal cases, the performance ratios are 0.85 and 0.91; the recovery ratios are 4.07% and 4.57%. The effect of membrane characteristics on the production cost is investigated. For the commercial membrane employed in this study, the increase of the membrane mass transfer coefficient up to two times is beneficial for cost reduction. PMID:25421065

No Cost – Low Cost Compressed Air System Optimization in Industry

NASA Astrophysics Data System (ADS)

Dharma, A.; Budiarsa, N.; Watiniasih, N.; Antara, N. G.

2018-04-01

Energy conservation is a systematic, integrated of effort, in order to preserve energy sources and improve energy utilization efficiency. Utilization of energy in efficient manner without reducing the energy usage it must. Energy conservation efforts are applied at all stages of utilization, from utilization of energy resources to final, using efficient technology, and cultivating an energy-efficient lifestyle. The most common way is to promote energy efficiency in the industry on end use and overcome barriers to achieve such efficiency by using system energy optimization programs. The facts show that energy saving efforts in the process usually only focus on replacing tools and not an overall system improvement effort. In this research, a framework of sustainable energy reduction work in companies that have or have not implemented energy management system (EnMS) will be conducted a systematic technical approach in evaluating accurately a compressed-air system and potential optimization through observation, measurement and verification environmental conditions and processes, then processing the physical quantities of systems such as air flow, pressure and electrical power energy at any given time measured using comparative analysis methods in this industry, to provide the potential savings of energy saving is greater than the component approach, with no cost to the lowest cost (no cost - low cost). The process of evaluating energy utilization and energy saving opportunities will provide recommendations for increasing efficiency in the industry and reducing CO2 emissions and improving environmental quality.

Supply of reactants for Redox bulk energy storage systems

NASA Technical Reports Server (NTRS)

Gahn, R. F.

1978-01-01

World resources, reserves, production, and costs of reactant materials, iron, chromium, titanium and bromine for proposed redox cell bulk energy storage systems are reviewed. Supplying required materials for multimegawatt hour systems appears to be feasible even at current production levels. Iron and chromium ores are the most abundant and lowest cost of four reactants. Chromium is not a domestic reserve, but redox system installations would represent a small fraction of U.S. imports. Vast quantities of bromine are available, but present production is low and therefore cost is high. Titanium is currently available at reasonable cost, with ample reserves available for the next fifty years.

Preconception risk assessment of infertile couples

PubMed Central

Nekuei, Nafisehsadat; Kazemi, Ashraf; Ehsanpur, Soheila; Beigi, Nastaran Mohammad Ali

2013-01-01

Background: With regard to the importance of preconception conditions in maternal health and fertility, preconception risk assessment makes treatment trends and pregnancy outcome more successful among infertile couples. This study has tried to investigate preconception risk assessment in infertile couples. Materials and Methods: This is a descriptive analytical survey conducted on 268 subjects, selected by convenient sampling, referring to Isfahan infertility centers (Iran). The data were collected by questionnaires through interview and clients’ medical records. Pre-pregnancy risk assessment including history taking (personal, familial, medical, medications, menstruation, and pregnancy), exams (physical, genital, and vital signs), and routine test requests (routine, cervix, infections, and biochemical tests) was performed in the present study. Results: The results showed that the lowest percentage of taking a complete history was for personal history (0.4%) and the highest was for history of menstruation (100%). The lowest percentage of complete exam was for physical exam (3.4%) and the highest for genital exam (100%). With regard to laboratory assessment, the highest percentage was for routine tests (36.6%) and the lowest was for infection tests (0.4%). Conclusion: Based o the results of the present study, most of the risk assessment components are poorly assessed in infertile couples. With regard to the importance of infertility treatment, spending high costs and time on that, and existence of high-risk individuals as well as treatment failures, health providers should essentially pay special attention to preconception risk assessment in infertile couples in order to enhance the chance of success and promote treatment outcome. PMID:23983724

Highly specific and cost-efficient detection of Salmonella Paratyphi A combining aptamers with single-walled carbon nanotubes.

PubMed

Yang, Ming; Peng, Zhihui; Ning, Yi; Chen, Yongzhe; Zhou, Qin; Deng, Le

2013-05-22

In this paper, a panel of single-stranded DNA aptamers with high affinity and specificity against Salmonella Paratyphi A was selected from an enriched oligonucleotide pool by a whole-cell-Systematic Evolution of Ligands by Exponential Enrichment (SELEX) procedure, during which four other Salmonella serovars were used as counter-selection targets. It was determined through a fluorescence assay that the selected aptamers had high binding ability and specificity to this pathogen. The dissociation constant of these aptamers were up to nanomolar range, and aptamer Apt22 with the lowest Kd (47 ± 3 nM) was used in cell imaging experiments. To detect this bacteria with high specificity and cost-efficiently, a novel useful detection method was also constructed based on the noncovalent self-assembly of single-walled carbon nanotubes (SWNTs) and DNAzyme-labeled aptamer detection probes. The amounts of target bacteria could be quantified by exploiting chemoluminescence intensity changes at 420 nm and the detection limit of the method was 103 cfu/mL. This study demonstrated the applicability of Salmonella specific aptamers and their potential for use in the detection of Salmonella in food, clinical and environmental samples.

Costs and difficulties of recruiting patients to provide e-health support: pilot study in one primary care trust

PubMed Central

2012-01-01

Background Better use of e-health services by patients could improve outcomes and reduce costs but there are concerns about inequalities of access. Previous research in outpatients suggested that anonymous personal email support may help patients with long term conditions to use e-health, but recruiting earlier in their 'journey' may benefit patients more. This pilot study explored the feasibility and cost of recruiting patients for an e-health intervention in one primary care trust. Methods The sample comprised 46 practices with total patient population of 250,000. We approached all practices using various methods, seeking collaboration to recruit patients via methods agreed with each practice. A detailed research diary was kept of time spent recruiting practices and patients. Researcher time was used to estimate costs. Patients who consented to participate were offered email support for their use of the Internet for health. Results Eighteen practices agreed to take part; we recruited 27 patients, most (23/27) from five practices. Practices agreed to recruit patients for an e-health intervention via waiting room leaflets (16), posters (16), practice nurses (15), doctors giving patients leaflets (5), a study website link (7), inclusion in planned mailshots (2), and a special mailshot to patients selected from practice computers (1). After low recruitment response we also recruited directly in five practices through research assistants giving leaflets to patients in waiting rooms. Ten practices recruited no patients. Those practices that were more difficult to recruit were less likely to recruit patients. Leaving leaflets for practice staff to distribute and placing posters in the practice were not effective in recruiting patients. Leaflets handed out by practice nurses and website links were more successful. The practice with lowest costs per patient recruited (£70) used a special mailshot to selected patients. Conclusion Recruitment via general practice was not successful and was therefore expensive. Direct to consumer methods and recruitment of patients in outpatients to offer email support may be more cost effective. If recruitment in general practice is required, contacting practices by letter and email, not following up non-responding practices, and recruiting patients with selected conditions by special mailshot may be the most cost-effective approach. PMID:22458706

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study).

PubMed

Azuara-Blanco, Augusto; Banister, Katie; Boachie, Charles; McMeekin, Peter; Gray, Joanne; Burr, Jennifer; Bourne, Rupert; Garway-Heath, David; Batterbury, Mark; Hernández, Rodolfo; McPherson, Gladys; Ramsay, Craig; Cook, Jonathan

2016-01-01

Many glaucoma referrals from the community to hospital eye services are unnecessary. Imaging technologies can potentially be useful to triage this population. To assess the diagnostic performance and cost-effectiveness of imaging technologies as triage tests for identifying people with glaucoma. Within-patient comparative diagnostic accuracy study. Markov economic model comparing the cost-effectiveness of a triage test with usual care. Secondary care. Adults referred from the community to hospital eye services for possible glaucoma. Heidelberg Retinal Tomography (HRT), including two diagnostic algorithms, glaucoma probability score (HRT-GPS) and Moorfields regression analysis (HRT-MRA); scanning laser polarimetry [glaucoma diagnostics (GDx)]; and optical coherence tomography (OCT). The reference standard was clinical examination by a consultant ophthalmologist with glaucoma expertise including visual field testing and intraocular pressure (IOP) measurement. (1) Diagnostic performance of imaging, using data from the eye with most severe disease. (2) Composite triage test performance (imaging test, IOP measurement and visual acuity measurement), using data from both eyes, in correctly identifying clinical management decisions, that is 'discharge' or 'do not discharge'. Outcome measures were sensitivity, specificity and incremental cost per quality-adjusted life-year (QALY). Data from 943 of 955 participants were included in the analysis. The average age was 60.5 years (standard deviation 13.8 years) and 51.1% were females. Glaucoma was diagnosed by the clinician in at least one eye in 16.8% of participants; 37.9% of participants were discharged after the first visit. Regarding diagnosing glaucoma, HRT-MRA had the highest sensitivity [87.0%, 95% confidence interval (CI) 80.2% to 92.1%] but the lowest specificity (63.9%, 95% CI 60.2% to 67.4%) and GDx had the lowest sensitivity (35.1%, 95% CI 27.0% to 43.8%) but the highest specificity (97.2%, 95% CI 95.6% to 98.3%). HRT-GPS had sensitivity of 81.5% (95% CI 73.9% to 87.6%) and specificity of 67.7% (95% CI 64.2% to 71.2%) and OCT had sensitivity of 76.9% (95% CI 69.2% to 83.4%) and specificity of 78.5% (95% CI 75.4% to 81.4%). Regarding triage accuracy, triage using HRT-GPS had the highest sensitivity (86.0%, 95% CI 82.8% to 88.7%) but the lowest specificity (39.1%, 95% CI 34.0% to 44.5%), GDx had the lowest sensitivity (64.7%, 95% CI 60.7% to 68.7%) but the highest specificity (53.6%, 95% CI 48.2% to 58.9%). Introducing a composite triage station into the referral pathway to identify appropriate referrals was cost-effective. All triage strategies resulted in a cost reduction compared with standard care (consultant-led diagnosis) but with an associated reduction in effectiveness. GDx was the least costly and least effective strategy. OCT and HRT-GPS were not cost-effective. Compared with GDx, the cost per QALY gained for HRT-MRA is £22,904. The cost per QALY gained with current practice is £156,985 compared with HRT-MRA. Large savings could be made by implementing HRT-MRA but some benefit to patients will be forgone. The results were sensitive to the triage costs. Automated imaging can be effective to aid glaucoma diagnosis among individuals referred from the community to hospital eye services. A model of care using a triage composite test appears to be cost-effective. There are uncertainties about glaucoma progression under routine care and the cost of providing health care. The acceptability of implementing a triage test needs to be explored. The National Institute for Health Research Health Technology Assessment programme.

Large-scale 3D geoelectromagnetic modeling using parallel adaptive high-order finite element method

DOE PAGES

Grayver, Alexander V.; Kolev, Tzanio V.

2015-11-01

Here, we have investigated the use of the adaptive high-order finite-element method (FEM) for geoelectromagnetic modeling. Because high-order FEM is challenging from the numerical and computational points of view, most published finite-element studies in geoelectromagnetics use the lowest order formulation. Solution of the resulting large system of linear equations poses the main practical challenge. We have developed a fully parallel and distributed robust and scalable linear solver based on the optimal block-diagonal and auxiliary space preconditioners. The solver was found to be efficient for high finite element orders, unstructured and nonconforming locally refined meshes, a wide range of frequencies, largemore » conductivity contrasts, and number of degrees of freedom (DoFs). Furthermore, the presented linear solver is in essence algebraic; i.e., it acts on the matrix-vector level and thus requires no information about the discretization, boundary conditions, or physical source used, making it readily efficient for a wide range of electromagnetic modeling problems. To get accurate solutions at reduced computational cost, we have also implemented goal-oriented adaptive mesh refinement. The numerical tests indicated that if highly accurate modeling results were required, the high-order FEM in combination with the goal-oriented local mesh refinement required less computational time and DoFs than the lowest order adaptive FEM.« less

Large-scale 3D geoelectromagnetic modeling using parallel adaptive high-order finite element method

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

Grayver, Alexander V.; Kolev, Tzanio V.

Here, we have investigated the use of the adaptive high-order finite-element method (FEM) for geoelectromagnetic modeling. Because high-order FEM is challenging from the numerical and computational points of view, most published finite-element studies in geoelectromagnetics use the lowest order formulation. Solution of the resulting large system of linear equations poses the main practical challenge. We have developed a fully parallel and distributed robust and scalable linear solver based on the optimal block-diagonal and auxiliary space preconditioners. The solver was found to be efficient for high finite element orders, unstructured and nonconforming locally refined meshes, a wide range of frequencies, largemore » conductivity contrasts, and number of degrees of freedom (DoFs). Furthermore, the presented linear solver is in essence algebraic; i.e., it acts on the matrix-vector level and thus requires no information about the discretization, boundary conditions, or physical source used, making it readily efficient for a wide range of electromagnetic modeling problems. To get accurate solutions at reduced computational cost, we have also implemented goal-oriented adaptive mesh refinement. The numerical tests indicated that if highly accurate modeling results were required, the high-order FEM in combination with the goal-oriented local mesh refinement required less computational time and DoFs than the lowest order adaptive FEM.« less

Increasing accuracy of vehicle detection from conventional vehicle detectors - counts, speeds, classification, and travel time.

DOT National Transportation Integrated Search

2014-09-01

Vehicle classification is an important traffic parameter for transportation planning and infrastructure : management. Length-based vehicle classification from dual loop detectors is among the lowest cost : technologies commonly used for collecting th...

Impacts of health insurance benefit design on percutaneous coronary intervention use and inpatient costs among patients with acute myocardial infarction in Shanghai, China.

PubMed

Yuan, Suwei; Liu, Yan; Li, Na; Zhang, Yunting; Zhang, Zhe; Tao, Jingjing; Shi, Lizheng; Quan, Hude; Lu, Mingshan; Ma, Jin

2014-03-01

Currently, the most popular hospital payment method in China is fee-for-service (FFS) with a global budget cap. As of December 2009, a policy change means that heart stents are covered by public health insurance, whereas previously they were not. This policy change provides us an opportunity to study how a change in insurance benefit affected the quantity and quality of hospital services. The new policy introduced incentives for both patients and providers: it encourages patient demand for percutaneous coronary intervention (PCI) services and stent use (moral hazard effect), and discourages hospital supply due to the financial pressures of the global cap (provider gaming effect). If the provider's gaming effect dominates the moral hazard effect, actual utilisation and costs might go down, and vice versa. Our hypothesis is that patients in the higher reimbursement groups will have fewer PCIs and lower inpatient costs. We aimed to examine the impact of health insurance benefit design on PCI and stent use, and on inpatient costs and out-of-pocket expenses for patients with acute myocardial infarction (AMI) in Shanghai. We included 720 patients with AMI (467 before the benefit change and 253 after) from a large teaching tertiary hospital in Shanghai. Data were collected via review of hospital medical charts, and from the hospital billing database. Patient information collected included demographic characteristics, medical history and procedure information. All patients were categorised into four groups according to their actual reimbursement ratio: high (90-100 %), moderate (80-90 %), low (0-80 %) and none (self-paid patients). Multiple regression and difference-in-difference (DID) models were used to investigate the impacts of the health insurance benefit design on PCI and stent use, and on total hospital costs and patients' out-of-pocket expenses. After the change in insurance benefit policy, compared with the self-paid group, PCI rates for the moderate and low reimbursement groups increased by 22.2 and 20.3 %, respectively, and decreased by 48.7 % for the high reimbursement group. The change in insurance benefit policy had no impact on the number of stents used. The high reimbursement group had the lowest hospital costs, and the low reimbursement group had the highest hospital costs, regardless of benefit policy change. The general linear regression results showed that the high reimbursement group had higher total hospital costs than the self-paid group, but were the lowest among all reimbursement groups after the benefit policy change (DIDh = 1,202.21, P = 0.0096). There were no significant changes in the other two groups, and there were no differences in the out-of-pocket costs across any of the insured groups. Our results suggest that the benefit policy change did not impact life-saving procedures or reduce patients' burden of disease among AMI patients. The effect of 'provider gaming' was the strongest for the high reimbursement group as a result of the global budget cap pressure. The current FFS with a global budget cap is of low efficiency for cost containment and equity improvement. Payment method reforms with alignment of financial incentives to improve provider behaviour in practicing evidence-based medicine are needed in China.

Cost comparison between uterine-sparing fibroid treatments one year following treatment

PubMed Central

2014-01-01

Background To compare one-year all-cause and uterine fibroid (UF)-related direct costs in patients treated with one of the following three uterine-sparing procedures: magnetic resonance-guided focused ultrasound (MRgFUS), uterine artery embolization (UAE) and myomectomy. Methods This retrospective observational cohort study used healthcare claims for several million individuals with healthcare coverage from employers in the MarketScan Database for the period 2003–2010. UF patients aged 25–54 on their first UF procedure (index) date with 366-day baseline experience, 366-day follow-up period, continuous health plan enrollment during baseline and follow-up, and absence of any baseline UF procedures were included in the final sample. Cost outcomes were measured by allowed charges (sum of insurer-paid and patient-paid amounts). UF-related cost was defined as difference in mean cost between study cohorts and propensity-score-matched control cohorts without UF. Multivariate adjustment of cost outcomes was conducted using generalized linear models. Results The study sample comprised 14,426 patients (MRgFUS = 14; UAE = 4,092; myomectomy = 10,320) with a higher percent of older patients in MRgFUS cohort (71% vs. 50% vs. 12% in age-group 45–54, P < 0.001). Adjusted all-cause mean cost was lowest for MRgFUS ($19,763; 95% CI: $10,425-$38,694) followed by myomectomy ($20,407; 95% CI: $19,483-$21,381) and UAE ($25,019; 95% CI: $23,738-$26,376) but without statistical significance. Adjusted UF-related costs were also not significantly different between the three procedures. Conclusions Adjusted all-cause and UF-related costs at one year were not significantly different between patients undergoing MRgFUS, myomectomy and UAE. PMID:25512868

Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa.

PubMed Central

Ekwueme, Donatus U.; Weniger, Bruce G.; Chen, Robert T.

2002-01-01

OBJECTIVE: To investigate and compare seven types of injection devices for their risks of iatrogenic transmission of bloodborne pathogens and their economic costs in sub-Saharan Africa. METHODS: Risk assumptions for each device and cost models were constructed to estimate the number of new hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections resulting from patient-to-patient, patient-to-health care worker, and patient-to-community transmission. Costs of device purchase and usage were derived from the literature, while costs of direct medical care and lost productivity from HBV and HIV disease were based on data collected in 1999 in Côte d'Ivoire, Ghana, and Uganda. Multivariate sensitivity analyses using Monte Carlo simulation characterized uncertainties in model parameters. Costs were summed from both the societal and health care system payer's perspectives. FINDINGS: Resterilizable and disposable needles and syringes had the highest overall costs for device purchase, usage, and iatrogenic disease: median US dollars 26.77 and US dollars 25.29, respectively, per injection from the societal perspective. Disposable-cartridge jet injectors and automatic needle-shielding syringes had the lowest costs, US dollars 0.36 and US dollars 0.80, respectively. Reusable-nozzle jet injectors and auto-disable needle and syringes were intermediate, at US dollars 0.80 and US dollars 0.91, respectively, per injection. CONCLUSION: Despite their nominal purchase and usage costs, conventional needles and syringes carry a hidden but huge burden of iatrogenic disease. Alternative injection devices for the millions of injections administered annually in sub-Saharan Africa would be of value and should be considered by policy-makers in procurement decisions. PMID:12481207

The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda.

PubMed

Ngabo, Fidele; Mvundura, Mercy; Gazley, Lauren; Gatera, Maurice; Rugambwa, Celse; Kayonga, Eugene; Tuyishime, Yvette; Niyibaho, Jeanne; Mwenda, Jason M; Donnen, Philippe; Lepage, Philippe; Binagwaho, Agnes; Atherly, Deborah

2016-01-01

Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child's caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction. Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile.

Balancing research and funding using value of information and portfolio tools for nanomaterial risk classification

NASA Astrophysics Data System (ADS)

Bates, Matthew E.; Keisler, Jeffrey M.; Zussblatt, Niels P.; Plourde, Kenton J.; Wender, Ben A.; Linkov, Igor

2016-02-01

Risk research for nanomaterials is currently prioritized by means of expert workshops and other deliberative processes. However, analytical techniques that quantify and compare alternative research investments are increasingly recommended. Here, we apply value of information and portfolio decision analysis—methods commonly applied in financial and operations management—to prioritize risk research for multiwalled carbon nanotubes and nanoparticulate silver and titanium dioxide. We modify the widely accepted CB Nanotool hazard evaluation framework, which combines nano- and bulk-material properties into a hazard score, to operate probabilistically with uncertain inputs. Literature is reviewed to develop uncertain estimates for each input parameter, and a Monte Carlo simulation is applied to assess how different research strategies can improve hazard classification. The relative cost of each research experiment is elicited from experts, which enables identification of efficient research portfolios—combinations of experiments that lead to the greatest improvement in hazard classification at the lowest cost. Nanoparticle shape, diameter, solubility and surface reactivity were most frequently identified within efficient portfolios in our results.

Virtual aluminum castings: An industrial application of ICME

NASA Astrophysics Data System (ADS)

Allison, John; Li, Mei; Wolverton, C.; Su, Xuming

2006-11-01

The automotive product design and manufacturing community is continually besieged by Hercule an engineering, timing, and cost challenges. Nowhere is this more evident than in the development of designs and manufacturing processes for cast aluminum engine blocks and cylinder heads. Increasing engine performance requirements coupled with stringent weight and packaging constraints are pushing aluminum alloys to the limits of their capabilities. To provide high-quality blocks and heads at the lowest possible cost, manufacturing process engineers are required to find increasingly innovative ways to cast and heat treat components. Additionally, to remain competitive, products and manufacturing methods must be developed and implemented in record time. To bridge the gaps between program needs and engineering reality, the use of robust computational models in up-front analysis will take on an increasingly important role. This article describes just such a computational approach, the Virtual Aluminum Castings methodology, which was developed and implemented at Ford Motor Company and demonstrates the feasibility and benefits of integrated computational materials engineering.

Comparison of techniques for the detection of helminth ova in drinking water and wastewater.

PubMed

Maya, C; Jimenez, B; Schwartzbrod, J

2006-02-01

Many countries use wastewater for irrigation. The World Health Organization established, as reuse guidelines, a maximum value of 1 helminth ovum/L for irrigation. Various techniques for enumerating helminth ova in water have been published. To determine the most adequate method for Mexico, four techniques were compared: the U.S. Environmental Protection Agency (U.S. EPA), membrane-filter, Leeds I, and Faust. Two types of water were used: drinking water and municipal wastewater effluent. Sensitivity, discrimination coefficients, precision, recovery efficiency, and cost were determined. In addition, several unseeded wastewater samples were analyzed. For drinking water, U.S. EPA and the membrane-filter techniques demonstrated comparable results; however, when wastewater was used, the membrane technique showed some deficiencies. Because the U.S. EPA technique may be used for samples with both high and low solids content, allows for the recovery of helminth ova with different specific gravities, and has the lowest total cost, it was selected as the best technique.

Generalized shading analysis for paraboloidal collector fields

NASA Technical Reports Server (NTRS)

Osborn, D. B.

1980-01-01

This paper presents the development and results of a generalized shading analysis for a field of point-focus parabolic dish concentrators. Shading of one concentrator by another with attendant loss of energy is a function of the position of the sun and the relative locations of the concentrators within the field. A method is presented for determining the annualized energy loss which includes a trade-off of system life-cycle energy as a function of concentrator spacing and field geometric layout. System energy output is computed on an annualized basis, employing 15 minute-increment environmental data tapes for the year 1976 at Barstow, California. For a land cost of $5000 per acre, lowest system energy cost occurs at about a 25 percent packing fraction (concentrator area/land area) for a typical 1-MWe dish-Stirling solar thermal power plant. Basic equations are given for computing the shading and concomitant energy loss as a function of concentrator center-to-center spacing, field layout site location.

Balancing research and funding using value of information and portfolio tools for nanomaterial risk classification.

PubMed

Bates, Matthew E; Keisler, Jeffrey M; Zussblatt, Niels P; Plourde, Kenton J; Wender, Ben A; Linkov, Igor

2016-02-01

Risk research for nanomaterials is currently prioritized by means of expert workshops and other deliberative processes. However, analytical techniques that quantify and compare alternative research investments are increasingly recommended. Here, we apply value of information and portfolio decision analysis-methods commonly applied in financial and operations management-to prioritize risk research for multiwalled carbon nanotubes and nanoparticulate silver and titanium dioxide. We modify the widely accepted CB Nanotool hazard evaluation framework, which combines nano- and bulk-material properties into a hazard score, to operate probabilistically with uncertain inputs. Literature is reviewed to develop uncertain estimates for each input parameter, and a Monte Carlo simulation is applied to assess how different research strategies can improve hazard classification. The relative cost of each research experiment is elicited from experts, which enables identification of efficient research portfolios-combinations of experiments that lead to the greatest improvement in hazard classification at the lowest cost. Nanoparticle shape, diameter, solubility and surface reactivity were most frequently identified within efficient portfolios in our results.

Airline Choice for Domestic Flights in Sao Paulo Metropolitan Area: An Application of the Conditional Logit Model

NASA Technical Reports Server (NTRS)

Moreno, Marcelo Baena

2006-01-01

Using the conditional (multinomial) LOGIT model, this paper addresses airline choice in the S o Paulo Metropolitan Area. There are two airports in this region, where two, three or even four airlines compete for passengers flying to an array of domestic destinations. The airline choice is believed to be a result of the tradeoff passengers face among flight cost, flight frequency and airline performance. It was found that the lowest fare better explains airline choice than the highest fare, whereas direct flight frequencies give better explanation to airline choice than indirect (connections and stops) and total (direct plus indirect) ones. Out of 15 variables tested, the lowest fare was the variable that best explained airline choice. However, its signal was counterintuitive (positive) possibly because the cheapest airline was offering few flights, so passengers overwhelmingly failed to choose the cheapest airline. The model specification most adjusted to the data considered the lowest fare, direct flight frequency in the travel day and period (morning or afternoon peak) and airline age. Passengers departing from S o Paulo-Guarulhos International Airport (GRU) airport make their airline choice in terms of cost whereas those from Sao Paulo-Congonhas Airport (CGH) airport do not. Finally, senior passengers place more importance on airline age than junior passengers.

Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona

PubMed Central

Riu, Marta; Chiarello, Pietro; Terradas, Roser; Sala, Maria; Garcia-Alzorriz, Enric; Castells, Xavier; Grau, Santiago; Cots, Francesc

2016-01-01

Aim To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. Methods We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive. Results A total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency. Conclusions Adjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance. PMID:27055117

Role of Cost on Failure to Access Prescribed Pharmaceuticals: The Case of Statins.

PubMed

McRae, Ian; van Gool, Kees; Hall, Jane; Yen, Laurann

2017-10-01

In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are "concessional" (holding prescribed pension or other government concession cards) or "general", and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines. The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment. Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions. Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments. The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.

Reducing the costs of meeting regional water demand through risk-based transfer agreements.

PubMed

Palmer, Reed N; Characklis, Gregory W

2009-04-01

Transfers of treated water among inter-connected utilities is becoming more common as the cost of developing new supplies grows, and transfer agreements require well developed rules describing when and how much water will be transferred. The nature of the decision rules governing an agreement must also be coordinated with respect to the treatment and conveyance capacity required to execute the transfers. This study explores different combinations of infrastructure and agreement type that define three different transfer programs, describing the frequency and volume of transfers associated with each, as well as their costs. The agreements are described in terms of the type of decision rule employed: Take-or-Pay, where the timing and quantity of transfers is fixed; Days of Supply Remaining (DSR), which uses a static hydrologic indicator to trigger transfers; and Risk-of-Failure, a probability-based decision rule that involves consideration of both supply and demand. This analysis is conducted within the context of the Research Triangle area of North Carolina (USA), a rapidly growing area that is beginning to approach the practical limits of water resource development. The Risk-of-Failure agreement is shown to reduce the average volume of transfers by over 80% compared to a Take-or-Pay agreement and by roughly half relative to the DSR agreement, leading to significant cost reductions. A utility's willingness to accept something less than guaranteed access to a specified quantity of water (i.e. an interruption) also has a significant impact on cost. Interruptions do not necessarily lead to lower reliability, but rather to the purchasing utility acquiring more water during off-peak periods when the seller has excess treatment capacity available. The lowest cost guaranteed agreement is 40-50% more expensive than the lowest cost interruptible contract.

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

PubMed

Surendran, U; Jayakumar, M; Marimuthu, S

2016-12-15

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

Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey.

PubMed

Watkins, C; Harvey, I; Carthy, P; Moore, L; Robinson, E; Brawn, R

2003-02-01

General practitioner (GP) prescribing accounts for about 10% of NHS expenditure. GPs at the top of the range have annual prescribing costs that are almost twice as much as those at the bottom of the range. This variation cannot be accounted for purely in terms of differences in underlying need for health care. To describe the relationship between GPs' prescribing costs and their attitudes towards prescribing decisions and prescribing information sources, and to identify potentially modifiable attitudinal and behavioural factors associated with high cost prescribing. A postal questionnaire was designed on the basis of hypotheses developed from a literature search and an earlier qualitative survey. This questionnaire was sent to a national sample of GPs with equal numbers of practices in the upper, middle, and lowest quintile of prescribing costs. GP practices in England. 1714 GPs in NHS practice. GPs' self-reported practices, attitudes and personal characteristics. There was a 64% response rate. Responders were more likely to be from larger practices, in less deprived areas, and with lower prescribing costs than were non-responders. Multivariable analysis showed that GPs with high prescribing costs were significantly more likely to work in dispensing practices, in practices with low income populations, in single handed practices, and in practices without a GP trainer. They were also significantly more likely to see drug company representatives more frequently, to prescribe newly available drugs more freely, to prescribe more readily to patients who expect a prescription, to report high levels of frustration from lack of time in the consultation, to find unsatisfactory those consultations which ended in advice only, and to express dissatisfaction with their review methods for repeat prescribing. They were significantly less likely to find useful criticism of prescribing habits by colleagues, and to check the BNF rather than other sources when uncertain about an aspect of drug treatment. While they cannot be held to have a causal relationship, the pattern of attitudes towards prescribing of GPs in the highest quintile of prescribing costs provide the basis for developing an educational intervention which may be an acceptable method of modifying the attitudes of GPs and consequently reducing their prescribing costs.

[Acoustic Levitation Methods and Apparatus

NASA Technical Reports Server (NTRS)

Barmatz, M. B.; Jacobi, N. (Inventor)

1982-01-01

Methods are described for acoustically levitating objects within chambers of spherical and cylindrical shape. The wavelengths for chambers of particular dimensions are given, for generating standing wave patterns of any of a variety of modes within the chambers. For a spherical chamber the lowest resonant mode is excited by applying a wavelength of 3.02R, where R is the chamber radius. The two lowest pure radial modes for that chamber, are excited by applying wavelengths of 1.40R and 0.814R. For a cylindrical chamber of radius R, the lowest mode is at a wavelength of 3.41R, and the lowest pure radial modes are at wavelengths of 1.64R and 0.896R.

Annual economic impacts of seasonal influenza on US counties: Spatial heterogeneity and patterns

PubMed Central

2012-01-01

Economic impacts of seasonal influenza vary across US counties, but little estimation has been conducted at the county level. This research computed annual economic costs of seasonal influenza for 3143 US counties based on Census 2010, identified inherent spatial patterns, and investigated cost-benefits of vaccination strategies. The computing model modified existing methods for national level estimation, and further emphasized spatial variations between counties, in terms of population size, age structure, influenza activity, and income level. Upon such a model, four vaccination strategies that prioritize different types of counties were simulated and their net returns were examined. The results indicate that the annual economic costs of influenza varied from $13.9 thousand to $957.5 million across US counties, with a median of $2.47 million. Prioritizing vaccines to counties with high influenza attack rates produces the lowest influenza cases and highest net returns. This research fills the current knowledge gap by downscaling the estimation to a county level, and adds spatial variability into studies of influenza economics and interventions. Compared to the national estimates, the presented statistics and maps will offer detailed guidance for local health agencies to fight against influenza. PMID:22594494

Availability, prices and affordability of essential medicines in Haiti

PubMed Central

Chahal, Harinder Singh; St. Fort, Nazaire; Bero, Lisa

2013-01-01

Background Haiti is the poorest country in the Western Hemisphere and faces numerous challenges, including inadequate medication access for its residents. The objective of this study was to determine the availability, prices, and affordability of essential medicines in Haiti and compare these findings to other countries. Methods We conducted a cross–sectional nationwide survey in 2011 of availability and consumer prices of 60 essential medicines in Haiti using a standardized methodology developed by the World Health Organization and Health Action International. The survey was conducted in 163 medicine outlets in four health care sectors (public, retail, nonprofit and mixed sectors). Medicine prices were expressed as ratios relative to the International Reference Price. Affordability was calculated by comparing the costs of treatment for common conditions with the salary of the lowest paid government worker and was compared to available data from four Latin American countries. Results For generic medicines, the availability in public, retail, nonprofit and mixed sectors was 20%, 37%, 24% and 23% of medications, respectively. Most of the available medicines were priced higher than the International Reference Price. The lowest paid government worker would need 2.5 days’ wages to treat an adult respiratory infection with generic medicines from the public sector. For treatment of common conditions with originator brands (OB) purchased from a retail pharmacy, costs were between 1.4 (anaerobic bacterial infection) and 13.7 (hyperlipidemia) days’ wages, respectively. Treatment of pediatric bacterial infections with the OB of ceftriaxone from a retail pharmacy would cost 24.6 days’ wages. Prices in Bolivia, Colombia, Mexico and Nicaragua were frequently lower for comparable medications. Conclusions The availability of essential medicines was low and prices varied widely across all four sectors. Over 75% of Haitians live on less than US$ 2.00 /day; therefore, most medication regimens are largely unaffordable. Inclusion of essential medications on the national formulary and working with organizations responsible for importing medications into Haiti, particularly drug donation agencies, are important first steps to increasing medication access. PMID:24363923

Three years in - changing plan features in the U.S. health insurance marketplace.

PubMed

McKillop, Caitlin N; Waters, Teresa M; Kaplan, Cameron M; Kaplan, Erin K; Thompson, Michael P; Graetz, Ilana

2018-06-15

A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act's (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces' ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and $55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning.

CYP2C19 LOF and GOF-Guided Antiplatelet Therapy in Patients with Acute Coronary Syndrome: A Cost-Effectiveness Analysis.

PubMed

Jiang, Minghuan; You, Joyce H S

2017-02-01

This study aimed to examine the cost-effectiveness of CYP2C19 loss-of-function and gain-of-function allele guided (LOF/GOF-guided) antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A life-long decision-analytic model was designed to simulate outcomes of three strategies: universal clopidogrel (75 mg daily), universal alternative P2Y 12 inhibitor (prasugrel 10 mg daily or ticagrelor 90 mg twice daily), and LOF/GOF-guided therapy (LOF/GOF allele carriers receiving alternative P2Y 12 inhibitor, wild-type patients receiving clopidogrel). Model outcomes included clinical event rates, quality-adjusted life-years (QALYs) gained and direct medical costs from perspective of US healthcare provider. Base-case analysis found nonfatal myocardial infarction (5.62%) and stent thrombosis (1.2%) to be the lowest in universal alternative P2Y 12 inhibitor arm, whereas nonfatal stroke (0.72%), cardiovascular death (2.42%), and major bleeding (2.73%) were lowest in LOF/GOF-guided group. LOF/GOF-guided arm gained the highest QALYs (7.5301 QALYs) at lowest life-long cost (USD 76,450). One-way sensitivity analysis showed base-case results were subject to the hazard ratio of cardiovascular death in carriers versus non-carriers of LOF allele and hazard ratio of cardiovascular death in non-carriers of LOF allele versus general patients. In probabilistic sensitivity analysis of 10,000 Monte Carlo simulations, LOF/GOF-guided therapy, universal alternative P2Y 12 inhibitor, and universal clopidogrel were the preferred strategy (willingness-to-pay threshold = 50,000 USD/QALY) in 99.07%, 0.04%, and 0.89% of time, respectively. Using both CYP2C19 GOF and LOF alleles to select antiplatelet therapy appears to be the preferred antiplatelet strategy over universal clopidogrel and universal alternative P2Y 12 inhibitor therapy for ACS patients with PCI.

A cost-effective, community-based, mosquito-trapping scheme that captures spatial and temporal heterogeneities of malaria transmission in rural Zambia

PubMed Central

2014-01-01

Background Monitoring mosquito population dynamics is essential to guide selection and evaluation of malaria vector control interventions but is typically implemented by mobile, centrally-managed teams who can only visit a limited number of locations frequently enough to capture longitudinal trends. Community-based (CB) mosquito trapping schemes for parallel, continuous monitoring of multiple locations are therefore required that are practical, affordable, effective, and reliable. Methods A CB surveillance scheme, with a monthly sampling and reporting cycle for capturing malaria vectors, using Centers for Disease Control and Prevention light traps (LT) and Ifakara Tent Traps (ITT), were conducted by trained community health workers (CHW) in 14 clusters of households immediately surrounding health facilities in rural south-east Zambia. At the end of the study, a controlled quality assurance (QA) survey was conducted by a centrally supervised expert team using human landing catch (HLC), LT and ITT to evaluate accuracy of the CB trapping data. Active surveillance of malaria parasite infection rates amongst humans was conducted by CHWs in the same clusters to determine the epidemiological relevance of these CB entomological surveys. Results CB-LT and CB-ITT exhibited relative sampling efficiencies of 50 and 7%, respectively, compared with QA surveys using the same traps. However, cost per sampling night was lowest for CB-LT ($13.6), followed closely by CB-ITT ($18.0), both of which were far less expensive than any QA survey (HLC: $138, LT: $289, ITT: $269). Cost per specimen of Anopheles funestus captured was lowest for CB-LT ($5.3), followed by potentially hazardous QA-HLC ($10.5) and then CB-ITT ($28.0), all of which were far more cost-effective than QA-LT ($141) and QA-ITT ($168). Time-trends of malaria diagnostic positivity (DP) followed those of An. funestus density with a one-month lag and the wide range of mean DP across clusters was closely associated with mean densities of An. funestus caught by CB-LT (P < 0.001). Conclusions CB trapping schemes appear to be far more affordable, epidemiologically relevant and cost-effective than centrally supervised trapping schemes and may well be applicable to enhance intervention trials and even enable routine programmatic monitoring of vector population dynamics on unprecedented national scales. PMID:24906704

Market responses to HMOs: price competition or rivalry?

PubMed

McLaughlin, C G

1988-01-01

Although competition for consumers is increasing in the health care sector, there is disagreement about whether it is resulting in cost containment, as its supporters have argued it would. In part this stems from a confusion between price competition, which under ideal circumstances leads to the production of services at the lowest possible cost, and nonprice competition--or rivalry--which under many circumstances will lead to increased costs. In this paper, I examine the evidence about the competitive response to the growing presence of health maintenance organizations in the health care marketplace. The available evidence suggests that providers are responding not with classical cost-containing price competition but, instead, with cost-increasing rivalry, characterized by increased expenditures to promote actual or perceived product differentiation.

Estimating medical costs of gastroenterological diseases

PubMed Central

Chou, Li-Fang

2004-01-01

AIM: To estimate the direct medical costs of gastroenterological diseases within the universal health insurance program among the population of local residents in Taiwan. METHODS: The data sources were the first 4 cohort datasets of 200 000 people from the National Health Insurance Research Database in Taipei. The ambulatory, inpatient and pharmacy claims of the cohort in 2001 were analyzed. Besides prevalence and medical costs of diseases, both amount and costs of utilization in procedures and drugs were calculated. RESULTS: Of the cohort with 183 976 eligible people, 44.2% had ever a gastroenterological diagnosis during the year. The age group 20-39 years had the lowest prevalence rate (39.2%) while the elderly had the highest (58.4%). The prevalence rate was higher in women than in men (48.5% vs. 40.0%). Totally, 30.4% of 14 888 inpatients had ever a gastroenterological diagnosis at discharge and 18.8% of 51 359 patients at clinics of traditional Chinese medicine had such a diagnosis there. If only the principal diagnosis on each claim was considered, 16.2% of admissions, 8.0% of outpatient visits, and 10.1% of the total medical costs (8 469 909 US dollars/ 83 830 239 US dollars) were attributed to gastroenterological diseases. On average, 46.0 US dollars per insured person in a year were spent in treating gastroenterological diseases. Diagnostic procedures related to gastroenterological diseases accounted for 24.2% of the costs for all diagnostic procedures and 2.3% of the total medical costs. Therapeutic procedures related to gastroenterological diseases accounted for 4.5% of the costs for all therapeutic procedures and 1.3% of the total medical costs. Drugs related to gastroenterological diseases accounted for 7.3% of the costs for all drugs and 1.9% of the total medical costs. CONCLUSION: Gastroenterological diseases are prevalent among the population of local residents in Taiwan, accounting for a tenth of the total medical costs. Further investigations are needed to differentiate costs in screening, ruling out, confirming, and treating. PMID:14716838

Prevalence of treated epilepsy in Korea based on national health insurance data.

PubMed

Lee, Seo-Young; Jung, Ki-Young; Lee, Il Keun; Yi, Sang Do; Cho, Yong Won; Kim, Dong Wook; Hwang, Seung-Sik; Kim, Sejin

2012-03-01

The Korean national health security system covers the entire population and all medical facilities. We aimed to estimate epilepsy prevalence, anticonvulsant utilization pattern and the cost. We identified prevalent epilepsy patients by the prescription of anticonvulsants under the diagnostic codes suggesting seizure or epilepsy from 2007 Korean National Health Insurance databases. The information of demography, residential area, the kind of medical security service reflecting economic status, anticonvulsants, and the costs was extracted. The overall prevalence of treated epilepsy patients was 2.41/1,000, and higher for men than women. The age-specific prevalence was the lowest in those in their thirties and forties. Epilepsy was more prevalent among lower-income individuals receiving medical aid. The regional prevalence was the highest in Jeju Island and lowest in Ulsan city. New anticonvulsants were more frequently used than old anticonvulsants in the younger age group. The total annual cost of epilepsy or seizure reached 0.46% of total medical expenditure and 0.27% of total expenditure on health. This is the first nationwide epidemiological report issued on epilepsy in Korea. Epilepsy prevalence in Korea is comparable to those in developed countries. Economic status and geography affect the prevalence of epilepsy.

Low-cost modular array-field designs for flat-panel and concentrator photovoltaic systems

NASA Astrophysics Data System (ADS)

Post, H. N.; Carmichael, D. C.; Alexander, G.; Castle, J. A.

1982-09-01

Described are the design and development of low-cost, modular array fields for flat-panel and concentrator photovoltaic (PV) systems. The objective of the work was to reduce substantially the cost of the array-field Balance-of-System (BOS) subsystems and site-specific design costs as compared to previous PV installations. These subsystems include site preparation, foundations, support structures, electrical writing, grounding, lightning protection, electromagnetic interference considerations, and controls. To reduce these BOS and design costs, standardized modular (building-block) designs for flat-panel and concentrator array fields have been developed that are fully integrated and optimized for lowest life-cycle costs. Using drawings and specifications now available, these building-block designs can be used in multiples to install various size array fields. The developed designs are immediately applicable (1982) and reduce the array-field BOS costs to a fraction of previous costs.

A Prospective Analysis of the Costs, Benefits, and Impacts of U.S. Renewable Portfolio Standards

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

Mai, Trieu; Wiser, Ryan; Barbose, Galen

This report evaluates the future costs, benefits, and other impacts of renewable energy used to meet current state renewable portfolio standards (RPSs). It also examines a future scenario where RPSs are expanded. The analysis examines changes in electric system costs and retail electricity prices, which include all fixed and operating costs, including capital costs for all renewable, non-renewable, and supporting (e.g., transmission and storage) electric sector infrastructure; fossil fuel, uranium, and biomass fuel costs; and plant operations and maintenance expenditures. The analysis evaluates three specific benefits: air pollution, greenhouse gas emissions, and water use. It also analyzes two other impacts,more » renewable energy workforce and economic development, and natural gas price suppression. This analysis finds that the benefits or renewable energy used to meet RPS polices exceed the costs, even when considering the highest cost and lowest benefit outcomes.« less

Predictive value and cost-effectiveness analysis of a rapid polymerase chain reaction for preoperative detection of nasal carriage of Staphylococcus aureus.

PubMed

Shrestha, Nabin K; Shermock, Kenneth M; Gordon, Steven M; Tuohy, Marion J; Wilson, Deborah A; Cwynar, Roberta E; Banbury, Michael K; Longworth, David L; Isada, Carlos M; Mawhorter, Steven D; Procop, Gary W

2003-05-01

To determine the accuracy and cost-effectiveness of a polymerase chain reaction (PCR) for detecting nasal carriage of Staphylococcus aureus directly from clinical specimens. CROSS-SECTIONAL STUDY: This occurred in a tertiary-care hospital in Cleveland, Ohio, and included 239 consecutive patients who were scheduled for a cardiothoracic surgical procedure. Conventional cultures and a PCR for S. aureus from nasal swabs were used as measurements. COST-EFFECTIVENESS ANALYSIS: Data sources were market prices and Bureau of Labor Statistics. The time horizon was the maximum period for availability of culture results (3 days). Interventions included universal mupirocin therapy without testing; initial therapy, with termination if PCR negative (treat-PCR); initial therapy, with termination if culture negative (treat-culture); treat PCR-positive carriers (PCR-guided treatment); and treat culture-positive carriers (culture-guided treatment). The perspective was institutional and costs and the length of time to treatment were outcome measures. Sixty-seven (28%) of the 239 swabs grew S. aureus. Rapid PCR was 97.0% sensitive and 97.1% specific for the detection of S. aureus. For populations with prevalences of nasal S. aureus carriage of up to 50%, the PCR assay had negative predictive values of greater than 97%. PCR-guided treatment had the lowest incremental cost-effectiveness ratio (1.93 dollars per additional day compared with the culture strategy). Among immediate treatment strategies, treat-PCR was most cost-effective. The universal therapy strategy cost 38.19 dollars more per additional day gained with carrier identification compared with the PCR strategy. Rapid real-time PCR is an accurate, rapid, and cost-effective method for identifying S. aureus carriers for preoperative intervention.

A space radiation transport method development

NASA Technical Reports Server (NTRS)

Wilson, J. W.; Tripathi, R. K.; Qualls, G. D.; Cucinotta, F. A.; Prael, R. E.; Norbury, J. W.; Heinbockel, J. H.; Tweed, J.

2004-01-01

Improved spacecraft shield design requires early entry of radiation constraints into the design process to maximize performance and minimize costs. As a result, we have been investigating high-speed computational procedures to allow shield analysis from the preliminary design concepts to the final design. In particular, we will discuss the progress towards a full three-dimensional and computationally efficient deterministic code for which the current HZETRN evaluates the lowest-order asymptotic term. HZETRN is the first deterministic solution to the Boltzmann equation allowing field mapping within the International Space Station (ISS) in tens of minutes using standard finite element method (FEM) geometry common to engineering design practice enabling development of integrated multidisciplinary design optimization methods. A single ray trace in ISS FEM geometry requires 14 ms and severely limits application of Monte Carlo methods to such engineering models. A potential means of improving the Monte Carlo efficiency in coupling to spacecraft geometry is given in terms of re-configurable computing and could be utilized in the final design as verification of the deterministic method optimized design. Published by Elsevier Ltd on behalf of COSPAR.

Minimize system cost by choosing optimal subsystem reliability and redundancy

NASA Technical Reports Server (NTRS)

Suich, Ronald C.; Patterson, Richard L.

1993-01-01

The basic question which we address in this paper is how to choose among competing subsystems. This paper utilizes both reliabilities and costs to find the subsystems with the lowest overall expected cost. The paper begins by reviewing some of the concepts of expected value. We then address the problem of choosing among several competing subsystems. These concepts are then applied to k-out-of-n: G subsystems. We illustrate the use of the authors' basic program in viewing a range of possible solutions for several different examples. We then discuss the implications of various solutions in these examples.

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

NASA Astrophysics Data System (ADS)

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

2008-08-01

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

Compact and Rugged Transceiver for Coherent Doppler Wind Lidar Applications in Space

NASA Technical Reports Server (NTRS)

Kavaya, Michael J.; Koch, Grady J.; Yu, Jirong; Amzajerdian, Farzin; Singh, Upendra N.; Trieu, Bo C.; Modlin, Ed A.; Petros, Mulugeta; Bai, Yingxin; Reithmaier, Karl;

An ab initio study on the four electronically lowest-lying states of CH 2 using the state-averaged complete active space second-order configuration interaction method

NASA Astrophysics Data System (ADS)

Yamaguchi, Yukio; Schaefer, Henry F., III

1997-12-01

Four electronically lowest-lying ( X˜ 3B 1, ã 1A 1, b˜ 1B 1, and c˜ 1A 1) states of CH 2 have been investigated systematically using ab initio electronic structure theory. Complete active space (CAS) self-consistent-field (SCF) second-order configuration interaction (SOCI) and state-averaged (SA) CASSCF-SOCI levels of theory have been employed. The CASSCF reference wave function was constructed by minimizing the total energy of a specified state, while the SACASSCF reference wave function was obtained by minimizing the equally weighted total energy of the four ( X˜ 3B 1, ã 1A 1, b˜ 1B 1, and c˜ 1A 1) states. The third excited state ( c˜ 1A 1 or 2 1A 1) is of particular theoretical interest because it is represented by the second root of CASSCF and SOCI Hamiltonian matrices. Theoretical treatments of states not the lowest of their symmetry require special attention due to their tendency of variational collapse to the lower-lying state(s). For these four lowest-lying states total energies and physical properties including dipole moments, harmonic vibrational frequencies, and associated infrared (IR) intensities were determined and compared with the results from the configuration interaction with single and double excitations (CISD) method and available experimental values. The CASSCF-SOCI method should provide the most reliable energetics and physical properties in the present study owing to its fully variational nature in the molecular orbital (MO) and CI spaces for a given state. It is demonstrated that the SACASSCF-SOCI wave functions produce results which are quite consistent with those from the CASSCF-SOCI method. Thus significantly increased application of the SACASSCF-SOCI method to the excited states of a wide variety of molecular systems is expected.

Sourcing in the Air Force: An Optimization Approach

DTIC Science & Technology

2009-09-01

quality supplies and services at the lowest cost ( Gabbard , 2004). The commodity sourcing strategy focuses on developing a specific sourcing strategy...Springer Series in Operations Research. New York: Springer-Verlag. Gabbard , E.G. (2004, April). Strategic sourcing: Critical elements and keys to success

A large-scale behavior change intervention to prevent Nipah transmission in Bangladesh: components and costs.

PubMed

Nahar, Nazmun; Asaduzzaman, Mohammad; Sultana, Rebeca; Garcia, Fernando; Paul, Repon C; Abedin, Jaynal; Sazzad, Hossain M S; Rahman, Mahmudur; Gurley, Emily S; Luby, Stephen P

2017-06-26

Nipah virus infection (NiV) is a bat-borne zoonosis transmitted to humans through consumption of NiV-contaminated raw date palm sap in Bangladesh. The objective of this analysis was to measure the cost of an NiV prevention intervention and estimate the cost of scaling it up to districts where spillover had been identified. We implemented a behavior change communication intervention in two districts, testing different approaches to reduce the risk of NiV transmission using community mobilization, interpersonal communication, posters and TV public service announcements on local television during the 2012-2014 sap harvesting seasons. In one district, we implemented a "no raw sap" approach recommending to stop drinking raw date palm sap. In another district, we implemented an "only safe sap" approach, recommending to stop drinking raw date palm sap but offering the option of drinking safe sap. This is sap covered with a barrier, locally called bana, to interrupt bats' access during collection. We conducted surveys among randomly selected respondents two months after the intervention to measure the proportion of people reached. We used an activity-based costing method to calculate the cost of the intervention. The implementation cost of the "no raw sap" intervention was $30,000 and the "only safe sap" intervention was $55,000. The highest cost was conducting meetings and interpersonal communication efforts. The lowest cost was broadcasting the public service announcements on local TV channels. To scale up a similar intervention in 30 districts where NiV spillover has occurred, would cost between $2.6 and $3.5 million for one season. Placing the posters would cost $96,000 and only broadcasting the public service announcement through local channels in 30 districts would cost $26,000. Broadcasting a TV public service announcement is a potential low cost option to advance NiV prevention. It could be supplemented with posters and targeted interpersonal communication, in districts with a high risk of NiV spillover.

Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

PubMed Central

2012-01-01

Background Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP) for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) in a large U.S. commercially-insured working age population. Methods Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM) databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM). Results We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE) of CAP were $14,429 (SE=44) overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123)), followed by diabetes ($21,395 (SE=171)) and COPD ($23,493 (SE=197)); mean excess costs were highest for patients with CHF ($34,436 (SE=549)). On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients. Conclusions Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities. PMID:23113880

Evolving design criteria for very large aperture space-based telescopes and their influence on the need for intergrated tools in the optimization process

NASA Astrophysics Data System (ADS)

Arnold, William R.

2015-09-01

NASA's Advanced Mirror Technology Development (AMTD) program has been developing the means to design and build the future generations of space based telescopes. With the nearing completion of the James Webb Space Telescope (JWST), the astrophysics community is already starting to define the requirements for follow on observatories. The restrictions of available launch vehicles and the possibilities of planned future vehicles have fueled the competition between monolithic primaries (with better optical quality) and segmented primaries (with larger apertures, but with diffraction, costs and figure control issues). Regardless of the current shroud sizes and lift capacities, these competing architectures share the need for rapid design tools. As part of the AMTD program a number of tools have been developed and tested to speed up the design process. Starting with the Arnold Mirror Modeler (which creates Finite Element Models (FEM) for structural analysis) and now also feeds these models into thermal stability analyses. They share common file formats and interchangeable results. During the development of the program, numerous trade studies were created for 4 meter and 8 meter monolithic primaries, complete with support systems. Evaluation of these results has led to a better understanding of how the specification drives the results. This paper will show some of the early trade studies for typical specification requirements such as lowest mirror bending frequency and suspension system lowest frequency. The results use representative allowable stress values for each mirror substrate material and construction method and generic material properties. These studies lead to some interesting relationships between feasible designs and the realities of actually trying to build these mirrors. Much of the traditional specifications were developed for much smaller systems, where the mass and volume of the primary where a small portion of the overall satellite. JWST shows us that as the aperture grows, the primary takes up the majority of the mass and volume and the established rules need to be adjusted. For example, a small change in lowest frequency requirement can change the cost by millions of dollars.

Evolving Design Criteria for Very Large Aperture Space-Based Telescopes and Their Influence on the Need for Integrated Tools in the Optimization Process

NASA Technical Reports Server (NTRS)

Arnold, William R., Sr.

2015-01-01

NASA's Advanced Mirror Technology Development (AMTD) program has been developing the means to design and build the future generations of space based telescopes. With the nearing completion of the James Webb Space Telescope (JWST), the astrophysics community is already starting to define the requirements for follow on observatories. The restrictions of available launch vehicles and the possibilities of planned future vehicles have fueled the competition between monolithic primaries (with better optical quality) and segmented primaries (with larger apertures, but with diffraction, costs and figure control issues). Regardless of the current shroud sizes and lift capacities, these competing architectures share the need for rapid design tools. As part of the AMTD program a number of tools have been developed and tested to speed up the design process. Starting with the Arnold Mirror Modeler (which creates Finite Element Models (FEM) for structural analysis) and now also feeds these models into thermal stability analyses. They share common file formats and interchangeable results. During the development of the program, numerous trade studies were created for 4 meter and 8 meter monolithic primaries, complete with support systems. Evaluation of these results has led to a better understanding of how the specification drives the results. This paper will show some of the early trade studies for typical specification requirements such as lowest mirror bending frequency and suspension system lowest frequency. The results use representative allowable stress values for each mirror substrate material and construction method and generic material properties. These studies lead to some interesting relationships between feasible designs and the realities of actually trying to build these mirrors. Much of the traditional specifications were developed for much smaller systems, where the mass and volume of the primary where a small portion of the overall satellite. JWST shows us that as the aperture grows, the primary takes up the majority of the mass and volume and the established rules need to be adjusted. For example, a small change in lowest frequency requirement can change the cost by millions of dollars.

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

U.S. and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review.

PubMed

Harvey, Michael J; Gaies, Michael G; Prosser, Lisa A

2015-08-01

The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'. Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs. Data extraction was completed by one author, using predefined criteria. From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g., range of total in-hospital costs of treatment: USD 42,554-537,554 [in 2013 values]). In the U.S.A., the reported costs of ECMO were highest for CDH repair, followed by cardiac conditions, and lowest for respiratory conditions. The US charges were highest for cardiac conditions. Outside the U.S.A., the ECMO cost was highest for cardiac conditions, followed by respiratory conditions, and lowest for CDH repair. No non-US studies reported charges. The current literature shows that a large variation exists in the in-hospital cost estimates for ECMO. Further research is needed to understand how the diagnosis, setting and other factors relate to this variation in the cost of this technology. Reliable costing methodologies and cost information will be critical to inform policymakers and stakeholders wishing to maximize the value of advanced medical technologies such as ECMO.

Cost/performance of solar reflective surfaces for parabolic dish concentrators

NASA Technical Reports Server (NTRS)

Bouquet, F.

1980-01-01

Materials for highly reflective surfaces for use in parabolic dish solar concentrators are discussed. Some important factors concerning performance of the mirrors are summarized, and typical costs are treated briefly. Capital investment cost/performance ratios for various materials are computed specifically for the double curvature parabolic concentrators using a mathematical model. The results are given in terms of initial investment cost for reflective surfaces per thermal kilowatt delivered to the receiver cavity for various operating temperatures from 400 to 1400 C. Although second surface glass mirrors are emphasized, first surface, chemically brightened and anodized aluminum surfaces as well as second surface, metallized polymeric films are treated. Conventional glass mirrors have the lowest cost/performance ratios, followed closely by aluminum reflectors. Ranges in the data due to uncertainties in cost and mirror reflectance factors are given.

Electrical conductivity of oxidized-graphenic nanoplatelets obtained from bamboo: effect of the oxygen content

NASA Astrophysics Data System (ADS)

Gross, K.; Prías Barragán, J. J.; Sangiao, S.; De Teresa, J. M.; Lajaunie, L.; Arenal, R.; Ariza Calderón, H.; Prieto, P.

2016-09-01

The large-scale production of graphene and reduced-graphene oxide (rGO) requires low-cost and eco-friendly synthesis methods. We employed a new, simple, cost-effective pyrolytic method to synthetize oxidized-graphenic nanoplatelets (OGNP) using bamboo pyroligneous acid (BPA) as a source. Thorough analyses via high-resolution transmission electron microscopy and electron energy-loss spectroscopy provides a complete structural and chemical description at the local scale of these samples. In particular, we found that at the highest carbonization temperature the OGNP-BPA are mainly in a sp2 bonding configuration (sp2 fraction of 87%). To determine the electrical properties of single nanoplatelets, these were contacted by Pt nanowires deposited through focused-ion-beam-induced deposition techniques. Increased conductivity by two orders of magnitude is observed as oxygen content decreases from 17% to 5%, reaching a value of 2.3 × 103 S m-1 at the lowest oxygen content. Temperature-dependent conductivity reveals a semiconductor transport behavior, described by the Mott three-dimensional variable range hopping mechanism. From the localization length, we estimate a band-gap value of 0.22(2) eV for an oxygen content of 5%. This investigation demonstrates the great potential of the OGNP-BPA for technological applications, given that their structural and electrical behavior is similar to the highly reduced rGO sheets obtained by more sophisticated conventional synthesis methods.

Energy conversion approaches and materials for high-efficiency photovoltaics.

PubMed

Green, Martin A; Bremner, Stephen P

2016-12-20

The past five years have seen significant cost reductions in photovoltaics and a correspondingly strong increase in uptake, with photovoltaics now positioned to provide one of the lowest-cost options for future electricity generation. What is becoming clear as the industry develops is that area-related costs, such as costs of encapsulation and field-installation, are increasingly important components of the total costs of photovoltaic electricity generation, with this trend expected to continue. Improved energy-conversion efficiency directly reduces such costs, with increased manufacturing volume likely to drive down the additional costs associated with implementing higher efficiencies. This suggests the industry will evolve beyond the standard single-junction solar cells that currently dominate commercial production, where energy-conversion efficiencies are fundamentally constrained by Shockley-Queisser limits to practical values below 30%. This Review assesses the overall prospects for a range of approaches that can potentially exceed these limits, based on ultimate efficiency prospects, material requirements and developmental outlook.

Water-supply options in arsenic-affected regions in Cambodia: targeting the bottom income quintiles.

PubMed

Chamberlain, Jim F; Sabatini, David A

2014-08-01

In arsenic-affected regions of Cambodia, rural water committees and planners can choose to promote various arsenic-avoidance and/or arsenic-removal water supply systems. Each of these has different costs of providing water, subsequently born by the consumer in order to be sustainable. On a volumetric basis ($/m3-yr) and of the arsenic-avoidance options considered, small-scale public water supply - e.g., treated water provided to a central tap stand - is the most expensive option on a life-cycle cost basis. Rainwater harvesting, protected hand dug wells, and vendor-supplied water are the cheapest with a normalized present worth value, ranging from $2 to $10 per cubic meter per year of water delivered. Subsidization of capital costs is needed to make even these options affordable to the lowest (Q5) quintile. The range of arsenic-removal systems considered here, using adsorptive media, is competitive with large-scale public water supply and deep tube well systems. Both community level and household-scale systems are in a range that is affordable to the Q4 quintile, though more research and field trials are needed. At a target cost of $5.00/m3, arsenic removal systems will compete with the OpEx costs for most of the arsenic-safe water systems that are currently available. The life-cycle cost approach is a valuable method for comparing alternatives and for assessing current water supply practices as these relate to equity and the ability to pay. Copyright © 2013 Elsevier B.V. All rights reserved.

Relative benefits of potential autonomy technology investments

NASA Technical Reports Server (NTRS)

Lincoln, W. P.; Elfes, A.; Hutsberger, T.; Rodriguez, G.; Weisbin, C. R.

2003-01-01

We developed a framework that looks at both cost and risk early in the design process in order to determine the investment strategy in new technology development that will lead to the lowest risk mission possible which enables desired science return within a given budget.

The Evolution of the Shared Services Business Unit.

ERIC Educational Resources Information Center

Forst, Leland

2000-01-01

Explains shared services, where common business practices are applied by a staff unit focused entirely on delivering needed services at the highest value and lowest cost to internal customers. Highlights include accountability; examples of pioneering shared services organizations; customer focus transition; relationship management; expertise…

Science and the Citizen.

ERIC Educational Resources Information Center

Scientific American, 1978

1978-01-01

Describes scientific events: computed tomography (CT) scanner and its costs, existence of Upsilon particle in its lowest excited state, animal psychology to determine their capabilities of symbolic communication, findings of Viking mission about Mars and its two moons, and finally gives credit to first discoverer of penicillin. (GA)

Lessons Learned From the Affordable Care Act: The Premium Subsidy Design May Promote Adverse Selection.

PubMed

Graetz, Ilana; McKillop, Caitlin N; Kaplan, Cameron M; Waters, Teresa M

2017-05-01

Since 2014, average premiums for health plans available in the Affordable Care Act marketplaces have increased. We examine how premium price changes affected the amount consumers pay after subsidies for the lowest-cost bronze and silver plans available by age in the federally facilitated exchanges. Between 2015 and 2016, benchmark plan premiums increased in 83.3% of counties. Overall, rising benchmark premiums were associated with lower average after-subsidy premiums for the lowest-cost bronze and silver plans for older subsidy-eligible adults, but with higher after-subsidy premiums for younger adults purchasing the same plans, regardless of income. With recent discussions to replace or overhaul the Affordable Care Act, it is critical that we learn from the successes and failures of the current policy. Our findings suggest that the subsidy design, which makes rising premiums costlier for younger adults looking to purchase an entry-level plan, may be contributing to adverse selection and instability in the marketplace.

Power plant allocation in East Kalimantan considering total cost and emissions

NASA Astrophysics Data System (ADS)

Muslimin; Utomo, D. S.

2018-04-01

The fulfillment of electricity need in East Kalimantan is the responsibility of State Electricity Company/Perusahaan Listrik Negara (PLN). But PLN faces constraints in the lack of generating capacity it has. So the allocation of power loads in East Kalimantan has its own challenges. Additional power supplies from other parties are required. In this study, there are four scenarios tested to meet the electricity needs in East Kalimantan with the goal of minimizing costs and emissions. The first scenario is only by using PLN power plant. The second scenario is by combining PLN + Independent Power Producer (IPP) power plants. The third scenario is by using PLN + Rented power plants. The fourth scenario is by using PLN + Excess capacity generation. Numerical experiment using nonlinear programming is conducted with the help of the solver. The result shows that in the peak load condition, the best combination is scenario 2 (PLN + IPP). While at the lowest load condition, the cheapest scenario is PLN + IPP while the lowest emission is PLN + Rent.

Cost-benefit analysis for invasive species control: the case of greater Canada goose Branta canadensis in Flanders (northern Belgium)

PubMed Central

Casaer, Jim; De Smet, Lieven; Devos, Koen; Huysentruyt, Frank; Robertson, Peter A.; Verbeke, Tom

2018-01-01

Background Sound decisions on control actions for established invasive alien species (IAS) require information on ecological as well as socio-economic impact of the species and of its management. Cost-benefit analysis provides part of this information, yet has received relatively little attention in the scientific literature on IAS. Methods We apply a bio-economic model in a cost-benefit analysis framework to greater Canada goose Branta canadensis, an IAS with documented social, economic and ecological impacts in Flanders (northern Belgium). We compared a business as usual (BAU) scenario which involved non-coordinated hunting and egg destruction with an enhanced scenario based on a continuation of these activities but supplemented with coordinated capture of moulting birds. To assess population growth under the BAU scenario we fitted a logistic growth model to the observed pre-moult capture population. Projected damage costs included water eutrophication and damage to cultivated grasslands and were calculated for all scenarios. Management costs of the moult captures were based on a representative average of the actual cost of planning and executing moult captures. Results Comparing the scenarios with different capture rates, different costs for eutrophication and various discount rates, showed avoided damage costs were in the range of 21.15 M€ to 45.82 M€ under the moult capture scenario. The lowest value for the avoided costs applied to the scenario where we lowered the capture rate by 10%. The highest value occurred in the scenario where we lowered the real discount rate from 4% to 2.5%. Discussion The reduction in damage costs always outweighed the additional management costs of moult captures. Therefore, additional coordinated moult captures could be applied to limit the negative economic impact of greater Canada goose at a regional scale. We further discuss the strengths and weaknesses of our approach and its potential application to other IAS. PMID:29404211

A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia.

PubMed

Lee, Jung-Seok; Mogasale, Vittal; Lim, Jacqueline K; Carabali, Mabel; Lee, Kang-Sung; Sirivichayakul, Chukiat; Dang, Duc Anh; Palencia-Florez, Diana Cristina; Nguyen, Thi Hien Anh; Riewpaiboon, Arthorn; Chanthavanich, Pornthep; Villar, Luis; Maskery, Brian A; Farlow, Andrew

2017-10-01

Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run.

The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure

PubMed Central

Joynt, Karen E.; Orav, E. John; Jha, Ashish K.

2012-01-01

Background Congestive Heart Failure (CHF) is common and costly, and despite pharmacologic and technical advances, outcomes remain suboptimal. Objective To examine whether hospitals that have more experience caring for patients with CHF provide better, more efficient care. Design We used national Medicare claims data from 2006–2007 to examine the relationship between hospitals’ case volume and quality, outcomes, and costs for patients with CHF. Setting 4,095 U.S. hospitals Patients Medicare fee-for-service patients with a primary discharge diagnosis of CHF Measurements Hospital Quality Alliance (HQA) CHF process measures, 30-day risk-adjusted mortality rates, 30-day risk-adjusted readmission rates, and costs per discharge. Results Hospitals in the lowest volume group had lower performance on HQA measures than medium- or high-volume hospitals (80.2% versus 87.0% versus 89.1%, p<0.001). Within the low volume group, being admitted to a hospital with a higher case volume was associated with lower mortality, lower readmission, and higher costs. For example, in the lowest volume group of hospitals, an increase of 10 cases of CHF was associated with 1% lower odds of mortality, 1% lower odds of readmissions and $22 higher costs per case. We found similar though smaller relationships between case volume and both mortality and costs in the medium and high-volume hospital cohorts. Limitations Our analysis was limited to Medicare patients 65 years of age or older; risk adjustment was performed using administrative data. Conclusions Experience with managing CHF, as measured by an institution’s volume, is associated with higher quality of care and better outcomes for patients, but at a higher cost. Understanding which practices employed by high-volume institutions account for these advantages can help improve quality of care and clinical outcomes for all CHF patients. PMID:21242366

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

PubMed Central

Chung, Roger Y; Tin, Keith YK; Cowling, Benjamin J; Chan, King Pan; Chan, Wai Man; Lo, Su Vui; Leung, Gabriel M

2009-01-01

Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC) expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning. PMID:19775476

The cost of unresectable stage III or stage IV melanoma in Italy

PubMed Central

2012-01-01

Background In recent decades, melanoma incidence has been increasing in European countries; in 2006, there were approximately 60,000 cases leading to 13,000 deaths. Within Europe there is some geographical variation in the incidence of melanoma, with the highest rates reported in Scandinavia (15 cases per 100,000 inhabitants per year) and the lowest in the Mediterranean countries (5 to 7 cases per 100,000 inhabitants per year). Methods The present article is based on the information collected in the MELODY study (MELanoma treatment patterns and Outcomes among patients with unresectable stage III or stage IV Disease: a retrospective longitudinal survey). In that study, the medical charts of patients were reviewed to document current treatment patterns and to analyse information on patients, disease characteristics and healthcare resource utilization related to the treatment of advanced melanoma regarding patients who presented with a diagnosis of malignant melanoma (stage I to IV) at participating sites between 01 July, 2005 and 30 June, 2006. Results Summarizing, though the length of the follow-up period varies among sample patients, an amount of the yearly cost per patient can be estimated, dividing the average per patient total cost (€ 5.040) by the average follow-up duration (17.5 months) and reporting to one year; on these grounds, unresectable stage III or stage IV melanoma in Italy would cost € 3,456 per patient per year. PMID:23116062

Genetic Algorithm Optimization of a Cost Competitive Hybrid Rocket Booster

NASA Technical Reports Server (NTRS)

Story, George

2015-01-01

Performance, reliability and cost have always been drivers in the rocket business. Hybrid rockets have been late entries into the launch business due to substantial early development work on liquid rockets and solid rockets. Slowly the technology readiness level of hybrids has been increasing due to various large scale testing and flight tests of hybrid rockets. One remaining issue is the cost of hybrids versus the existing launch propulsion systems. This paper will review the known state-of-the-art hybrid development work to date and incorporate it into a genetic algorithm to optimize the configuration based on various parameters. A cost module will be incorporated to the code based on the weights of the components. The design will be optimized on meeting the performance requirements at the lowest cost.

Genetic Algorithm Optimization of a Cost Competitive Hybrid Rocket Booster

NASA Technical Reports Server (NTRS)

Story, George

2014-01-01

Performance, reliability and cost have always been drivers in the rocket business. Hybrid rockets have been late entries into the launch business due to substantial early development work on liquid rockets and later on solid rockets. Slowly the technology readiness level of hybrids has been increasing due to various large scale testing and flight tests of hybrid rockets. A remaining issue is the cost of hybrids vs the existing launch propulsion systems. This paper will review the known state of the art hybrid development work to date and incorporate it into a genetic algorithm to optimize the configuration based on various parameters. A cost module will be incorporated to the code based on the weights of the components. The design will be optimized on meeting the performance requirements at the lowest cost.

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

PubMed Central

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

2016-01-01

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

PhoneSat - The Smartphone Nanosatellite

NASA Technical Reports Server (NTRS)

Cockrell, James J.; Yost, Bruce; Petro, Andrew

2013-01-01

NASAs PhoneSat project will test whether spacecraft can be built using smartphones to launch the lowest-cost satellites ever flown in space. Each PhoneSat nanosatellite is one cubesat unit - a satellite in a 10 cm (approx. 4 inches) cube or about the size of a tissue box - and weighs approximately three pounds. Engineers believe PhoneSat technology will enable NASA to launch multiple new satellites capable of conducting science and exploration missions at a small fraction of the cost of conventional satellites.

PhoneSat - The Smartphone Nanosatellite

NASA Technical Reports Server (NTRS)

Cockrell, James J.; Yost, Bruce; Petro, Andrew

2013-01-01

NASA's PhoneSat project tests whether spacecraft can be built using smartphones to launch the lowest-cost satellites ever flown in space. Each PhoneSat nanosatellite is one cubesat unit - a satellite in a 10 cm (approx. 4 inches) cube or about the size of a tissue box - and weighs approximately 1 kg (2.2 pounds). Engineers believe PhoneSat technology will enable NASA to launch multiple new satellites capable of conducting science and exploration missions at a small fraction of the cost of conventional satellites.

Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project.

PubMed

De Smedt, Delphine; Kotseva, Kornelia; De Bacquer, Dirk; Wood, David; De Backer, Guy; Dallongeville, Jean; Seppo, Lehto; Pajak, Andrzej; Reiner, Zeljko; Vanuzzo, Diego; Georgiev, Borislav; Gotcheva, Nina; Annemans, Lieven

2012-11-01

The EUROASPIRE III survey indicated that the guidelines on cardiovascular disease prevention are poorly implemented in patients with established coronary heart disease (CHD). The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in eight EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, and the U.K.). METHODS AND RESULTS The individual risk for subsequent cardiovascular events was estimated, based on published Framingham equations. Based on the EUROASPIRE III data, the type of suboptimal prevention, if any, was identified for each individual, and the effects of optimized tailored prevention (smoking cessation, diet and exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated. Costs of prevention and savings of avoided events were based on country-specific data. A willingness to pay threshold of €30,000/quality-adjusted life year (QALY) was used. The robustness of the results was validated by sensitivity analyses. Overall, the cost-effectiveness analyses for the eight countries showed mainly favourable results with an average incremental cost-effectiveness ratio (ICER) of €12,484 per QALY. Only in the minority of patients at the lowest risk for recurrent events, intensifying preventive therapy seems not cost-effective. Also, the single impact of intensified cholesterol control seems less cost-effective, possibly because their initial 2-year risk was already fairly low, hence the room for improvement is rather limited. These results underscore the societal value of optimizing prevention in most patients with established CHD, but also highlight the need for setting priorities towards patients more at risk and the need for more studies comparing intensified prevention with usual care in these patients.

Economic analysis of fuel ethanol production from winter hulled barley by the EDGE (Enhanced Dry Grind Enzymatic) process.

PubMed

Nghiem, Nhuan P; Ramírez, Edna C; McAloon, Andrew J; Yee, Winnie; Johnston, David B; Hicks, Kevin B

2011-06-01

A process and cost model was developed for fuel ethanol production from winter barley based on the EDGE (Enhanced Dry Grind Enzymatic) process. In this process, in addition to β-glucanases, which are added to reduce the viscosity of the mash, β-glucosidase is also added to completely hydrolyze the oligomers obtained during the hydrolysis of β-glucans to glucose. The model allows determination of capital costs, operating costs, and ethanol production cost for a plant producing 40 million gallons of denatured fuel ethanol annually. A sensitivity study was also performed to examine the effects of β-glucosidase and barley costs on the final ethanol production cost. The results of this study clearly demonstrate the economic benefit of adding β-glucosidase. Lower ethanol production cost was obtained compared to that obtained without β-glucosidase addition in all cases except one where highest β-glucosidase cost allowance and lowest barley cost were used. Copyright © 2011 Elsevier Ltd. All rights reserved.

Near-term hybrid vehicle program, phase 1. Appendix D: Sensitivity analysis resport

NASA Technical Reports Server (NTRS)

1979-01-01

Parametric analyses, using a hybrid vehicle synthesis and economics program (HYVELD) are described investigating the sensitivity of hybrid vehicle cost, fuel usage, utility, and marketability to changes in travel statistics, energy costs, vehicle lifetime and maintenance, owner use patterns, internal combustion engine (ICE) reference vehicle fuel economy, and drive-line component costs and type. The lowest initial cost of the hybrid vehicle would be $1200 to $1500 higher than that of the conventional vehicle. For nominal energy costs ($1.00/gal for gasoline and 4.2 cents/kWh for electricity), the ownership cost of the hybrid vehicle is projected to be 0.5 to 1.0 cents/mi less than the conventional ICE vehicle. To attain this ownership cost differential, the lifetime of the hybrid vehicle must be extended to 12 years and its maintenance cost reduced by 25 percent compared with the conventional vehicle. The ownership cost advantage of the hybrid vehicle increases rapidly as the price of fuel increases from $1 to $2/gal.

Low cost Ku-band earth terminals for voice/data/facsimile

NASA Technical Reports Server (NTRS)

Kelley, R. L.

1977-01-01

A Ku-band satellite earth terminal capable of providing two way voice/facsimile teleconferencing, 128 Kbps data, telephone, and high-speed imagery services is proposed. Optimized terminal cost and configuration are presented as a function of FDMA and TDMA approaches to multiple access. The entire terminal from the antenna to microphones, speakers and facsimile equipment is considered. Component cost versus performance has been projected as a function of size of the procurement and predicted hardware innovations and production techniques through 1985. The lowest cost combinations of components has been determined in a computer optimization algorithm. The system requirements including terminal EIRP and G/T, satellite size, power per spacecraft transponder, satellite antenna characteristics, and link propagation outage were selected using a computerized system cost/performance optimization algorithm. System cost and terminal cost and performance requirements are presented as a function of the size of a nationwide U.S. network. Service costs are compared with typical conference travel costs to show the viability of the proposed terminal.

Hospital-based glaucoma clinics: what are the costs to patients?

PubMed

Sharma, A; Jofre-Bonet, M; Panca, M; Lawrenson, J G; Murdoch, I

2010-06-01

To investigate the costs to patients attending hospital-based glaucoma clinics. A patient-based costs questionnaire was developed and completed for patients attending six ophthalmology units across London (Ealing General Hospital, St Georges Hospital, Mile End Hospital, Upney Centre Barking, St Ann's Hospital and the Royal London Hospital). The questionnaire considered age, sex, ethnicity as well as patient-based costs, opportunity costs, and companion costs. All patients visiting for review or appointments were approached non-selectively. A total of 100 patients were sampled from each unit. The mean age of the full sample was 69.6 years (SD 12.6), with little variation between sites (68.5-71.8 years). There was an almost equal sex distribution (male (298 (50.6%)). There was no major difference in occupational distribution between sites. The majority of people came to hospital by bus (40%) or car (26%). Female patients went slightly more by cab or car, whereas male patients went slightly more by foot or train. There was some variability in transport method by site. The data showed that the Royal London hospital had the highest mean cost per visit (pound16.20), whereas St Georges had the lowest (pound12.90). Upney had the second highest mean cost per visit (pound15.20), whereas Ealing and St Ann's had similar mean costs of (pound13.25) and (pound13), respectively. Travel costs accounted for about one-fifth of the total patient's costs. For all glaucoma clinics, total societal costs were higher than the sum of patients' costs because of the high frequency of companions. A surprising finding was that two-thirds of the population (392 or 66.6%) reported no qualification-considerably higher than the national census statistics for the same population. To our knowledge this paper presents direct and indirect patient costs in attending hospital glaucoma units for the first time. It highlights the significance of opportunity costs when considering health-care interventions as they amount to a third or more of the total costs of patient attendances to clinics.

Cost per care of the first year of direct antiviral agents in the Liguria Region: a multicenter analysis

PubMed Central

Cenderello, Giovanni; Fanizza, Caterina; Marenco, Simona; Nicolini, Laura Ambra; Artioli, Stefania; Baldissarro, Isabella; Dentone, Chiara; De Leo, Pasqualina; Di Biagio, Antonio

2017-01-01

Aims Despite the remarkable efficacy shown in clinical practice, concerns have been raised about the costs associated with direct antiviral agent (DAA) therapy. This article presents the real-life costs for DAA treatment sustained by the Italian National Health Service in the Liguria Region (Northern Italy). Methods A retrospective analysis of the cost per care sustained for DAA treatment, relating to the period from January 1 to December 31, 2015 in five centers in Liguria was performed. All patients undergoing DAA-based treatments for hepatitis C virus (HCV) infection were enrolled. On-treatment costs included: HCV treatment, laboratory test, outpatient services, attended visits, drugs used for the management of adverse events (erythropoietin, albumin or red blood cell packs) and inpatient service admissions. Results In total, 327 patients were enrolled. No difference in terms of sustained virologic response (SVR) rate among different treatments was reported. The majority (85.0%) of patients did not report any side effects and only 15 (4.6%) required hospital admission. Forty-two patients (12.8%) required high-cost drugs for the management of adverse events. The overall cost sustained was €14,744,433. DAA±ribavirin (RBV) accounted for the wide majority of this cost (98.9%; €14,585,123). Genotype (GT) 1, the most commonly treated GT, was associated with an average cost of €43,445 per patient. Detailed analysis of the costs for GT 1 showed the treatment based on ritonavir boosted paritaprevir/ombitasvir + dasabuvir±RBV with an average cost of €24,978 (RBV+) and €25,448 (RBV−) per patient was the most cost-effective. The average cost per SVR was €48,184. Once again, the ritonavir boosted paritaprevir/ombitasvir + dasabuvir regimen was associated with the lowest cost/SVR (€25,448/SVR [GT 1b] and similar results for other GTs). Conclusion Antiviral regimen is the major contributor to costs in the treatment of HCV infection. Appropriate regimen selection could result in a major cost saving, which can be reinvested to allow more patients to be treated. PMID:28579812

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

PubMed

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

2016-01-01

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

Apparatus and method for investigation of energy consumption of microwave assisted drying systems.

PubMed

Göllei, Attila; Vass, András; Magyar, Attila; Pallai, Elisabeth

2009-10-01

Convective, hot air drying by itself is relatively efficient for removing water from the surface environment of agricultural seed products. However, moving internal moisture to the surface needs rather a long time, as a rule. The major research aim of the authors was to decrease the processing time and processing costs, to improve the quality of the dried product, and to increase drying efficiency. For this reason their research activities focused on the development of a special drying apparatus and a method suitable for measuring of energy conditions in a hybrid (microwave and convective) dryer. Experimental investigations were made with moistened wheat as model material. Experiments were carried out in microwave, convective and hybrid drying systems. The microwave drying alone was more efficient than the convective method. The lowest energy consumption and shortest drying time were obtained by the use of a hybrid method in which the waste energy of magnetron was utilized and the temperature was controlled. In this way, it was possible to keep the temperature of the dried product at a constant and safe value and to considerably decrease the energy consumption.

Recombinase polymerase amplification (RPA) combined with lateral flow (LF) strip for equipment-free detection of Cryptosporidium spp. oocysts in dairy cattle feces.

PubMed

Wu, Yao-Dong; Zhou, Dong-Hui; Zhang, Long-Xian; Zheng, Wen-Bin; Ma, Jian-Gang; Wang, Meng; Zhu, Xing-Quan; Xu, Min-Jun

2016-09-01

Cryptosporidium is a widespread protozoan parasite that infects a large number of vertebrate animals, resulting in varying degrees of diarrhea or even death. As dairy cattle feces is an important source of Cryptosporidium spp. infection, development of a handy and accurate detection method via its oocysts in dairy cattle feces would be interesting and necessary. We herein developed a quick detecting method using recombinase polymerase amplification (RPA) combined with lateral flow (LF) strip to detect DNA of Cryptosporidium oocysts in dairy cattle feces. The DNA was released by boiled water with 0.1 % N-lauroylsarcosine sodium salt (LSS). The established method was proven to be of higher sensitivity than normal polymerase chain reaction (PCR) amplification with the lowest detection of 0.5 oocyst per reaction, and specificity with no cross reactivity to other common protozoan species in the intestine of dairy cattle. The diagnostic method established herein is simple, rapid, and cost-effective, and has potential for further development as a diagnostic kit for the diagnosis of cryptosporidiosis of dairy cattle.

Supply Chain Management: Are You Maximizing Your Procurement Activity?

ERIC Educational Resources Information Center

Dobbin, James; Jenkins, Mike

2000-01-01

Today's purchasing professionals recognize the need to reduce non-value-added procedures (clerical functions) while emphasizing strategic planning. Results-oriented supply-chain managers need superb communication, negotiation, and leadership skills to achieve long-term value and resist the lowest, first- cost bids. (Contains 13 references.) (MLH)

Pricing and availability of some essential child specific medicines in Odisha

PubMed Central

Swain, Trupti Rekha; Rath, Bandana; Dehury, Suhasini; Tarai, Anjali; Das, Priti; Samal, Rajashree; Samal, Satyajit; Nayak, Harshavardhan

2015-01-01

Objectives: Continuous availability of affordable medicines in appropriate formulations is essential to reduce morbidity and mortality in children. Odisha an eastern Indian state records very high mortality of children. The study aims at documenting the availability and prices paid for purchasing essential child-specific medicines. Materials and Methods: The survey of 34 essential medicines was conducted in six randomly selected districts of Odisha. Data were collected from medicine outlets of the public, private, and other sector (Nongovernmental Organization [NGO]/mission sectors) of six randomly selected districts, using WHO/Health Action International medicine price collection methodology. For each medicine surveyed, data were collected on the highest and lowest-priced formulations available in each facility. Results: Both public sector and other sector health facilities procure only one brand of medicines, mean percentage availability of medicines being 17% and 21.8%, respectively. In the private sector, the mean percentage availability of the high and lowest-priced medicines for a particular drug product was 10.8% and 38.5%, respectively. The public sector procurement price is 48% lower than international reference prices. In the private sector, high-priced, and low-priced products are sold at 1.83 and 1.46 times the international reference price, respectively. Substantial price variation was observed for some medicines across individual outlets. Medicines were found to cost 2.08 times their international reference price in NGO/mission sector facilities. Conclusions: The availability of children's medicines in public sector facilities of Odisha state is poor. Medicines for children cost relatively high in both private and NGO sectors compared to the international reference price. The availability medicines should be improved on an urgent basis to improve access of medicines for children of Odisha. PMID:26600637

Improving the first-line treatment of febrile illnesses in Ghana: willingness to pay for malaria rapid diagnostic tests at licensed chemical shops in the Kintampo area.

PubMed

Tawiah, Theresa; Malam, Keziah; Kwarteng, Anthony; Bart-Plange, Constance; Febir, Lawrence; Aubyn, Vivian; Obermann, Konrad; Owusu-Agyei, Seth; Asante, Kwaku Poku

2018-01-01

Use of malaria rapid diagnostic test (mRDT) enhances patient management and reduces costs associated with the inappropriate use of antimalarials. Despite its proven clinical effectiveness, mRDT is not readily available at licensed chemical shops in Ghana. Therefore, in order to improve the use of mRDT, there is the need to understand the willingness to pay for and sell mRDT. This study assessed patients' willingness to pay and licensed chemical operators' (LCS) willingness to sell mRDTs. The study was a cross-sectional survey conducted in Kintampo North Municipality and Kintampo South District of Ghana. Contingent valuation method using the dichotomous approach was applied to explore patient's willingness to pay. In-depth interviews (IDIs) were used to obtain information from licensed chemical operators' willingness to sell. Majority 161 (97%) of the customers were willing to pay for mRDT while 100% of licensed chemical operators were also willing to sell mRDT. The average lowest amount respondents were willing to pay was Ghana cedis (GH¢) 1.1 (US$ 0.26) and an average highest amount of GH¢ 2.1 (US$ 0.49). LCS operators were willing to sell the test kit at an average lowest price of GH¢1 (US$ 0.23) and average highest price of GH¢2 (US$ 0.47). Community members were willing to pay for mRDT and LCS operators are willing to sell mRDTs. However, the high cost of the mRDT is likely to prevent the widespread use of mRDT. There is a clear need to find system-compatible ways to subsidize the use of mRDT via National Health Insurance scheme.

Economic and environmental review of Waste-to-Energy systems for municipal solid waste management in medium and small municipalities.

PubMed

Fernández-González, J M; Grindlay, A L; Serrano-Bernardo, F; Rodríguez-Rojas, M I; Zamorano, M

2017-09-01

The application of Directive 2008/98/CE on Municipal Solid Waste (MSW) implies the need to introduce technologies to generate energy from waste. Incineration, the most widely used method, is difficult to implement in low populated areas because it requires a large amount of waste to be viable (100,000 tons per year). This paper analyses the economic and environmental costs of different MSW-to-Energy technologies (WtE) in an area comprising of 13 municipalities in southern Spain. We analyse anaerobic digestion (Biomethanization), the production of solid recovered fuel (SRF) and gasification, and compare these approaches to the present Biological Mechanical Treatment (BMT) with elimination of the reject in landfill, and incineration with energy recovery. From an economic standpoint the implementation of WtE systems reduces the cost of running present BMT systems and incineration; gasification presents the lowest value. From the environmental standpoint, Life Cycle Assessment shows that any WtE alternatives, including incineration, present important advantages for the environment when compared to BMT. Finally, in order to select the best alternative, a multi-criteria method is applied, showing that anaerobic digestion is the optimal solution for the area studied. Copyright © 2017 Elsevier Ltd. All rights reserved.

Job demand-control and job stress at work: A cross-sectional study among prison staff

PubMed Central

Akbari, Jafar; Akbari, Rouhollah; Shakerian, Mahnaz; Mahaki, Behzad

2017-01-01

Introduction: Job stress can impose significant costs to the workplaces and organizations due to some issues such as absenteeism, less productivity, and medical costs. Job overload and lack of decision latitude can lead to job stress. The current study aimed to investigate the job demands and control as predictor of job stress and its relationship, with some of the demographic characteristics of Iranian prison staff. Materials and Methods: This study was performed on 171 male employees working in four prisons located in Ilam, Iran. The sampling method was census and all four prisons’ staff were selected to respond the Job Content Questionnaires. Finally, the data were analyzed using t-test or independent samples test as well as SPSS 20. Results: The highest amount of job demand (mean = 21.28) and the lowest amount of job control on average (9.76) were reported by those staff working in Darehshahr prison. There was also a significant relationship between job post and job control among the prison staff (β = −0.375, P = 0.001). Conclusion: The level of job stress reported by prison staff was high in this study mainly caused by high job demand and low job control, especially in Darehshahr prison staff. PMID:28546980

Technical Development of Slurry Three-Dimensional Printer

NASA Astrophysics Data System (ADS)

Jiang, Cho-Pei; Hsu, Huang-Jan; Lee, Shyh-Yuan

2017-09-01

The aim of this paper is to review the technical development of slurry three-dimensional printer (3DP) which based on photo-polymerization and constrained surface method. Basically, slurry consists of ceramic powder, resin and photo-initiator. The light engines for solidifying the photo-curable slurry can be classified as laser, liquid crystal panel (LCD), digital light processing (DLP). The slurry can be reacted and solidified by selective ray according to the reaction spectrum of photo-initiator. Ceramic powder used in this study is zirconia oxide. Experimental results show that ceramic particle size affects the viscosity of slurry severely resulting in low accuracy and the occurrence of micro crack in the layer casting procedure. Therefore, the effect of particle size on the curability and accuracy of built green part is discussed. A single dental crown is proposed to be fabricated by these three light engines as a benchmark for comparison. In addition, the cost and the limitation are compared in the aspect of dental crown fabrication. Consequently, the lowest cost is LCD-type slurry 3DP system. DLP-type slurry 3DP can produce green body with the fastest fabrication time. The volumetric error of sintered part that made by these three fabrication methods is similar because the composition of slurry is the same.

Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe

PubMed Central

Hatzold, Karin; Reed, Jason; Edgil, Dianna; Jaramillo, Juan; Castor, Delivette; Forsythe, Steven; Xaba, Sinokuthemba; Mugurungi, Owen

2014-01-01

Background Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. Methods and Findings We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. Conclusions VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established. PMID:24801515

Inventory of Data Sources for Estimating Health Care Costs in the United States

PubMed Central

Lund, Jennifer L.; Yabroff, K. Robin; Ibuka, Yoko; Russell, Louise B.; Barnett, Paul G.; Lipscomb, Joseph; Lawrence, William F.; Brown, Martin L.

2011-01-01

Objective To develop an inventory of data sources for estimating health care costs in the United States and provide information to aid researchers in identifying appropriate data sources for their specific research questions. Methods We identified data sources for estimating health care costs using 3 approaches: (1) a review of the 18 articles included in this supplement, (2) an evaluation of websites of federal government agencies, non profit foundations, and related societies that support health care research or provide health care services, and (3) a systematic review of the recently published literature. Descriptive information was abstracted from each data source, including sponsor, website, lowest level of data aggregation, type of data source, population included, cross-sectional or longitudinal data capture, source of diagnosis information, and cost of obtaining the data source. Details about the cost elements available in each data source were also abstracted. Results We identified 88 data sources that can be used to estimate health care costs in the United States. Most data sources were sponsored by government agencies, national or nationally representative, and cross-sectional. About 40% were surveys, followed by administrative or linked administrative data, fee or cost schedules, discharges, and other types of data. Diagnosis information was available in most data sources through procedure or diagnosis codes, self-report, registry, or chart review. Cost elements included inpatient hospitalizations (42.0%), physician and other outpatient services (45.5%), outpatient pharmacy or laboratory (28.4%), out-of-pocket (22.7%), patient time and other direct nonmedical costs (35.2%), and wages (13.6%). About half were freely available for downloading or available for a nominal fee, and the cost of obtaining the remaining data sources varied by the scope of the project. Conclusions Available data sources vary in population included, type of data source, scope, and accessibility, and have different strengths and weaknesses for specific research questions. PMID:19536009

Out-of-pocket costs for facility-based maternity care in three African countries.

PubMed

Perkins, Margaret; Brazier, Ellen; Themmen, Ellen; Bassane, Brahima; Diallo, Djeneba; Mutunga, Angeline; Mwakajonga, Tuntufye; Ngobola, Olipa

2009-07-01

OBJECTIVE To estimate out-of-pocket medical expenses to women and families for maternity care at all levels of the health system in Burkina Faso, Kenya and Tanzania. METHODS In a population-based survey in 2003, 6345 women who had given birth in the previous 24 months were interviewed about the costs incurred during childbirth. Three years later, in 2006, an additional 8302 women with recent deliveries were interviewed in the same districts to explore their maternity care-seeking experiences and associated costs. The majority of women interviewed reported paying out-of-pocket costs for facility-based deliveries. Out-of-pocket costs were highest in Kenya (a mean of US$18.4 for normal and complicated deliveries), where 98% of women who delivered in a health facility had to pay some fees. In Burkina Faso, 92% of women reported paying some fees (mean of US$7.9). Costs were lowest in Tanzania, where 91% of women reported paying some fees (mean of US$5.1). In all three countries, women in the poorest wealth quintile did not pay significantly less for maternity costs than the wealthiest women. Costs for complicated delivery were double those for normal delivery in Burkina Faso and Kenya, and represented more than 16% of mean monthly household income in Burkina Faso, and 35% in Kenya. In Tanzania and Burkina Faso most institutional births were at mid-level government health facilities (health centres or dispensaries). In contrast, in Kenya, 42% of births were at government hospitals, and 28% were at private or mission facilities, contributing to the overall higher costs in this country compared with Burkina Faso and Tanzania. However, among women delivering in government health facilities in Kenya, reported out-of-pocket costs were significantly lower in 2006 than in 2003, indicating that a 2004 national policy eliminating user fees at mid- and lower-level government health facilities was having some impact.

High temperature molten salt containment

NASA Astrophysics Data System (ADS)

Wang, K. Y.; West, R. E.; Kreith, F.; Lynn, P. P.

1985-05-01

The feasibility of several design options for high-temperature, sensible heat storage containment is examined. The major concerns for a successful containment design include heat loss, corrosive tolerance, structural integrity, and cost. This study is aimed at identifying the most promising high-temperature storage tank among eight designs initially proposed. The study is based on the heat transfer calculations and the structure study of the tank wall and the tank foundation and the overall cost analyses. The results indicate that the single-tank, two-media sloped wall tank has the potential of being lowest in cost. Several relevant technical uncertainties that warrant further research efforts are also identified.

Integrated Glass Coating Manufacturing Line

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

Brophy, Brenor

2015-09-30

This project aims to enable US module manufacturers to coat glass with Enki’s state of the art tunable functionalized AR coatings at the lowest possible cost and highest possible performance by encapsulating Enki’s coating process in an integrated tool that facilitates effective process improvement through metrology and data analysis for greater quality and performance while reducing footprint, operating and capital costs. The Phase 1 objective was a fully designed manufacturing line, including fully specified equipment ready for issue of purchase requisitions; a detailed economic justification based on market prices at the end of Phase 1 and projected manufacturing costs andmore » a detailed deployment plan for the equipment.« less

Systems definition space based power conversion systems: Executive summary

NASA Technical Reports Server (NTRS)

1977-01-01

Potential space-located systems for the generation of electrical power for use on earth were investigated. These systems were of three basic types: (1) systems producing electrical power from solar energy; (2) systems producing electrical power from nuclear reactors; (3) systems for augmenting ground-based solar power plants by orbital sunlight reflectors. Configurations implementing these concepts were developed through an optimization process intended to yield the lowest cost for each. A complete program was developed for each concept, identifying required production rates, quantities of launches, required facilities, etc. Each program was costed in order to provide the electric power cost appropriate to each concept.

A simplified life-cycle cost comparison of various engines for small helicopter use

NASA Technical Reports Server (NTRS)

Civinskas, K. C.; Fishbach, L. M.

1974-01-01

A ten-year, life-cycle cost comparison is made of the following engines for small helicopter use: (1) simple turboshaft; (2) regenerative turboshaft; (3) compression-ignition reciprocator; (4) spark-ignited rotary; and (5) spark-ignited reciprocator. Based on a simplified analysis and somewhat approximate data, the simple turboshaft engine apparently has the lowest costs for mission times up to just under 2 hours. At 2 hours and above, the regenerative turboshaft appears promising. The reciprocating and rotary engines are less attractive, requiring from 10 percent to 80 percent more aircraft to have the same total payload capability as a given number of turbine powered craft. A nomogram was developed for estimating total costs of engines not covered in this study.

Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya.

PubMed

Wafula, Charles Ouma; Edwards, Nancy; Kaseje, Dan C O

2017-02-28

Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up. The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically. Data were collected from November 2010 to December 2013 through key informant interviews and focus group discussions. We interviewed 16 key informants (eight District community health strategy focal persons, eight frontline field officers), and eight focus group discussions (four with community health volunteers and four with community health committee) and 560 sets of monthly cost data. Cost data were tabulated using Microsoft Excel. Qualitative data were transcribed and coded using a content analysis framework. Four critical elements: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits, drove cost variations across the three sites. Attrition rate was highest in peri-urban site where population is highly mobile and lowest in nomadic site. More households were covered by community health workers in the peri-urban area making per capita costs considerably less than in the nomadic settings where long distances had to be covered to reach sparsely distributed households. Livelihood opportunity costs for Community Health Volunteers were highest in nomadic setting, while peri-urban ones reported substantial employability benefits resulting from training. Social opportunity benefits were highest in rural site. Results show that costs of implementing community health strategy varied due to different area contextual factors in Kenya. This study identified four critical elements that drive cost variations: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits. Health programme managers and policy-makers need to pay attention to details of contextual factors in costing for effective implementation of community health strategies.

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program

PubMed Central

Litterbach, Eloise-Kate V; Denney-Wilson, Elizabeth A; Russell, Catherine G; Taki, Sarah; Ong, Kok-Leong; Elliott, Rosalind M; Lymer, Sharyn J; Campbell, Karen J

2016-01-01

Background Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants’ baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. PMID:27634633

Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis.

PubMed

Alfirevic, Zarko; Keeney, Edna; Dowswell, Therese; Welton, Nicky J; Medley, Nancy; Dias, Sofia; Jones, Leanne V; Gyte, Gillian; Caldwell, Deborah M

2016-08-01

More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group's Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012-13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed 'best'. Few studies collected information on women's views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention. Future trials should be powered to detect a method that is more cost-effective than misoprostol solution and report outcomes included in this NMA. This study is registered as PROSPERO CRD42013005116. The National Institute for Health Research Health Technology Assessment programme.

Prospective Costs, Benefits, and Impacts of U.S. Renewable Portfolio Standards

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

Heeter, Jenny S; Mai, Trieu T; Bird, Lori A

These slides were presented at a webinar on January 9, 2017. The slides overview a report that evaluates the future costs, benefits, and other impacts of renewable energy used to meet current state renewable portfolio standards (RPSs). It also examines a future scenario where RPSs are expanded. The analysis examines changes in electric system costs and retail electricity prices, which include all fixed and operating costs, including capital costs for all renewable, non-renewable, and supporting (e.g., transmission and storage) electric sector infrastructure; fossil fuel, uranium, and biomass fuel costs; and plant operations and maintenance expenditures. The analysis evaluates three specificmore » benefits: air pollution, greenhouse gas emissions, and water use. It also analyzes two other impacts, renewable energy workforce and economic development, and natural gas price suppression. The analysis finds that the benefits or renewable energy used to meet RPS polices exceed the costs, even when considering the highest cost and lowest benefit outcomes.« less

The Healthy LifeWorks Project: a pilot study of the economic analysis of a comprehensive workplace wellness program in a Canadian government department.

PubMed

Makrides, Lydia; Smith, Steven; Allt, Jane; Farquharson, Jane; Szpilfogel, Claudine; Curwin, Sandra; Veinot, Paula; Wang, Feifei; Edington, Dee

2011-07-01

To examine the relationship between health risks and absenteeism and drug costs vis-a-vis comprehensive workplace wellness. Eleven health risks, and change in drug claims, short-term and general illness calculated across four risk change groups. Wellness score examined using Wilcoxon test and regression model for cost change. The results showed 31% at risk; 9 of 11 risks associated with higher drug costs. Employees moving from low to high risk showed highest relative increase (81%) in drug costs; moving from high to low had lowest (24%). Low-high had highest increase in absenteeism costs (160%). With each risk increase, absenteeism costs increased by $CDN248 per year (P < 0.05) with average decrease of 0.07 risk factors and savings $CDN6979 per year. Both high-risk reduction and low-risk maintenance are important to contain drug costs. Only low-risk maintenance also avoids absenteeism costs associated with high risks.

Higher Education in California: Student Costs

ERIC Educational Resources Information Center

Jackson, Jacob

2014-01-01

Increases in tuition across California's public four-year universities have heightened concerns about the affordability of a college education, especially for those with the lowest incomes. In-state full tuition at the University of California (UC) and California State University (CSU) has risen more dramatically than at other public universities…

24 CFR 941.101 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... housing residents over the long term and have the lowest possible life cycle costs, taking into account... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Purpose and scope. 941.101 Section 941.101 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued...

The Workplace Realities

ERIC Educational Resources Information Center

Carnevale, Anthony P.

2008-01-01

From the Civil War until the 1970s, the United States was the world's most successful mass-production economy, the very best at producing standardized goods and services at least cost and selling them at the lowest price. These mass-production successes required rigorous discipline and narrow skill. Final products and services were broken down…

Shopping for Health Benefits.

ERIC Educational Resources Information Center

Natale, Jo Anna

1992-01-01

Among the ways school districts can obtain the best possible health benefits at the lowest possible cost are the following: (1) reduce the number of full-time employees; (2) set up a utilization review committee; (3) enlist a preferred provider organization; (4) offer wellness programs; (5) develop a self-insurance plan; and (6) consider a…

46 CFR Sec. 6 - Awarding of work.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Awarding of work. Sec. 6 Section 6 Shipping MARITIME... of work. (a) Those portions of all bids reflecting the total aggregate cost of the work involved shall be opened publicly. The work shall be awarded to the contractor submitting the lowest qualified...

46 CFR Sec. 6 - Awarding of work.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Awarding of work. Sec. 6 Section 6 Shipping MARITIME... of work. (a) Those portions of all bids reflecting the total aggregate cost of the work involved shall be opened publicly. The work shall be awarded to the contractor submitting the lowest qualified...

POLLUTION PREVENTION STRATEGIES FOR THE MINIMIZING OF INDUSTRIAL WASTES IN THE VCM-PVC INDUSTRY

EPA Science Inventory

In many U.S. companies, pollution prevention strategies coincide with economic interests. Typically a company strives to be the lowest-cost producer, to be competitive, and to reduce wastes. In this paper, the author reviews pollution prevention strategies in the vinyl chloride m...

7 CFR 17.5 - Contracts between commodity suppliers and importers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... substantial increase in freight costs to the participant; (B) For small quantities offered at additional... purposes of this section, “lowest landed cost” means the combination of commodity price and ocean freight... the quantity which must be shipped on privately owned U.S.-flag commercial vessels, as determined by...

7 CFR 17.5 - Contracts between commodity suppliers and importers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... substantial increase in freight costs to the participant; (B) For small quantities offered at additional... purposes of this section, “lowest landed cost” means the combination of commodity price and ocean freight... the quantity which must be shipped on privately owned U.S.-flag commercial vessels, as determined by...

7 CFR 17.5 - Contracts between commodity suppliers and importers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... substantial increase in freight costs to the participant; (B) For small quantities offered at additional... purposes of this section, “lowest landed cost” means the combination of commodity price and ocean freight... the quantity which must be shipped on privately owned U.S.-flag commercial vessels, as determined by...

7 CFR 17.5 - Contracts between commodity suppliers and importers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... substantial increase in freight costs to the participant; (B) For small quantities offered at additional... purposes of this section, “lowest landed cost” means the combination of commodity price and ocean freight... the quantity which must be shipped on privately owned U.S.-flag commercial vessels, as determined by...

48 CFR 14.201-8 - Price-related factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... delays to the Government resulting from such factors as differences in inspection, locations of supplies... be for the items or combinations of items that result in the lowest aggregate cost to the Government... supplies, and, if foreign, the application of the Buy American Act or any other prohibition on foreign...

JSC interactive basic accounting system

NASA Technical Reports Server (NTRS)

Spitzer, J. F.

1978-01-01

Design concepts for an interactive basic accounting system (IBAS) are considered in terms of selecting the design option which provides the best response at the lowest cost. Modeling the IBAS workload and applying this workload to a U1108 EXEC 8 based system using both a simulation model and the real system is discussed.

Efficacy, safety and cost per responder of biologics in the treatment of non-radiographic axial spondyloarthritis.

PubMed

Olivieri, Ignazio; Fanizza, Caterina; Gilio, Michele; Ravasio, Roberto

2016-01-01

Anti-tumour necrosis factor (TNF) agents are recommended as second-line therapy for patients with axial spondyloarthropathies. This analysis reviewed data on studies investigating the efficacy and tolerability of anti-TNF agents in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who had failed first-line non-steroidal anti-inflammatory (NSAID) treatment. Efficacy data from RCTs were used to calculate the number needed to treat (NNT) for individual anti-TNFs and then the cost per responder was determined to provide an indication of the value of each therapy. A systematic literature review and analysis of search results over the period January 2008 to September 2014 identified four randomised placebo-controlled trials that were included in the analysis. Adalimumab, etanercept and certolizumab pegol were all effective and well tolerated in patients with nr-axSpA. A patient was more likely to reach ASAS20 or ASAS40 when treated with etanercept or adalimumab, the NNT was lowest for adalimumab, and the risk of adverse events was higher with certolizumab pegol 200 mg every 2 weeks. The cost per responder (NNT) was lowest for adalimumab, followed closely by certolizumab 400 mg every 4 weeks, intermediate for certolizumab 200 mg every 2 weeks and highest for etanercept. Although all anti-TNF agents were associated with clinical improvement in patients with nr-axSpA, adalimumab presented a better cost per responder than etanercept and certolizumab pegol.

Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts >350 cells/uL in Rural Uganda.

PubMed

Jain, Vivek; Chang, Wei; Byonanebye, Dathan M; Owaraganise, Asiphas; Twinomuhwezi, Ellon; Amanyire, Gideon; Black, Douglas; Marseille, Elliot; Kamya, Moses R; Havlir, Diane V; Kahn, James G

2015-01-01

Evidence favoring earlier HIV ART initiation at high CD4+ T-cell counts (CD4>350/uL) has grown, and guidelines now recommend earlier HIV treatment. However, the cost of providing ART to individuals with CD4>350 in Sub-Saharan Africa has not been well estimated. This remains a major barrier to optimal global cost projections for accelerating the scale-up of ART. Our objective was to compute costs of ART delivery to high CD4+count individuals in a typical rural Ugandan health center-based HIV clinic, and use these data to construct scenarios of efficient ART scale-up. Within a clinical study evaluating streamlined ART delivery to 197 individuals with CD4+ cell counts >350 cells/uL (EARLI Study: NCT01479634) in Mbarara, Uganda, we performed a micro-costing analysis of administrative records, ART prices, and time-and-motion analysis of staff work patterns. We computed observed per-person-per-year (ppy) costs, and constructed models estimating costs under several increasingly efficient ART scale-up scenarios using local salaries, lowest drug prices, optimized patient loads, and inclusion of viral load (VL) testing. Among 197 individuals enrolled in the EARLI Study, median pre-ART CD4+ cell count was 569/uL (IQR 451-716). Observed ART delivery cost was $628 ppy at steady state. Models using local salaries and only core laboratory tests estimated costs of $529/$445 ppy (+/-VL testing, respectively). Models with lower salaries, lowest ART prices, and optimized healthcare worker schedules reduced costs by $100-200 ppy. Costs in a maximally efficient scale-up model were $320/$236 ppy (+/- VL testing). This included $39 for personnel, $106 for ART, $130/$46 for laboratory tests, and $46 for administrative/other costs. A key limitation of this study is its derivation and extrapolation of costs from one large rural treatment program of high CD4+ count individuals. In a Ugandan HIV clinic, ART delivery costs--including VL testing--for individuals with CD4>350 were similar to estimates from high-efficiency programs. In higher efficiency scale-up models, costs were substantially lower. These favorable costs may be achieved because high CD4+ count patients are often asymptomatic, facilitating more efficient streamlined ART delivery. Our work provides a framework for calculating costs of efficient ART scale-up models using accessible data from specific programs and regions.

Lightweight custom composite prosthetic components using an additive manufacturing-based molding technique.

PubMed

Leddy, Michael T; Belter, Joseph T; Gemmell, Kevin D; Dollar, Aaron M

2015-01-01

Additive manufacturing techniques are becoming more prominent and cost-effective as 3D printing becomes higher quality and more inexpensive. The idea of 3D printed prosthetics components promises affordable, customizable devices, but these systems currently have major shortcomings in durability and function. In this paper, we propose a fabrication method for custom composite prostheses utilizing additive manufacturing, allowing for customizability, as well the durability of professional prosthetics. The manufacturing process is completed using 3D printed molds in a multi-stage molding system, which creates a custom finger or palm with a lightweight epoxy foam core, a durable composite outer shell, and soft urethane gripping surfaces. The composite material was compared to 3D printed and aluminum materials using a three-point bending test to compare stiffness, as well as gravimetric measurements to compare weight. The composite finger demonstrates the largest stiffness with the lowest weight compared to other tested fingers, as well as having customizability and lower cost, proving to potentially be a substantial benefit to the development of upper-limb prostheses.

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

Neuhauser, K.; Gates, C.

This research project evaluates post-retrofit performance measurements, energy use data and construction costs for 13 projects that participated in the National Grid Deep Energy Retrofit Pilot program. The projects implemented a package of measures defined by performance targets for building enclosure components and building enclosure air tightness. Nearly all of the homes reached a post-retrofit air tightness result of 1.5 ACH 50. Homes that used the chainsaw retrofit technique along with roof insulation, and wall insulation applied to the exterior had the best air tightness results and the lowest heating and cooling source energy use. Analysis of measure costs andmore » project objectives yielded a categorization of costs relative to energy performance objectives. On average about ½ of the energy-related measure costs correspond primarily to energy-related objectives, and 20% of energy-related measure costs relate primarily to non-energy objectives.« less

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

Gates, C.; Neuhauser, K.

This research project evaluates post-retrofit performance measurements, energy use data and construction costs for 13 projects that participated in the National Grid Deep Energy Retrofit Pilot program. The projects implemented a package of measures defined by performance targets for building enclosure components and building enclosure air tightness. Nearly all of the homes reached a post-retrofit air tightness result of 1.5 ACH 50. Homes that used the chainsaw retrofit technique along with roof insulation, and wall insulation applied to the exterior had the best air tightness results and the lowest heating and cooling source energy use. Analysis of measure costs andmore » project objectives yielded a categorization of costs relative to energy performance objectives. On average about 1/2 of the energy-related measure costs correspond primarily to energy-related objectives, and 20% of energy-related measure costs relate primarily to non-energy objectives.« less

Cost Effectiveness Analysis of Quasi-In-Motion Wireless Power Transfer for Plug-In Hybrid Electric Transit Buses from Fleet Perspective

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

Wang, Lijuan; Gonder, Jeff; Brooker, Aaron

This study evaluated the costs and benefits associated with the use of stationary-wireless-power-transfer-enabled plug-in hybrid electric buses and determined the cost effectiveness relative to conventional buses and hybrid electric buses. A factorial design was performed over a number of different battery sizes, charging power levels, and f bus stop charging stations. The net present costs were calculated for each vehicle design and provided the basis for design evaluation. In all cases, given the assumed economic conditions, the conventional bus achieved the lowest net present cost while the optimal plug-in hybrid electric bus scenario beat out the hybrid electric comparison scenario.more » The parameter sensitivity was also investigated under favorable and unfavorable market penetration assumptions.« less

Quality assessment of published health economic analyses from South America.

PubMed

Machado, Márcio; Iskedjian, Michael; Einarson, Thomas R

2006-05-01

Health economic analyses have become important to healthcare systems worldwide. No studies have previously examined South America's contribution in this area. To survey the literature with the purpose of reviewing, quantifying, and assessing the quality of published South American health economic analyses. A search of MEDLINE (1990-December 2004), EMBASE (1990-December 2004), International Pharmaceutical Abstracts (1990-December 2004), Literatura Latino-Americana e do Caribe em Ciências da Saúde (1982-December 2004), and Sistema de Informacion Esencial en Terapéutica y Salud (1980-December 2004) was completed using the key words cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-minimization analysis (CMA), and cost-benefit analysis (CBA); abbreviations CEA, CUA, CMA, and CBA; and all South American country names. Papers were categorized by type and country by 2 independent reviewers. Quality was assessed using a 12 item checklist, characterizing scores as 4 (good), 3 (acceptable), 2 (poor), 1 (unable to judge), and 0 (unacceptable). To be included in our investigation, studies needed to have simultaneously examined costs and outcomes. We retrieved 25 articles; one duplicate article was rejected, leaving 24 (CEA = 15, CBA = 6, CMA = 3; Brazil = 9, Argentina = 5, Colombia = 3, Chile = 2, Ecuador = 2, 1 each from Peru, Uruguay, Venezuela). Variability between raters was less than 0.5 point on overall scores (OS) and less than 1 point on all individual items. Mean OS was 2.6 (SD 1.0, range 1.4-3.8). CBAs scored highest (OS 2.8, SD 0.8), CEAs next (OS 2.7, SD 0.7), and CMAs lowest (OS 2.0, SD 0.5). When scored by type of question, definition of study aim scored highest (OS 3.0, SD 0.8), while ethical issues scored lowest (OS 1.5, SD 0.9). By country, Peru scored highest (mean OS 3.8) and Uruguay had the lowest scores (mean OS 2.2). A nonsignificant time trend was noted for OS (R2 = 0.12; p = 0.104). Quality scores of health economic analyses articles published in South America were rated poor to acceptable and lower than previous research from other countries. Thus, efforts are needed to improve the reporting quality of these analyses in South America. Future research should examine the region's level of expertise and educational opportunities for those in the field of health economics.

Handling the procurement of prostheses for total hip replacement: description of an original value based approach and application to a real-life dataset reported in the UK

PubMed Central

Messori, Andrea; Trippoli, Sabrina; Marinai, Claudio

2017-01-01

Objectives In most European countries, innovative medical devices are not managed according to cost–utility methods, the reason being that national agencies do not generally evaluate these products. The objective of our study was to investigate the cost-utility profile of prostheses for hip replacement and to calculate a value-based score to be used in the process of procurement and tendering for these devices. Methods The first phase of our study was aimed at retrieving the studies reporting the values of QALYs, direct cost, and net monetary benefit (NMB) from patients undergoing total hip arthroplasty (THA) with different brands of hip prosthesis. The second phase was aimed at calculating, on the basis of the results of cost–utility analysis, a tender score for each device (defined according to standard tendering equations and adapted to a 0–100 scale). This allowed us to determine the ranking of each device in the simulated tender. Results We identified a single study as the source of information for our analysis. Nine device brands (cemented, cementless, or hybrid) were evaluated. The cemented prosthesis Exeter V40/Elite Plus Ogee, the cementless device Taperloc/Exceed, and the hybrid device Exeter V40/Trident had the highest NMB (£152 877, £156 356, and £156 210, respectively) and the best value-based tender score. Conclusions The incorporation of value-based criteria in the procurement process can contribute to optimising the value for money for THA devices. According to the approach described herein, the acquisition of these devices does not necessarily converge on the product with the lowest cost; in fact, more costly devices should be preferred when their increased cost is offset by the monetary value of the increased clinical benefit. PMID:29259062

Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China.

PubMed

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days' wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day's wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days' wages for losartan. For originator brands, the costs rise to 1.2 days' wages for salbutamol inhaler and 15.6 days' wages for omeprazole. The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.

Comparison of commercial RNA extraction kits and qPCR master mixes for studying gene expression in small biopsy tissue samples from the equine gastric epithelium.

PubMed

Tesena, Parichart; Korchunjit, Wasamon; Taylor, Jane; Wongtawan, Tuempong

2017-01-01

Gastric tissue biopsy and gene expression analysis are important tools for disease diagnosis and study of the physiology of the equine stomach. However, RNA extraction from gastric biopsy samples is a complex procedure because the samples contain low quantities of RNA and are contaminated with mucous protein and bacterial flora. The objectives of these studies were to compare the performance of RNA extraction methods and to investigate the sensitivity of commercial qPCR master mixes for gene expression analysis of gastric biopsy samples. Three commercial RNA extraction methods (TRIzol ™ , GENEzol ™ and MiniPrep ™ ) and four qPCR master mixes with SYBR ® green (qPCRBIO, KAPA, QuantiNova, and PerfeCTa) were compared. RNA qualification and quantitation were compared. Real-time PCR was used to compare qPCR master mixes. The results revealed that TRIzol and GENEzol obtained significantly higher yield of RNA (P<0.01) but that TRIzol had the highest contamination of protein and DNA (P<0.05). Conversely, MiniPrep resulting in a significantly higher purification of RNA (P<0.05) but provided the lowest yield of RNA (P<0.01). For PCR master mixes, KAPA was significantly (P<0.05) more sensitive than other qPCR kits for all amounts of DNA template, particularly at the lowest amount of cDNA. In conclusion, GENEzol is the best method to obtain a high RNA yield and purification and it is more cost-effective than the others as well. Regarding the qPCR master mixes, KAPA SYBR qPCR Master Mix (2x) Universal is superior to the other tested master mixes for studying gene expression in equine gastric biopsies.

Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study

PubMed Central

Monsivais, Pablo; Jones, Nicholas RV; Brand, Christian; Woodcock, James

2017-01-01

Objective To quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios. Design For the physical activity scenarios, all car trips from <1 to <8 miles long were progressively replaced with cycling. For the diet scenarios, the study population was assumed to increase fruit and vegetable (F&V) consumption by 1–5 portions of F&V per day, or to eat at least 5 portions per day. Health effects were modelled with the comparative risk assessment method. Consumer costs were based on fuel cost savings and average costs of F&V, and GHG emissions to fuel usage and F&V production. Setting Working age population for England. Participants Data from the Health Survey for England, National Travel Survey and National Diet and Nutrition Survey. Primary outcomes measured Changes in premature deaths, consumer costs and GHG emissions stratified by age, gender and socioeconomic status (SES). Results Premature deaths were reduced by between 75 and 7648 cases per year for the physical activity scenarios, and 3255 and 6187 cases per year for the diet scenarios. Mortality reductions were greater among people of medium and high SES in the physical activity scenarios, whereas people with lower SES benefited more in the diet scenarios. Similarly, transport fuel costs fell more for people of high SES, whereas diet costs increased most for the lowest SES group. Net GHG emissions decreased by between 0.2 and 10.6 million tons of carbon dioxide equivalent (MtCO2e) per year for the physical activity scenarios and increased by between 1.3 and 6.3 MtCO2e/year for the diet scenarios. Conclusions Increasing F&V consumption offers the potential for large health benefits and reduces health inequalities. Replacing short car trips with cycling offers the potential for net benefits for health, GHG emissions and consumer costs. PMID:28399514

Use of a validated algorithm to estimate the annual cost of effective biologic treatment for rheumatoid arthritis.

PubMed

Curtis, Jeffrey R; Schabert, Vernon F; Yeaw, Jason; Korn, Jonathan R; Quach, Caroleen; Harrison, David J; Yun, Huifeng; Joseph, George J; Collier, David

2014-08-01

To estimate biologic cost per effectively treated patient with rheumatoid arthritis (RA) using a claims-based algorithm for effectiveness. Patients with RA aged 18-63 years in the IMS PharMetrics Plus database were categorized as effectively treated if they met all six criteria: (1) a medication possession ratio ≥80% (subcutaneous) or at least as many infusions as specified in US labeling (intravenous); (2) no biologic dose increase; (3) no biologic switch; (4) no new non-biologic disease-modifying anti-rheumatic drug; (5) no new or increased oral glucocorticoid; and (6) ≤1 glucocorticoid injection. Biologic cost per effectively treated patient was defined as total cost of the index biologic (drug plus intravenous administration) divided by the number of patients categorized by the algorithm as effectively treated. Similar methods were used for the index biologic in the second year and for a second biologic after a switch. Rates that the index biologic was categorized as effective in the first year were 31.0% etanercept (2243/7247), 28.6% adalimumab (1426/4991), 28.6% abatacept (332/1160), 27.2% golimumab (71/261), and 20.2% infliximab (474/2352). Mean biologic cost per effectively treated patient, per the algorithm, was $50,141 etanercept, $53,386 golimumab, $56,942 adalimumab, $73,516 abatacept, and $114,089 infliximab. Biologic cost per effectively treated patient, using this algorithm, was lower for patients who continued the index biologic in the second year and higher after switching. When a claims-based algorithm was applied to a large commercial claims database, etanercept was categorized as the most effective and had the lowest estimated 1-year biologic cost per effectively treated patient. This proxy for effectiveness from claims databases was validated against a clinical effectiveness scale, but analyses of the second year or the year after a biologic switch were not included in the validation. Costs of other medications were not included in cost calculations.

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors

PubMed Central

Contreras-Hernández, Iris; Mould-Quevedo, Joaquín F; Torres-González, Rubén; Goycochea-Robles, María Victoria; Pacheco-Domínguez, Reyna Lizette; Sánchez-García, Sergio; Mejía-Aranguré, Juan Manuel; Garduño-Espinosa, Juan

2008-01-01

Background Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS). Methods A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period. Results Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib. Conclusion From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib. PMID:19014495

Impact of Insurance Provider on Overall Costs in Failed Back Surgery Syndrome: A Cost Study of 122,827 Patients.

PubMed

Elsamadicy, Aladine A; Farber, Samuel Harrison; Yang, Siyun; Hussaini, Syed Mohammed Qasim; Murphy, Kelly R; Sergesketter, Amanda; Suryadevara, Carter M; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P

2017-06-01

Failed back surgery syndrome (FBSS) affects 40% of patients following spine surgery with estimated costs of $20 billion to the US health care system. The aim of this study was to assess the cost differences across the different insurance providers for FBSS patients. A retrospective longitudinal study was performed using the Truven MarketScan ® database to identify FBSS patients from 2001 to 2012. Patients were grouped into Commercial, Medicaid, or Medicare cohorts. We collected one-year prior to FBSS diagnosis (baseline), then at year of spinal cord stimulation (SCS)-implantation and nine-year post-SCS implantation cost outcomes. We identified 122,827 FBSS patients, with 117,499 patients who did not undergo an SCS-implantation (Commercial: n = 49,075, Medicaid: n = 23,180, Medicare: n = 45,244) and 5328 who did undergo an SCS implantation (Commercial: n = 2279, Medicaid: n = 1003, Medicare: n = 2046). Baseline characteristics were similar between the cohorts, with the Medicare-cohort being significantly older. Over the study period, there were significant differences in overall cost metrics between the cohorts who did not undergo SCS implantation with the Medicaid-cohort had the lowest annual median (interquartile range) total cost (Medicaid: $4530.4 [$1440.6, $11,973.5], Medicare: $7292.0 [$3371.4, $13,989.4], Commercial: $4944.3 [$363.8, $13,294.0], p < 0.0001). However, when comparing the patients who underwent SCS implantation, the commercial-cohort had the lowest annual median (interquartile range) total costs (Medicaid: $4045.6 [$1146.9, $11,533.9], Medicare: $7158.1 [$3160.4, $13,916.6], Commercial: $2098.1 [$0.0, $8919.6], p < 0.0001). Our study demonstrates a significant difference in overall costs between various insurance providers in the management of FBSS, with Medicaid-insured patients having lower overall costs compared to Commercial- and Medicare-patients. SCS is cost-effective across all insurance groups (Commercial > Medicaid > Medicare) beginning at two years and continuing through nine-year follow-up. Further studies are necessary to understand the cost differences between these insurance providers, in hopes of reducing unnecessary health care expenditures for patients with FBSS. © 2017 International Neuromodulation Society.

Drug Policy in the Czech Republic.

PubMed

Skoupá, Jana

2017-09-01

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

PRODUCTION AND ECONOMIC OPTIMIZATION OF DIETARY PROTEIN AND CARBOHYDRATE IN THE CULTURE OF JUVENILE SEA URCHIN Lytechinus variegatus

PubMed Central

Heflin, Laura E.; Makowsky, Robert; Taylor, J. Christopher; Williams, Michael B.; Lawrence, Addison L.; Watts, Stephen A.

2016-01-01

Juvenile Lytechinus variegatus (ca. 3.95± 0.54 g) were fed one of 10 formulated diets with different protein (ranging from 11- 43%) and carbohydrate (12 or 18%; brackets determined from previous studies) levels. Urchins (n= 16 per treatment) were fed a daily sub-satiation ration equivalent to 2.0% of average body weight for 10 weeks. Our objective was (1) to create predictive models of growth, production and efficiency outcomes and (2) to generate economic analysis models in relation to these dietary outcomes for juvenile L. variegatus held in culture. At dietary protein levels below ca. 30%, models for most growth and production outcomes predicted increased rates of growth and production among urchins fed diets containing 18% dietary carbohydrate levels as compared to urchins fed diets containing 12% dietary carbohydrate. For most outcomes, growth and production was predicted to increase with increasing level of dietary protein up to ca. 30%, after which, no further increase in growth and production were predicted. Likewise, dry matter production efficiency was predicted to increase with increasing protein level up to ca. 30%, with urchins fed diets with 18% carbohydrate exhibiting greater efficiency than those fed diets with 12% carbohydrate. The energetic cost of dry matter production was optimal at protein levels less than those required for maximal weight gain and gonad production, suggesting an increased energetic cost (decreased energy efficiency) is required to increase gonad production relative to somatic growth. Economic analysis models predict when cost of feed ingredients are low, the lowest cost per gram of wet weight gain will occur at 18% dietary carbohydrate and ca. 25- 30% dietary protein. In contrast, lowest cost per gram of wet weight gain will occur at 12% dietary carbohydrate and ca. 35- 40% dietary protein when feed ingredient costs are high or average. For both 18 and 12% levels of dietary carbohydrate, cost per gram of wet weight gain is predicted to be maximized at low dietary protein levels, regardless of feed ingredient costs. These models will compare dietary requirements and growth outcomes in relation to economic costs and provide insight for future commercialization of sea urchin aquaculture. PMID:28082753

PRODUCTION AND ECONOMIC OPTIMIZATION OF DIETARY PROTEIN AND CARBOHYDRATE IN THE CULTURE OF JUVENILE SEA URCHIN Lytechinus variegatus.

PubMed

Heflin, Laura E; Makowsky, Robert; Taylor, J Christopher; Williams, Michael B; Lawrence, Addison L; Watts, Stephen A

2016-10-01

Juvenile Lytechinus variegatus (ca. 3.95± 0.54 g) were fed one of 10 formulated diets with different protein (ranging from 11- 43%) and carbohydrate (12 or 18%; brackets determined from previous studies) levels. Urchins (n= 16 per treatment) were fed a daily sub-satiation ration equivalent to 2.0% of average body weight for 10 weeks. Our objective was (1) to create predictive models of growth, production and efficiency outcomes and (2) to generate economic analysis models in relation to these dietary outcomes for juvenile L. variegatus held in culture. At dietary protein levels below ca. 30%, models for most growth and production outcomes predicted increased rates of growth and production among urchins fed diets containing 18% dietary carbohydrate levels as compared to urchins fed diets containing 12% dietary carbohydrate. For most outcomes, growth and production was predicted to increase with increasing level of dietary protein up to ca. 30%, after which, no further increase in growth and production were predicted. Likewise, dry matter production efficiency was predicted to increase with increasing protein level up to ca. 30%, with urchins fed diets with 18% carbohydrate exhibiting greater efficiency than those fed diets with 12% carbohydrate. The energetic cost of dry matter production was optimal at protein levels less than those required for maximal weight gain and gonad production, suggesting an increased energetic cost (decreased energy efficiency) is required to increase gonad production relative to somatic growth. Economic analysis models predict when cost of feed ingredients are low, the lowest cost per gram of wet weight gain will occur at 18% dietary carbohydrate and ca. 25- 30% dietary protein. In contrast, lowest cost per gram of wet weight gain will occur at 12% dietary carbohydrate and ca. 35- 40% dietary protein when feed ingredient costs are high or average. For both 18 and 12% levels of dietary carbohydrate, cost per gram of wet weight gain is predicted to be maximized at low dietary protein levels, regardless of feed ingredient costs. These models will compare dietary requirements and growth outcomes in relation to economic costs and provide insight for future commercialization of sea urchin aquaculture.

Optimizing conceptual aircraft designs for minimum life cycle cost

NASA Technical Reports Server (NTRS)

Johnson, Vicki S.

1989-01-01

A life cycle cost (LCC) module has been added to the FLight Optimization System (FLOPS), allowing the additional optimization variables of life cycle cost, direct operating cost, and acquisition cost. Extensive use of the methodology on short-, medium-, and medium-to-long range aircraft has demonstrated that the system works well. Results from the study show that optimization parameter has a definite effect on the aircraft, and that optimizing an aircraft for minimum LCC results in a different airplane than when optimizing for minimum take-off gross weight (TOGW), fuel burned, direct operation cost (DOC), or acquisition cost. Additionally, the economic assumptions can have a strong impact on the configurations optimized for minimum LCC or DOC. Also, results show that advanced technology can be worthwhile, even if it results in higher manufacturing and operating costs. Examining the number of engines a configuration should have demonstrated a real payoff of including life cycle cost in the conceptual design process: the minimum TOGW of fuel aircraft did not always have the lowest life cycle cost when considering the number of engines.

Economic impact of Clostridium difficile infection in a multihospital cohort of academic health centers.

PubMed

Pakyz, Amy; Carroll, Norman V; Harpe, Spencer E; Oinonen, Michael; Polk, Ronald E

2011-06-01

To assess the economic impact of Clostridium difficile infection (CDI) in a large multihospital cohort. Retrospective case-control study. Administrative claims data from 45 academic medical centers. A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-associated CDI (19,214 controls). Patients with health care-associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined-Diagnosis Related Group (APR-DRG) severity of illness level, race, and sex with use of multivariable linear regression. The adjusted mean cost for cases was significantly higher than that for controls ($55,769 vs $28,609), and adjusted mean length of stay was twice as long (21.1 vs 10.0 days). The interaction between CDI and APR-DRG severity of illness level was significant; the effect of CDI on costs and length of stay decreased as severity of illness increased. This large CDI economic evaluation confirms that health care-associated cases of CDI are associated with significantly higher mean cost and longer length of stay than those of matched controls, with the greatest effect on costs at the lowest level of severity of illness.

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

PubMed Central

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

2012-01-01

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

Recruitment of private practices for primary care research: experience in a preventive services clinical trial.

PubMed

McBride, P E; Massoth, K M; Underbakke, G; Solberg, L I; Beasley, J W; Plane, M B

1996-10-01

Recruitment of community primary care practices for studies to improve health service delivery is important to many health care organizations. Prior studies have focused on individual physician recruitment or academic settings. This descriptive study evaluated the efficiency and utility of three different recruitment methods to encourage community practice participation in a preventive services research trial. Primary care practices in four midwestern states were recruited using different sources for initial mailings (physician lists, practice lists, and a managed care organization's primary care network) and different recruiting methods. Outcome measures included response rates, participation rates, and comparative costs of each method. Of the 86 eligible practices contacted, 52 (60%) consented to participate. Mailing to individual physicians was the most cumbersome and expensive method and had the lowest response rate. Initial contacts with practice medical directors increased the participation rate substantially, and practice recruitment meetings improved both study participation and practice-project communication. Experience with these three methods suggests that the most efficient way to recruit practices for participation in a preventive services research trial involves targeted mailings and phone calls to medical directors, followed by on-site practice meetings.

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program.

PubMed

Laws, Rachel A; Litterbach, Eloise-Kate V; Denney-Wilson, Elizabeth A; Russell, Catherine G; Taki, Sarah; Ong, Kok-Leong; Elliott, Rosalind M; Lymer, Sharyn J; Campbell, Karen J

2016-09-15

Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants' baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment.

MESA - A new approach to low cost scientific spacecraft

NASA Astrophysics Data System (ADS)

Keyes, G. W.; Case, C. M.

1982-09-01

Today, the greatest obstacle to science and exploration in space is its cost. The present investigation is concerned with approaches for reducing this cost. Trends in the scientific spacecraft market are examined, and a description is presented for the MESA space platform concept. The cost drivers are considered, taking into account planning, technical aspects, and business factors. It is pointed out that the primary function of the MESA concept is to provide a satellite system at the lowest possible price. In order to reach this goal an attempt is made to benefit from all of the considered cost drivers. It is to be tried to work with the customer early in the mission analysis stage in order to assist in finding the right compromise between mission cost and return. A three phase contractual arrangement is recommended for MESA platforms. The phases are related to mission feasibility, specification definition, and design and development. Modular kit design promotes flexibility at low cost.

Energy Conversion Alternatives Study (ECAS), Westinghouse phase 1. Volume 11: Advanced steam systems. [energy conversion efficiency for electric power plants using steam

NASA Technical Reports Server (NTRS)

Wolfe, R. W.

1976-01-01

A parametric analysis was made of three types of advanced steam power plants that use coal in order to have a comparison of the cost of electricity produced by them a wide range of primary performance variables. Increasing the temperature and pressure of the steam above current industry levels resulted in increased energy costs because the cost of capital increased more than the fuel cost decreased. While the three plant types produced comparable energy cost levels, the pressurized fluidized bed boiler plant produced the lowest energy cost by the small margin of 0.69 mills/MJ (2.5 mills/kWh). It is recommended that this plant be designed in greater detail to determine its cost and performance more accurately than was possible in a broad parametric study and to ascertain problem areas which will require development effort. Also considered are pollution control measures such as scrubbers and separates for particulate emissions from stack gases.

Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

PubMed

Copanitsanou, Panagiota; Valkeapää, Kirsi; Cabrera, Esther; Katajisto, Jouko; Leino-Kilpi, Helena; Sigurdardottir, Arun K; Unosson, Mitra; Zabalegui, Adelaida; Lemonidou, Chryssoula

2017-04-01

Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research. © 2016 Wiley Periodicals, Inc.

The cost of hybrid waste water systems: A systematic framework for specifying minimum cost-connection rates.

PubMed

Eggimann, Sven; Truffer, Bernhard; Maurer, Max

2016-10-15

To determine the optimal connection rate (CR) for regional waste water treatment is a challenge that has recently gained the attention of academia and professional circles throughout the world. We contribute to this debate by proposing a framework for a total cost assessment of sanitation infrastructures in a given region for the whole range of possible CRs. The total costs comprise the treatment and transportation costs of centralised and on-site waste water management systems relative to specific CRs. We can then identify optimal CRs that either deliver waste water services at the lowest overall regional cost, or alternatively, CRs that result from households freely choosing whether they want to connect or not. We apply the framework to a Swiss region, derive a typology for regional cost curves and discuss whether and by how much the empirically observed CRs differ from the two optimal ones. Both optimal CRs may be reached by introducing specific regulatory incentive structures. Copyright © 2016 Elsevier Ltd. All rights reserved.

Organize to manage reliability

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

Ricketts, R.

An analysis of maintenance costs in hydrocarbon processing industry (HPI) plants has revealed that attitudes and practices of personnel are the major single bottom line factor. In reaching this conclusion, Solomon Associates examined comparative analysis of plant records over the past decade. The authors learned that there was a wide range of performance independent of refinery age, capacity, processing complexity, and location. Facilities of all extremes in these attributes are included in both high-cost and low-cost categories. Those in the lowest quartile of performance posted twice the resource consumption as the best quartile. Furthermore, there was almost no similarity betweenmore » refineries within a single company. The paper discusses cost versus availability, maintenance spending, two organizational approaches used (repair focused and reliability focused), and organizational style and structure.« less

Individual versus family psychotherapy in managed care: comparing the costs of treatment by the mental health professions.

PubMed

Russell Crane, D; Payne, Scott H

2011-07-01

In an effort to understand how psychotherapy is practiced in the "real world," outpatient claims data were examined to determine the cost of individual and family therapy provided by marital and family therapists, master's nurses, master's social workers, medical doctors, psychologists, or professional counselors. Claims for 490,000 unique persons over 4 years were obtained from CIGNA. Family therapy proved to be substantially more cost-effective than individual or "mixed" psychotherapy. Physicians provided care in the fewest sessions, marital and family therapists had the highest success (86.6%) and lowest recidivism rates (13.4%), and professional counselors were the least costly. Outcomes were overwhelmingly successful, with 85% of patients requiring only one episode of care. © 2011 American Association for Marriage and Family Therapy.

Boiler tuning using SPO at Detroit Edison`s River Rouge plant for best economic performance while minimizing NO{sub x} emissions

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

Haman, R.L.; Kerry, T.G.; Jarc, C.A.

1996-12-31

A technology provided by Ultramax Corporation and EPRI, based on sequential process optimization (SPO), is being used as a cost-effective tool to gain improvements prior to decisions for capital-intensive solutions. This empirical method of optimization, called the ULTRAMAX{reg_sign} Method, can determine the best boiler capabilities and help delay, or even avoid, expensive retrofits or repowering. SPO can serve as a least-cost way to attain the right degree of compliance with current and future phases of CAAA. Tuning ensures a staged strategy to stay ahead of emissions regulations, but not so far ahead as to cause regret for taking actions thatmore » ultimately are not mandated or warranted. One large utility investigating SPO as a tool to lower NO{sub x} emissions and to optimize boiler performance is Detroit Edison. The company has applied SPO to tune two coal-fired units at its River Rouge Power Plant to evaluate the technology for possible system-wide usage. Following the successful demonstration in reducing NO{sub x} from these units, SPO is being considered for use in other Detroit Edison fossil-fired plants. Tuning first will be used as a least-cost option to drive NO{sub x} to its lowest level with operating adjustment. In addition, optimization shows the true capability of the units and the margins available when the Phase 2 rules become effective in 2000. This paper includes a case study of the second tuning process and discusses the opportunities the technology affords.« less

Low power signal processing electronics for wearable medical devices.

PubMed

Casson, Alexander J; Rodriguez-Villegas, Esther

2010-01-01

Custom designed microchips, known as Application Specific Integrated Circuits (ASICs), offer the lowest possible power consumption electronics. However, this comes at the cost of a longer, more complex and more costly design process compared to one using generic, off-the-shelf components. Nevertheless, their use is essential in future truly wearable medical devices that must operate for long periods of time from physically small, energy limited batteries. This presentation will demonstrate the state-of-the-art in ASIC technology for providing online signal processing for use in these wearable medical devices.

Reliability and accuracy of real-time visualization techniques for measuring school cafeteria tray waste: validating the quarter-waste method.

PubMed

Hanks, Andrew S; Wansink, Brian; Just, David R

2014-03-01

Measuring food waste is essential to determine the impact of school interventions on what children eat. There are multiple methods used for measuring food waste, yet it is unclear which method is most appropriate in large-scale interventions with restricted resources. This study examines which of three visual tray waste measurement methods is most reliable, accurate, and cost-effective compared with the gold standard of individually weighing leftovers. School cafeteria researchers used the following three visual methods to capture tray waste in addition to actual food waste weights for 197 lunch trays: the quarter-waste method, the half-waste method, and the photograph method. Inter-rater and inter-method reliability were highest for on-site visual methods (0.90 for the quarter-waste method and 0.83 for the half-waste method) and lowest for the photograph method (0.48). This low reliability is partially due to the inability of photographs to determine whether packaged items (such as milk or yogurt) are empty or full. In sum, the quarter-waste method was the most appropriate for calculating accurate amounts of tray waste, and the photograph method might be appropriate if researchers only wish to detect significant differences in waste or consumption of selected, unpackaged food. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Research requirements for development of advanced-technology helicopter transmissions. [reduction of maintenance costs

NASA Technical Reports Server (NTRS)

Lemanski, A. J.

1976-01-01

Helicopter drive-system technology which would result in the largest benefit in direct maintenance cost when applied to civil helicopters in the 1980 timeframe was developed. A prototype baseline drive system based on 1975 technology provided the basis for comparison against the proposed advanced technology in order to determine the potential for each area recommended for improvement. A specific design example of an advanced-technology main transmission is presented to define improvements for maintainability, weight, producibility, reliability, noise, vibration, and diagnostics. Projections of the technology achievable in the 1980 timeframe are presented. Based on this data, the technologies with the highest payoff (lowest direct maintenance cost) for civil-helicopter drive systems are identified.

An evaluation of inferential procedures for adaptive clinical trial designs with pre-specified rules for modifying the sample size.

PubMed

Levin, Gregory P; Emerson, Sarah C; Emerson, Scott S

2014-09-01

Many papers have introduced adaptive clinical trial methods that allow modifications to the sample size based on interim estimates of treatment effect. There has been extensive commentary on type I error control and efficiency considerations, but little research on estimation after an adaptive hypothesis test. We evaluate the reliability and precision of different inferential procedures in the presence of an adaptive design with pre-specified rules for modifying the sampling plan. We extend group sequential orderings of the outcome space based on the stage at stopping, likelihood ratio statistic, and sample mean to the adaptive setting in order to compute median-unbiased point estimates, exact confidence intervals, and P-values uniformly distributed under the null hypothesis. The likelihood ratio ordering is found to average shorter confidence intervals and produce higher probabilities of P-values below important thresholds than alternative approaches. The bias adjusted mean demonstrates the lowest mean squared error among candidate point estimates. A conditional error-based approach in the literature has the benefit of being the only method that accommodates unplanned adaptations. We compare the performance of this and other methods in order to quantify the cost of failing to plan ahead in settings where adaptations could realistically be pre-specified at the design stage. We find the cost to be meaningful for all designs and treatment effects considered, and to be substantial for designs frequently proposed in the literature. © 2014, The International Biometric Society.

Radiologist income, receipts, and academic performance: an analysis of many nations.

PubMed

Semelka, Richard C; Busireddy, K K; Burke, Lauren Mb; Ramalho, Miguel; Martí-Bonmatí, Luis; Morana, Giovanni; AlObaidy, Mamdoh; Elias, Jorge

2016-12-01

Background Considerable interest exists in comparison between healthcare systems across multiple countries, especially where cost enters the discussion. Purpose To evaluate the relationship between radiologists' income, receipts for studies, and academic performance across multiple countries. Material and Methods The annual income of radiologists and receipts for computed tomography (CT) and magnetic resonance imaging (MRI) were obtained based on a survey sent to expert radiologists practicing in 23 countries of varying developmental status. Articles published in generalist radiology journals determined the academic performance of each country. Results Among the developed countries, Canada has the highest estimated annual income for both private ($700,000/year) and university radiologists ($600,000/year) while Spain has the lowest income for private practice ($68,000/year) and Portugal has the lowest income for university practice ($57,300/year). Among the developing countries, Saudi Arabia has the highest incomes for both private ($210,000/year) and university ($140,000/year) radiologists and Vietnam has the lowest incomes for both private ($30,000/year) and university ($6,000/year) radiologists. Total receipts for CT and MRI studies ranged from $80/study (Portugal) to $1000/study (USA) in developed countries, and ranged from $30/study (Egypt) to $700/study (Saudi Arabia) in developing countries. A moderate correlation ( r = 0.482) was seen between radiologist's income and the receipts for combined practice in all countries. The radiology journal academic quotient was highest in The Netherlands among developed countries, and Turkey among developing countries. Conclusion A relatively broad range of radiologists' income is observed among developed and developing countries, which shows correlation with the receipts for advanced imaging studies. Countries with an acceptable compromise between income, receipts, and academic performance, may be the best models for other countries to emulate.

Efficient exact-exchange time-dependent density-functional theory methods and their relation to time-dependent Hartree-Fock.

PubMed

Hesselmann, Andreas; Görling, Andreas

2011-01-21

A recently introduced time-dependent exact-exchange (TDEXX) method, i.e., a response method based on time-dependent density-functional theory that treats the frequency-dependent exchange kernel exactly, is reformulated. In the reformulated version of the TDEXX method electronic excitation energies can be calculated by solving a linear generalized eigenvalue problem while in the original version of the TDEXX method a laborious frequency iteration is required in the calculation of each excitation energy. The lowest eigenvalues of the new TDEXX eigenvalue equation corresponding to the lowest excitation energies can be efficiently obtained by, e.g., a version of the Davidson algorithm appropriate for generalized eigenvalue problems. Alternatively, with the help of a series expansion of the new TDEXX eigenvalue equation, standard eigensolvers for large regular eigenvalue problems, e.g., the standard Davidson algorithm, can be used to efficiently calculate the lowest excitation energies. With the help of the series expansion as well, the relation between the TDEXX method and time-dependent Hartree-Fock is analyzed. Several ways to take into account correlation in addition to the exact treatment of exchange in the TDEXX method are discussed, e.g., a scaling of the Kohn-Sham eigenvalues, the inclusion of (semi)local approximate correlation potentials, or hybrids of the exact-exchange kernel with kernels within the adiabatic local density approximation. The lowest lying excitations of the molecules ethylene, acetaldehyde, and pyridine are considered as examples.

Optimizing the U.S. Electric System with a High Penetration of Renewables

NASA Astrophysics Data System (ADS)

Corcoran, B. A.; Jacobson, M. Z.

2012-12-01

As renewable energy generators are increasingly being installed throughout the U.S., there is growing interest in interconnecting diverse renewable generators (primarily wind and solar) across large geographic areas through an enhanced transmission system. This reduces variability in the aggregate power output, increases system reliability, and allows for the development of the best overall group of renewable technologies and sites to meet the load. Studies are therefore needed to determine the most efficient and economical plan to achieve large area interconnections in a future electric system with a high penetration of renewables. This research quantifies the effects of aggregating electric load and, separately, electric load together with diverse renewable generation throughout the ten Federal Energy Regulatory Commission (FERC) regions in the contiguous U.S. The effects of aggregating electric load alone -- including generator capacity capital cost savings, load energy shift operating cost savings, reserve requirement cost savings, and transmission costs -- were calculated for various groupings of FERC regions using 2006 data. Transmission costs outweighed cost savings due to aggregation in nearly all cases. East-west transmission layouts had the highest overall cost, and interconnecting ERCOT to adjacent FERC regions resulted in increased costs, both due to limited existing transmission capacity. Scenarios consisting of smaller aggregation groupings had the lowest overall cost. This analysis found no economic case for further aggregation of load alone within the U.S., except possibly in the West and Northwest. If aggregation of electric load is desired, then small, regional consolidations yield the lowest overall system cost. Next, the effects of aggregating electric load together with renewable electricity generation are being quantified through the development and use of an optimization tool in AMPL (A Mathematical Programming Language). This deterministic linear program solves for the least-cost organizational structure and system (generator, transmission, storage, and reserve requirements) for a highly renewable U.S. electric grid. The analysis will 1) examine a highly renewable 2006 electric system, and 2) create a "roadmap" from the existing 2006 system to a highly renewable system in 2030, accounting for projected price and demand changes and generator retirements based on age and environmental regulations. Ideally, results from this study will offer insight for a federal renewable energy policy (such as a renewable portfolio standard) and how to best organize regions for transmission planning.

Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis

PubMed Central

Carvalho, Natalie; Gutiérrez-Delgado, Cristina; Orozco, Ricardo; Mancuso, Anna; Hogan, Daniel R; Lee, Diana; Murakami, Yuki; Sridharan, Lakshmi; Medina-Mora, María Elena; González-Pier, Eduardo

2012-01-01

Objective To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. Design Cost effectiveness analysis based on epidemiological modelling. Interventions 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. Data sources Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. Main outcome measures Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. Results Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300 000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios—for example, cataract surgeries. Conclusions Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions. PMID:22389335

10 CFR 435.306 - Selecting a life cycle effective proposed building design.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Selecting a life cycle effective proposed building design... Residential Buildings § 435.306 Selecting a life cycle effective proposed building design. In selecting... prototype, has the highest Net Savings or lowest total life cycle costs calculated in compliance with...

10 CFR 435.306 - Selecting a life cycle effective proposed building design.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Selecting a life cycle effective proposed building design... Residential Buildings § 435.306 Selecting a life cycle effective proposed building design. In selecting... prototype, has the highest Net Savings or lowest total life cycle costs calculated in compliance with...

10 CFR 435.306 - Selecting a life cycle effective proposed building design.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Selecting a life cycle effective proposed building design... Residential Buildings § 435.306 Selecting a life cycle effective proposed building design. In selecting... prototype, has the highest Net Savings or lowest total life cycle costs calculated in compliance with...

Lowest cost, nearest term options for a manned Mars mission

NASA Technical Reports Server (NTRS)

Sauls, Bob; Mortensen, Michael; Myers, Renee; Guacci, Giovanni; Montes, Fred

1992-01-01

This study is part of a NASA/USRA Advanced Design Program project executed for the purpose of examining the requirements of a first manned Mars mission. The mission, classified as a split/sprint mission, has been designed for a crew of six with a total manned trip time of one year.

Exploring the Airways for Adult Education. Section 310, Final Report.

ERIC Educational Resources Information Center

Morris, Betty

Intended to enable an individual to converse with satellite antenna dealers and to select a dealer and acquire an antenna to suit his/her needs at the lowest cost, this edited version of a final project report provides detailed guidelines for purchasing of communications satellites distance education delivery systems and specific technical…

A Hardware Testbed for Distributed Learning, Estimation, and Approximation Theory with Sensor Vehicle Networks

DTIC Science & Technology

2012-04-25

Virginia Tech VAL. Because of the excellent performance of the Trimble-based systems that were tested in the past, the Trimble subsidy Applanix was...initially contacted for available systems. The lowest cost, turnkey Trimble/ Applanix the POS LV 210 far exceeded the performance requirements of the

Structure And Efficiency Of Timber Markets

Treesearch

Brian C. Murray; Jeffrey P. Prestemon

2003-01-01

Perfect competition has long been the standard by which economists have judged the market's ability to achieve an efficient social outcome. The competitive process, unfettered by the imperfections discussed below, forges an outcome in which goods and services are produced at their lowest possible cost, and market equilibrium is achieved at the point at which the...

Neighbourhood Socio-Economic Factors in Relation to Student Drug Use and Programs.

ERIC Educational Resources Information Center

Smart, Reginald G.; And Others

1994-01-01

Examines relationships between drug use problems and socioeconomic status of neighborhoods where students in grades 11 and 13 reside. Found largest number of alcohol and drug problems in areas with lowest socioeconomic characteristics, characterized by low-cost substandard housing, social and racial problems, and delinquency. Includes 13…

On Affordability: Public Higher Education in New England

ERIC Educational Resources Information Center

Syverud, Gretchen

2015-01-01

As the lowest-priced higher education institutions serving the greatest share of students in New England, public institutions are a crucial access point for the region's students who may not have other opportunities to enroll in college. Maintaining the cost of attending a public institution in New England is imperative for students, families,…

The Distributional and Cost Implications of Negative Expected Family Contributions

ERIC Educational Resources Information Center

Kelchen, Robert

2017-01-01

Eligibility for many federal, state, and institutional financial aid programs is determined by the expected family contribution (EFC) from the Free Application for Federal Student Aid (FAFSA), which functions as a tool to ration scarce aid dollars. The lowest possible EFC under current rules is zero, but this obscures a wider distribution of…

The Hidden Costs of Direct Loans

ERIC Educational Resources Information Center

Bruns, Kevin

2007-01-01

For more than 40 years, student-loan providers have helped millions of American families achieve the kinds of dreams made possible by the best higher-education system in the world. Federal guaranteed loans, or loans made by individual lenders that are backed by the federal government, have made college more affordable by being the lowest-cost…

10 CFR 435.306 - Selecting a life cycle effective proposed building design.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Selecting a life cycle effective proposed building design... Residential Buildings § 435.306 Selecting a life cycle effective proposed building design. In selecting... prototype, has the highest Net Savings or lowest total life cycle costs calculated in compliance with...

41 CFR 301-10.121 - What classes of airline accommodations are available?

Code of Federal Regulations, 2010 CFR

2010-07-01

... higher than coach and lower than first-class, in both cost and amenities. This class of accommodation is...-class. The basic class of accommodation by airlines that is normally the lowest fare offered regardless of airline terminology used. For reference purposes only, coach-class may also be referred to by...

COMPARISON OF RECENTLY USED PHACOEMULSIFICATION SYSTEMS USING A HEALTH TECHNOLOGY ASSESSMENT METHOD.

PubMed

Huang, Jiannan; Wang, Qi; Zhao, Caimin; Ying, Xiaohua; Zou, Haidong

2017-01-01

To compare the recently used phacoemulsification systems using a health technology assessment (HTA) model. A self-administered questionnaire, which included questions to gauge on the opinions of the recently used phacoemulsification systems, was distributed to the chief cataract surgeons in the departments of ophthalmology of eighteen tertiary hospitals in Shanghai, China. A series of senile cataract patients undergoing phacoemulsification surgery were enrolled in the study. The surgical results and the average costs related to their surgeries were all recorded and compared for the recently used phacoemulsification systems. The four phacoemulsification systems currently used in Shanghai are the Infiniti Vision, Centurion Vision, WhiteStar Signature, and Stellaris Vision Enhancement systems. All of the doctors confirmed that the systems they used would help cataract patients recover vision. A total of 150 cataract patients who underwent phacoemulsification surgery were enrolled in the present study. A significant difference was found among the four groups in cumulative dissipated energy, with the lowest value found in the Centurion group. No serious complications were observed and a positive trend in visual acuity was found in all four groups after cataract surgery. The highest total cost of surgery was associated with procedures conducted using the Centurion Vision system, and significant differences between systems were mainly because of the cost of the consumables used in the different surgeries. This HTA comparison of four recently used phacoemulsification systems found that each of system offers a satisfactory vision recovery outcome, but differs in surgical efficacy and costs.

Design and Analysis of Photovoltaic (PV) Power Plant at Different Locations in Malaysia

NASA Astrophysics Data System (ADS)

Islam, M. A.; Hasanuzzaman, M.; Rahim, N. A.

2018-05-01

Power generation from sun oriented vitality through a photovoltaic (PV) system is ended up prevalent over the world due to clean innovation. Geographical location of Malaysia is very favorable for PV power generation system. The Malaysian government has also taken different steps to increase the use of solar energy especially by emphasizing on building integrated PV (BIPV) system. Comparative study on the feasibility of BIPV installation at the different location of Malaysia is rarely found. On the other hand, solar cell temperature has a negative impact on the electricity generation. So in this study cost effectiveness and initial investment cost of building integrated grid connected solar PV power plant in different regions of Malaysia have been carried. The effect of PV solar cell temperature on the payback period (PBP) is also investigated. Highest PBP is 12.38 years at Selangor and lowest PBP is 9.70 years at Sabah (Kota Kinabalu). Solar cell temperature significantly increases the PBP of PV plant and highest 14.64% and lowest 13.20% raise of PBP are encountered at Penang and Sarawak respectively.

Future Costs, Benefits, and Impacts of Renewables Used to Meet U.S. Renewable Portfolio Standards

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

This brochure provides a brief overview of the report titled 'A Prospective Analysis of the Costs, Benefits, and Impacts of U.S. Renewable Portfolio Standards.' The report evaluates the future costs, benefits, and other impacts of renewable energy used to meet current state renewable portfolio standards (RPSs). It also examines a future scenario where RPSs are expanded. The analysis examines changes in electric system costs and retail electricity prices, which include all fixed and operating costs, including capital costs for all renewable, non-renewable, and supporting (e.g., transmission and storage) electric sector infrastructure; fossil fuel, uranium, and biomass fuel costs; and plantmore » operations and maintenance expenditures. The analysis evaluates three specific benefits: air pollution, greenhouse gas emissions, and water use. It also analyzes two other impacts, renewable energy workforce and economic development, and natural gas price suppression. The analysis finds that the benefits or renewable energy used to meet RPS polices exceed the costs, even when considering the highest cost and lowest benefit outcomes.« less

Funnel metadynamics as accurate binding free-energy method

PubMed Central

Limongelli, Vittorio; Bonomi, Massimiliano; Parrinello, Michele

2013-01-01

A detailed description of the events ruling ligand/protein interaction and an accurate estimation of the drug affinity to its target is of great help in speeding drug discovery strategies. We have developed a metadynamics-based approach, named funnel metadynamics, that allows the ligand to enhance the sampling of the target binding sites and its solvated states. This method leads to an efficient characterization of the binding free-energy surface and an accurate calculation of the absolute protein–ligand binding free energy. We illustrate our protocol in two systems, benzamidine/trypsin and SC-558/cyclooxygenase 2. In both cases, the X-ray conformation has been found as the lowest free-energy pose, and the computed protein–ligand binding free energy in good agreement with experiments. Furthermore, funnel metadynamics unveils important information about the binding process, such as the presence of alternative binding modes and the role of waters. The results achieved at an affordable computational cost make funnel metadynamics a valuable method for drug discovery and for dealing with a variety of problems in chemistry, physics, and material science. PMID:23553839

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

PubMed

Zuckerman, Stephen; Skopec, Laura; Guterman, Stuart

2017-12-01

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

Fuel prices, emission standards, and generation costs for coal vs natural gas power plants.

PubMed

Pratson, Lincoln F; Haerer, Drew; Patiño-Echeverri, Dalia

2013-05-07

Low natural gas prices and stricter, federal emission regulations are promoting a shift away from coal power plants and toward natural gas plants as the lowest-cost means of generating electricity in the United States. By estimating the cost of electricity generation (COE) for 304 coal and 358 natural gas plants, we show that the economic viability of 9% of current coal capacity is challenged by low natural gas prices, while another 56% would be challenged by the stricter emission regulations. Under the current regulations, coal plants would again become the dominant least-cost generation option should the ratio of average natural gas to coal prices (NG2CP) rise to 1.8 (it was 1.42 in February 2012). If the more stringent emission standards are enforced, however, natural gas plants would remain cost competitive with a majority of coal plants for NG2CPs up to 4.3.

Economic and Social Factors in Designing Disease Control Strategies for Epidemics on Networks

NASA Astrophysics Data System (ADS)

Kleczkowski, A.; Dybiec, B.; Gilligan, C. A.

2006-11-01

Models for control of epidemics on local, global and small-world networks are considered, with only partial information accessible about the status of individuals and their connections. The main goal of an effective control measure is to stop the epidemic at a lowest possible cost, including treatment and cost necessary to track the disease spread. We show that delay in detection of infectious individuals and presence of long-range links are the most important factors determining the cost. However, the details of long-range links are usually the least-known element of the social interactions due to their occasional character and potentially short life-span. We show that under some conditions on the probability of disease spread, it is advisable to attempt to track those links, even if this involves additional costs. Thus, collecting some additional knowledge about the network structure might be beneficial to ensure a successful and cost-effective control.

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

Wang, Lijuan; Gonder, Jeff; Burton, Evan

This study evaluates the costs and benefits associated with the use of a stationary-wireless- power-transfer-enabled plug-in hybrid electric bus and determines the cost effectiveness relative to a conventional bus and a hybrid electric bus. A sensitivity sweep was performed over many different battery sizes, charging power levels, and number/location of bus stop charging stations. The net present cost was calculated for each vehicle design and provided the basis for design evaluation. In all cases, given the assumed economic conditions, the conventional bus achieved the lowest net present cost while the optimal plug-in hybrid electric bus scenario beat out the hybridmore » electric comparison scenario. The study also performed parameter sensitivity analysis under favorable and high unfavorable market penetration assumptions. The analysis identifies fuel saving opportunities with plug-in hybrid electric bus scenarios at cumulative net present costs not too dissimilar from those for conventional buses.« less

Linear chirp phase perturbing approach for finding binary phased codes

NASA Astrophysics Data System (ADS)

Li, Bing C.

2017-05-01

Binary phased codes have many applications in communication and radar systems. These applications require binary phased codes to have low sidelobes in order to reduce interferences and false detection. Barker codes are the ones that satisfy these requirements and they have lowest maximum sidelobes. However, Barker codes have very limited code lengths (equal or less than 13) while many applications including low probability of intercept radar, and spread spectrum communication, require much higher code lengths. The conventional techniques of finding binary phased codes in literatures include exhaust search, neural network, and evolutionary methods, and they all require very expensive computation for large code lengths. Therefore these techniques are limited to find binary phased codes with small code lengths (less than 100). In this paper, by analyzing Barker code, linear chirp, and P3 phases, we propose a new approach to find binary codes. Experiments show that the proposed method is able to find long low sidelobe binary phased codes (code length >500) with reasonable computational cost.

Cost-effectiveness of HIV and syphilis antenatal screening: a modeling study

PubMed Central

Bristow, Claire C.; Larson, Elysia; Anderson, Laura J.; Klausner, Jeffrey D.

2016-01-01

Objectives The World Health Organization called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonized approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women, and preventing syphilis re-infection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100,000 antenatal care patients in Malawi. Methods We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis, and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs, and the expected newborn disability adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multi-way sensitivity analysis, allowing for ranges of inputs. Results Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116,639) per 100,000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced disability adjusted life years (DALYs) compared to HIV testing alone. Conclusion The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared to all other screening strategies. Adding dual rapid testing to the existing prevention of mother-to-child HIV transmission programs in Malawi and similar countries is likely to be advantageous. PMID:26920867

Recruitment and Enrollment for the Simultaneous Conduct of 2 Randomized Controlled Trials for Patients with Subacute and Chronic Low Back Pain at a CAM Research Center

PubMed Central

Long, Cynthia R.; Haan, Andrea G.; Spencer, Lori Byrd; Meeker, William C.

2008-01-01

Abstract Objective To describe recruitment and enrollment experiences of 2 low back pain (LBP) randomized controlled trials (RCTs). Design Descriptive report. Setting Chiropractic research center in the midwest United States that is not a fee-for-service clinic. Participants Both trials enrolled participants with subacute or chronic LBP without neurologic signs who had not received spinal manipulative care during the previous month. For study 1 we screened 1940 potential participants to enroll 192 participants (89 women and 103 men), mean age 40.0 ± 9.4 years (range, 21–54 years). For study 2 we screened 1849 potential participants to enroll 240 participants (105 women and 135 men) at least 55 years old (mean, 63.1 ± 6.7 years). Interventions Study 1 randomly assigned participants to 2 weeks of 2 different chiropractic techniques or a wait list control group. Study 2 randomly assigned participants to 6 weeks of 2 different chiropractic techniques or medical care consisting of 3 provider visits for medications. Outcome measures Recruitment source costs and yield, and baseline characteristics of enrolled versus nonparticipants were recorded. Results We conducted 3789 telephone screens for both trials to enroll 432 (11%) participants, at a cost in excess of $156,000 for recruitment efforts. The cost per call for all callers averaged $41, ranging from $4 to $300 based on recruitment method; for enrolled participants, the cost per call was $361, ranging from $33 to $750. Direct mail efforts accounted for 62% of all callers, 57% for enrolled participants, and had the second lowest cost per call for recruitment efforts. Conclusions It is important that complementary and alternative medicine (CAM) research can be successfully conducted at CAM institutions. However, the costs associated with recruitment efforts for studies conducted at CAM institutions may be higher than expected and many self-identified participants are users of the CAM therapy. Therefore, strategies for efficient recruitment methods and targeting nonusers of CAM therapies should be developed early for CAM trials. PMID:18990046

Cost-Effectiveness Analysis of Abatacept Compared with Adalimumab on Background Methotrexate in Biologic-Naive Adult Patients with Rheumatoid Arthritis and Poor Prognosis.

PubMed

Alemao, Evo; Johal, Sukhvinder; Al, Maiwenn J; Rutten-van Mölken, Maureen

2018-02-01

To assess cost effectiveness of abatacept versus adalimumab, each administered with methotrexate, in treating patients with rheumatoid arthritis (RA) stratified according to baseline anticitrullinated protein antibody (ACPA) levels (marker of poor prognosis in RA). A payer-perspective cost-effectiveness model simulated disease progression in patients with RA who had previously failed conventional disease-modifying antirheumatic drugs and were starting biologic therapy. Patients commenced treatment with abatacept or adalimumab plus methotrexate and were evaluated after 6 months. Therapy continuation was based on the European League Against Rheumatism treatment response; disease progression was based on the Health Assessment Questionnaire Disability Index score. These score changes were used to estimate health state utilities and direct medical costs. Quality-adjusted life-years (QALYs) and incremental cost per QALY gained were calculated by baseline ACPA groups (Q1, 28-234 AU/ml; Q2, 235-609 AU/ml; Q3, 613-1045 AU/ml; and Q4, 1060-4894 AU/ml). Scenario analysis and one-way and probabilistic sensitivity analyses were used to evaluate robustness of model assumptions. Abatacept resulted in QALY gain versus adalimumab in ACPA Q1, Q3, and Q4; between-treatment difference (difference: Q1, -0.115 Q2, -0.009 Q3, 0.045; and Q4, 0.279). Total lifetime discounted cost was higher for abatacept versus adalimumab in most quartiles (Q2, £77,612 vs. £77,546; Q3, £74,441 vs. £73,263; and Q4, £78,428 vs. £76,696) because of longer time on treatment. Incremental cost per QALY for abatacept (vs. adalimumab) was the lowest in the high ACPA titer group (Q4, £6200/QALY), followed by the next lowest titer group (Q3, £26,272/QALY). Abatacept is a cost effective alternative to adalimumab in patients with RA with high ACPA levels. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Physician trainees' decision making and information processing: choice size and Medicare Part D.

PubMed

Barnes, Andrew J; Hanoch, Yaniv; Martynenko, Melissa; Wood, Stacey; Rice, Thomas; Federman, Alex D

2013-01-01

Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians' decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees' decision processes, strategy, and their ability to pick the cheapest drug plan-as price was deemed the most important factor in Medicare beneficiaries' plan choice-from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, p<0.01) and paid significantly less in excess premiums ($60.00 vs. $128.51, p<0.01). Compared to the three-plan condition, in the nine-plan condition participants spent significantly less time acquiring information on each attribute (p<0.05) and were more likely to employ decision strategies focusing on comparing alternate plans across a single attribute (search pattern, p<0.05). After adjusting for decision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (p<0.05). Although employing more efficient search strategies in the complex choice environment, physician trainees experienced similar difficulty in choosing the lowest cost prescription drug plans as older patients do. Our results add further evidence that simplifications to the Medicare Part D decision environment are needed and suggest physicians' role in their patients' Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.

Molecular structure and interactions in the ionic liquid 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide.

PubMed

Dhumal, Nilesh R; Noack, Kristina; Kiefer, Johannes; Kim, Hyung J

2014-04-03

Electronic structure theory (density functional and Møller-Plesset perturbation theory) and vibrational spectroscopy (FT-IR and Raman) are employed to study molecular interactions in the room-temperature ionic liquid 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide. Different conformers of a cation-anion pair based on their molecular interactions are simulated in the gas phase and in a dielectric continuum solvent environment. Although the ordering of conformers in energy varies with theoretical methods, their predictions for three lowest energy conformers in the gas phase are similar. Strong C-H---N interactions between the acidic hydrogen atom of the cation imidazole ring and the nitrogen atom of the anion are predicted for either the lowest or second lowest energy conformer. In a continuum solvent, different theoretical methods yield the same ion-pair conformation for the lowest energy state. In both phases, the density functional method predicts that the anion is in a trans conformation in the lowest energy ion pair state. The theoretical results are compared with experimental observations from Raman scattering and IR absorption spectroscopies and manifestations of the molecular interactions in the vibrational spectra are discussed. The directions of the frequency shifts of the characteristic vibrations relative to the free anion and cation are explained by calculating the difference electron density coupled with electron density topography.

Do adjunct tuberculosis tests, when combined with Xpert MTB/RIF, improve accuracy and the cost of diagnosis in a resource-poor setting?

PubMed Central

Theron, Grant; Pooran, Anil; Peter, Jonny; van Zyl-Smit, Richard; Mishra, Hridesh Kumar; Meldau, Richard; Calligaro, Greg; Allwood, Brian; Sharma, Surendra Kumar; Dawson, Rod; Dheda, Keertan

2017-01-01

Information regarding the utility of adjunct diagnostic tests in combination with Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is limited. We hypothesised adjunct tests could enhance accuracy and/or reduce the cost of tuberculosis (TB) diagnosis prior to MTB/RIF testing, and rule-in or rule-out TB in MTB/RIF-negative individuals. We assessed the accuracy and/or laboratory-associated cost of diagnosis of smear microscopy, chest radiography (CXR) and interferon-γ release assays (IGRAs; T-SPOT-TB (Oxford Immunotec, Oxford, UK) and QuantiFERON-TB Gold In-Tube (Cellestis, Chadstone, Australia)) combined with MTB/RIF for TB in 480 patients in South Africa. When conducted prior to MTB/RIF: 1) smear microscopy followed by MTB/RIF (if smear negative) had the lowest cost of diagnosis of any strategy investigated; 2) a combination of smear microscopy, CXR (if smear negative) and MTB/RIF (if imaging compatible with active TB) did not further reduce the cost per TB case diagnosed; and 3) a normal CXR ruled out TB in 18% of patients (57 out of 324; negative predictive value (NPV) 100%). When downstream adjunct tests were applied to MTB/RIF-negative individuals, radiology ruled out TB in 24% (56 out of 234; NPV 100%), smear microscopy ruled in TB in 21% (seven out of 24) of culture-positive individuals and IGRAs were not useful in either context. In resource-poor settings, smear microscopy combined with MTB/RIF had the highest accuracy and lowest cost of diagnosis compared to either technique alone. In MTB/RIF-negative individuals, CXR has poor rule-in value but can reliably rule out TB in approximately one in four cases. These data inform upon the programmatic utility of MTB/RIF in high-burden settings. PMID:22075479

Cost Analysis for Large Civil Transport Rotorcraft

NASA Technical Reports Server (NTRS)

Coy, John J.

2006-01-01

This paper presents cost analysis of purchase price and DOC+I (direct operating cost plus interest) that supports NASA s study of three advanced rotorcraft concepts that could enter commercial transport service within 10 to 15 years. The components of DOC+I are maintenance, flight crew, fuel, depreciation, insurance, and finance. The cost analysis aims at VTOL (vertical takeoff and landing) and CTOL (conventional takeoff and landing) aircraft suitable for regional transport service. The resulting spreadsheet-implemented cost models are semi-empirical and based on Department of Transportation and Army data from actual operations of such aircraft. This paper describes a rationale for selecting cost tech factors without which VTOL is more costly than CTOL by a factor of 10 for maintenance cost and a factor of two for purchase price. The three VTOL designs selected for cost comparisons meet the mission requirement to fly 1,200 nautical miles at 350 knots and 30,000 ft carrying 120 passengers. The lowest cost VTOL design is a large civil tilt rotor (LCTR) aircraft. With cost tech factors applied, the LCTR is reasonably competitive with the Boeing 737-700 when operated in economy regional service following the business model of the selected baseline operation, that of Southwest Airlines.

Lowest cost due to highest productivity and highest quality

NASA Astrophysics Data System (ADS)

Wenk, Daniel

2003-03-01

Since global purchasing in the automotive industry has been taken up all around the world there is one main key factor that makes a TB-supplier today successful: Producing highest quality at lowest cost. The fact that Tailored Blanks, which today may reach up to 1/3 of a car body weight, are purchased on the free market but from different steel suppliers, especially in Europe and NAFTA, the philosophy on OEM side has been changing gradually towards tough evaluation criteria. "No risk at the stamping side" calls for top quality Tailored- or Tubular Blank products. Outsourcing Tailored Blanks has been starting in Japan but up to now without any quality request from the OEM side like ISO 13919-1B (welding quality standard in Europe and USA). Increased competition will automatically push the quality level and the ongoing approach to combine high strength steel with Tailored- and Tubular Blanks will ask for even more reliable system concepts which enables to weld narrow seams at highest speed. Beside producing quality, which is the key to reduce one of the most important cost driver "material scrap," in-line quality systems with true and reliable evaluation is going to be a "must" on all weld systems. Traceability of all process related data submitted to interfaces according to customer request in combination with ghost-shift-operation of TB systems are tomorrow's state-of-the-art solutions of Tailored Blank-facilities.

Cost and performance of thermal storage concepts in solar thermal systems, Phase 2-liquid metal receivers

NASA Astrophysics Data System (ADS)

McKenzie, A. W.

Cost and performance of various thermal storage concepts in a liquid metal receiver solar thermal power system application have been evaluated. The objectives of this study are to provide consistently calculated cost and performance data for thermal storage concepts integrated into solar thermal systems. Five alternative storage concepts are evaluated for a 100-MW(e) liquid metal-cooled receiver solar thermal power system for 1, 6, and 15 hours of storage: sodium 2-tank (reference system), molten draw salt 2-tank, sand moving bed, air/rock, and latent heat (phase change) with tube-intensive heat exchange (HX). The results indicate that the all sodium 2-tank thermal storage concept is not cost-effective for storage in excess of 3 or 4 hours; the molten draw salt 2-tank storage concept provides significant cost savings over the reference sodium 2-tank concept; and the air/rock storage concept with pressurized sodium buffer tanks provides the lowest evaluated cost of all storage concepts considered above 6 hours of storage.

Influence of the partial volume correction method on 18F-fluorodeoxyglucose brain kinetic modelling from dynamic PET images reconstructed with resolution model based OSEM

PubMed Central

Bowen, Spencer L.; Byars, Larry G.; Michel, Christian J.; Chonde, Daniel B.; Catana, Ciprian

2014-01-01

Kinetic parameters estimated from dynamic 18F-fluorodeoxyglucose PET acquisitions have been used frequently to assess brain function in humans. Neglecting partial volume correction (PVC) for a dynamic series has been shown to produce significant bias in model estimates. Accurate PVC requires a space-variant model describing the reconstructed image spatial point spread function (PSF) that accounts for resolution limitations, including non-uniformities across the field of view due to the parallax effect. For OSEM, image resolution convergence is local and influenced significantly by the number of iterations, the count density, and background-to-target ratio. As both count density and background-to-target values for a brain structure can change during a dynamic scan, the local image resolution may also concurrently vary. When PVC is applied post-reconstruction the kinetic parameter estimates may be biased when neglecting the frame-dependent resolution. We explored the influence of the PVC method and implementation on kinetic parameters estimated by fitting 18F-fluorodeoxyglucose dynamic data acquired on a dedicated brain PET scanner and reconstructed with and without PSF modelling in the OSEM algorithm. The performance of several PVC algorithms was quantified with a phantom experiment, an anthropomorphic Monte Carlo simulation, and a patient scan. Using the last frame reconstructed image only for regional spread function (RSF) generation, as opposed to computing RSFs for each frame independently, and applying perturbation GTM PVC with PSF based OSEM produced the lowest magnitude bias kinetic parameter estimates in most instances, although at the cost of increased noise compared to the PVC methods utilizing conventional OSEM. Use of the last frame RSFs for PVC with no PSF modelling in the OSEM algorithm produced the lowest bias in CMRGlc estimates, although by less than 5% in most cases compared to the other PVC methods. The results indicate that the PVC implementation and choice of PSF modelling in the reconstruction can significantly impact model parameters. PMID:24052021

Network-based reading system for lung cancer screening CT

NASA Astrophysics Data System (ADS)

Fujino, Yuichi; Fujimura, Kaori; Nomura, Shin-ichiro; Kawashima, Harumi; Tsuchikawa, Megumu; Matsumoto, Toru; Nagao, Kei-ichi; Uruma, Takahiro; Yamamoto, Shinji; Takizawa, Hotaka; Kuroda, Chikazumi; Nakayama, Tomio

2006-03-01

This research aims to support chest computed tomography (CT) medical checkups to decrease the death rate by lung cancer. We have developed a remote cooperative reading system for lung cancer screening over the Internet, a secure transmission function, and a cooperative reading environment. It is called the Network-based Reading System. A telemedicine system involves many issues, such as network costs and data security if we use it over the Internet, which is an open network. In Japan, broadband access is widespread and its cost is the lowest in the world. We developed our system considering human machine interface and security. It consists of data entry terminals, a database server, a computer aided diagnosis (CAD) system, and some reading terminals. It uses a secure Digital Imaging and Communication in Medicine (DICOM) encrypting method and Public Key Infrastructure (PKI) based secure DICOM image data distribution. We carried out an experimental trial over the Japan Gigabit Network (JGN), which is the testbed for the Japanese next-generation network, and conducted verification experiments of secure screening image distribution, some kinds of data addition, and remote cooperative reading. We found that network bandwidth of about 1.5 Mbps enabled distribution of screening images and cooperative reading and that the encryption and image distribution methods we proposed were applicable to the encryption and distribution of general DICOM images via the Internet.

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

Neal, J.W.

The nation`s rural electric cooperatives own a high proportion of coal-fired generation, in excess of 80 percent of their generating capacity. As the electric utility industry moves toward a competitive electricity market, the generation mix for electric cooperatives is expected to change. Distributed generation will likely serve more customer loads than is now the case, and that will lead to an increase in gas-fired generation capacity. But, clean low-cost central station coal-fired capacity is expected to continue to be the primary source of power for growing rural electric cooperatives. Gasification combined cycle could be the lowest cost coal based generationmore » option in this new competitive market if both capital cost and electricity production costs can be further reduced. This paper presents anticipated utility business scenarios for the deregulated future and identifies combined cycle power plant configurations that might prove most competitive.« less

Multiconfiguration pair-density functional theory investigation of the electronic spectrum of MnO4-

NASA Astrophysics Data System (ADS)

Sharma, Prachi; Truhlar, Donald G.; Gagliardi, Laura

2018-03-01

The electronic spectrum of permanganate ions contains various highly multiconfigurational ligand-to-metal charge transfer states and is notorious for being one of the most challenging systems to be treated by quantum-chemical methods. Here we studied the lowest nine vertical excitation energies using restricted active space second-order perturbation theory (RASPT2) and multiconfiguration pair-density functional theory (MC-PDFT) to test and compare these two theories in computing such a challenging spectrum. The results are compared to literature data, including time-dependent density functional theory, completely renormalized equation-of-motion couple-cluster theory with single and double excitations, symmetry-adapted-cluster configuration interaction, and experimental spectra in the gas phase and solution. Our results show that MC-PDFT accurately predicts the spectrum at a significantly reduced cost as compared to RASPT2.

Multiconfiguration pair-density functional theory investigation of the electronic spectrum of MnO4.

PubMed

Sharma, Prachi; Truhlar, Donald G; Gagliardi, Laura

2018-03-28

The electronic spectrum of permanganate ions contains various highly multiconfigurational ligand-to-metal charge transfer states and is notorious for being one of the most challenging systems to be treated by quantum-chemical methods. Here we studied the lowest nine vertical excitation energies using restricted active space second-order perturbation theory (RASPT2) and multiconfiguration pair-density functional theory (MC-PDFT) to test and compare these two theories in computing such a challenging spectrum. The results are compared to literature data, including time-dependent density functional theory, completely renormalized equation-of-motion couple-cluster theory with single and double excitations, symmetry-adapted-cluster configuration interaction, and experimental spectra in the gas phase and solution. Our results show that MC-PDFT accurately predicts the spectrum at a significantly reduced cost as compared to RASPT2.

Optimizing the Placement of Burnable Poisons in PWRs

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

Yilmaz, Serkan; Ivanov, Kostadin; Levine, Samuel

2005-07-15

The principal focus of this work is on developing a practical tool for designing the minimum amount of burnable poisons (BPs) for a pressurized water reactor using a typical Three Mile Island Unit 1 2-yr cycle as the reference design. The results of this study are to be applied to future reload designs. A new method, the Modified Power Shape Forced Diffusion (MPSFD) method, is presented that initially computes the BP cross section to force the power distribution into a desired shape. The method employs a simple formula that expresses the BP cross section as a function of the differencemore » between the calculated radial power distributions (RPDs) and the limit set for the maximum RPD. This method places BPs into all fresh fuel assemblies (FAs) having an RPD greater than the limit. The MPSFD method then reduces the BP content by reducing the BPs in fresh FAs with the lowest RPDs. Finally, the minimum BP content is attained via a heuristic fine-tuning procedure.This new BP design program has been automated by incorporating the new MPSFD method in conjunction with the heuristic fine-tuning program. The program has automatically produced excellent results for the reference core, and has the potential to reduce fuel costs and save manpower.« less

Urban trees and traffic safety: considering the U.S. roadside policy and crash data

Treesearch

Kathleen L. Wolf

2006-01-01

In the mid to late 20th century, U.S. transportation agencies focused on traffic planning and design practices intended to achieve high levels of traffic capacity and safety for roads at lowest cost. Intangible values of the roadside such as community character and environmental systems were often overlooked, including the urban forest....

41 CFR 301-10.112 - What must I do when different airlines furnish the same service at different fares?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL EXPENSES 10-TRANSPORTATION EXPENSES Common Carrier Transportation Use of Contract City-Pair... the same points for the same type of accommodations, you must use the lowest cost service unless your...

Commercial Network Television: Strategies for Programming and the Content of Prime Time TV, 1976-1979.

ERIC Educational Resources Information Center

Austin, Bruce A.

The 1976-79 schedules of the three major television networks were analyzed to determine what strategies were used to organize prime time schedules and what types of programs appeared during prime time viewing periods. Five essential programing strategies were identified: fraction of selection (cost versus reward), lowest common denominator (wide…

41 CFR 102-118.150 - What are the major mandatory terms and conditions governing the use of passenger transportation...

Code of Federal Regulations, 2010 CFR

2010-07-01

... same rate in effect on that date as published by the Secretary of the Treasury pursuant to the Debt... conditions governing the use of passenger transportation documents are: (a) Government travel must be via the lowest cost available, that meets travel requirements; e.g., Government contract, fare, through...

48 CFR 52.247-38 - F.o.b. Inland Carrier, Point of Exportation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... requirements to protect the goods and to ensure assessment of the lowest applicable transportation charge; (2... shipment in good order and condition in or on the conveyance of the carrier on the date or within the period specified; and (ii) Pay and bear all applicable charges, including transportation costs, to the...

48 CFR 52.247-38 - F.o.b. Inland Carrier, Point of Exportation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... requirements to protect the goods and to ensure assessment of the lowest applicable transportation charge; (2... shipment in good order and condition in or on the conveyance of the carrier on the date or within the period specified; and (ii) Pay and bear all applicable charges, including transportation costs, to the...

48 CFR 52.247-38 - F.o.b. Inland Carrier, Point of Exportation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... requirements to protect the goods and to ensure assessment of the lowest applicable transportation charge; (2... shipment in good order and condition in or on the conveyance of the carrier on the date or within the period specified; and (ii) Pay and bear all applicable charges, including transportation costs, to the...

48 CFR 52.247-38 - F.o.b. Inland Carrier, Point of Exportation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... requirements to protect the goods and to ensure assessment of the lowest applicable transportation charge; (2... shipment in good order and condition in or on the conveyance of the carrier on the date or within the period specified; and (ii) Pay and bear all applicable charges, including transportation costs, to the...

77 FR 76883 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

... compliance with future caps on emissions. As Commenter points out, Ohio's submittal states that ``companies... reduce them at the lowest possible cost. The fact that companies anticipate the economic benefits of... Dayton Power and Light Company, Duke Energy Ohio, Inc., and Columbus Southern Power Co., Civil Action No...

The Association between Charlson Comorbidity Index and the Medical Care Cost of Cancer: A Retrospective Study.

PubMed

Yoon, Seok-Jun; Kim, Eun-Jung; Seo, Hyun-Ju; Oh, In-Hwan

2015-01-01

This study compared comorbidity-related medical care cost associated with different types of cancer, by examining breast (N = 287), colon (N = 272), stomach (N = 614), and lung (N = 391) cancer patients undergoing surgery. Using medical benefits claims data, we calculated Charlson Comorbidity Index (CCI) and total medical cost. The effect of comorbidity on the medical care cost was investigated using multiple regression and logistic regression models and controlling for demographic characteristics and cancer stage. The treatment costs incurred by stomach and colon cancer patients were 1.05- and 1.01-fold higher, respectively, in patients with higher CCI determined. For breast cancer, the highest costs were seen in those with chronic obstructive pulmonary disease (COPD), but the increase in cost reduced as CCI increased. Colon cancer patients with diabetes mellitus and a CCI = 1 score had the highest medical costs. The lowest medical costs were incurred by lung cancer patients with COPD and a CCI = 2 score. The comorbidities had a major impact on the use of medical resources, with chronic comorbidities incurring the highest medical costs. The results indicate that comorbidities affect cancer outcomes and that they must be considered strategies mitigating cancer's economic and social impact.

Determinants of nursing home costs in Florida: policy implications and support in national research findings.

PubMed Central

Traxler, H G

1982-01-01

Descriptive and econometric analysis of the major nonquality determinants of nursing home costs for Florida shows that mean costs, size, and occupancy rate increased between 1971 and 1976, that per diem costs and occupancy rate were inversely related, and that the per diem cost was lower in rural than in urban areas. Regression of the data shows that--next to inflation, as expressed by the Consumer Price Index--the occupancy rate accounts for most of the variation in per diem costs, followed by size, urban-rural location, and by type of control. The hypothetical "optimal," defined as lowest cost-size range, was calculated to be more than 350 beds. Recent research substantiates most of these findings. Medicaid Cost Reports from Florida's nursing homes were the source of the information analyzed; by 1976, the sixth year of the study, the data base covered nearly 9 of 10 licensed beds in the State. Some policy implications can be drawn from the analysis. Reductions in per diem costs could be achieved by higher occupancy rates, especially in the larger nursing homes, and a reduction in the rate of inflation would reduce the rate of increase in nursing home costs. PMID:6815706

Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review

PubMed Central

Ramani, Enusa; Wee, Hyeseung; Kim, Jerome H.

2016-01-01

Background Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. Objectives To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. Data sources Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. Study eligibility criteria The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. Participants No participants are involved, only costs are collected. Intervention Oral cholera vaccination and cost estimation. Study appraisal and synthesis method A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). Results Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in routine immunization systems were lowest from US$ 0.36 (in US$2014) equivalent to I$ 0.99 (in I$2014). Limitations The reported cost categories are not standardized at collection point and may lead to misclassification. Costs for some OCV campaigns are not available and analysis does not include direct and indirect costs to vaccine recipients. Conclusions and implications of key findings Vaccine delivery cost estimation is needed for budgeting and economic analysis of vaccination programs. The cost categorization methodology presented in this study is helpful in collecting OCV delivery costs in a standardized manner, comparing delivery costs, planning vaccination campaigns and informing decision-making. PMID:27930668

Systems definition space-based power conversion systems. [for satellite power transmission to earth

NASA Technical Reports Server (NTRS)

1976-01-01

Potential space-located systems for the generation of electrical power for use on Earth are discussed and include: (1) systems producing electrical power from solar energy; (2) systems producing electrical power from nuclear reactors; and (3) systems for augmenting ground-based solar power plants by orbital sunlight reflectors. Systems (1) and (2) would utilize a microwave beam system to transmit their output to Earth. Configurations implementing these concepts were developed through an optimization process intended to yield the lowest cost for each. A complete program was developed for each concept, identifying required production rates, quantities of launches, required facilities, etc. Each program was costed in order to provide the electric power cost appropriate to each concept.

Life support approaches for Mars missions

NASA Astrophysics Data System (ADS)

Drysdale, A. E.; Ewert, M. K.; Hanford, A. J.

Life support approaches for Mars missions are evaluated using an equivalent system mass (ESM) approach, in which all significant costs are converted into mass units. The best approach, as defined by the lowest mission ESM, depends on several mission parameters, notably duration, environment and consequent infrastructure costs, and crew size, as well as the characteristics of the technologies which are available. Generally, for the missions under consideration, physicochemical regeneration is most cost effective. However, bioregeneration is likely to be of use for producing salad crops for any mission, for producing staple crops for medium duration missions, and for most food, air and water regeneration for long missions (durations of a decade). Potential applications of in situ resource utilization need to be considered further.

Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

NASA Astrophysics Data System (ADS)

Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

2016-05-01

To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P <0.05). Compared with gelatin sponge and alginate dressing hemostatic effect, The difference was not statistically significant. (2) Tube maintenance cost: Puncture point using gelatin sponge, The local maintenance costs of the catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (P<0.05). Conclusion: The choice of compression hemostasis material for the puncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

Efficiency of Emission Control Measures on Particulate Matter-Related Health Impacts and Economic Cost during the 2014 Asia-Pacific Economic Cooperation Meeting in Beijing.

PubMed

Liu, Qichen; Huang, Jing; Guo, Bin; Guo, Xinbiao

2016-12-28

Background : The Asia-Pacific Economic Cooperation (APEC) meeting was held from 5 November to 11 November 2014 in Beijing, and comprehensive emission control measures were implemented. The efficiency of these measures on particulate matter-related health impacts and economic cost need to be evaluated. Methods : The influences of emission control measures during APEC on particulate matter were evaluated, and health economic effects were assessed. Results : Average concentrations of PM 2.5 and PM 10 during APEC were reduced by 57.0%, and 50.6% respectively, compared with pre-APEC period. However, the concentrations of particulate matter rebounded after APEC. Compared with the pre-APEC and post-APEC periods, the estimated number of deaths caused by non-accidental, cardiovascular and respiratory diseases that could be attributed to PM 2.5 and PM 10 during the APEC were the lowest. The economic cost associated with mortality caused by PM 2.5 and PM 10 during the APEC were reduced by (61.3% and 66.6%) and (50.3% and 60.8%) respectively, compared with pre-APEC and post-APEC. Conclusions : The emission control measures were effective in improving short term air quality and reducing health risks and medical expenses during 2014 APEC, but more efforts is needed for long term and continuous air quality improvement and health protection.

Efficiency of Emission Control Measures on Particulate Matter-Related Health Impacts and Economic Cost during the 2014 Asia-Pacific Economic Cooperation Meeting in Beijing

PubMed Central

Liu, Qichen; Huang, Jing; Guo, Bin; Guo, Xinbiao

2016-01-01

Background: The Asia-Pacific Economic Cooperation (APEC) meeting was held from 5 November to 11 November 2014 in Beijing, and comprehensive emission control measures were implemented. The efficiency of these measures on particulate matter-related health impacts and economic cost need to be evaluated. Methods: The influences of emission control measures during APEC on particulate matter were evaluated, and health economic effects were assessed. Results: Average concentrations of PM2.5 and PM10 during APEC were reduced by 57.0%, and 50.6% respectively, compared with pre-APEC period. However, the concentrations of particulate matter rebounded after APEC. Compared with the pre-APEC and post-APEC periods, the estimated number of deaths caused by non-accidental, cardiovascular and respiratory diseases that could be attributed to PM2.5 and PM10 during the APEC were the lowest. The economic cost associated with mortality caused by PM2.5 and PM10 during the APEC were reduced by (61.3% and 66.6%) and (50.3% and 60.8%) respectively, compared with pre-APEC and post-APEC. Conclusions: The emission control measures were effective in improving short term air quality and reducing health risks and medical expenses during 2014 APEC, but more efforts is needed for long term and continuous air quality improvement and health protection. PMID:28036006

STATISTICAL PROCEDURES FOR DETERMINATION AND VERIFICATION OF MINIMUM REPORTING LEVELS FOR DRINKING WATER METHODS

EPA Science Inventory

The United States Environmental Protection Agency's (EPA) Office of Ground Water and Drinking Water (OGWDW) has developed a single-laboratory quantitation procedure: the lowest concentration minimum reporting level (LCMRL). The LCMRL is the lowest true concentration for which fu...

Use of optimization to predict the effect of selected parameters on commuter aircraft performance

NASA Technical Reports Server (NTRS)

Wells, V. L.; Shevell, R. S.

1982-01-01

An optimizing computer program determined the turboprop aircraft with lowest direct operating cost for various sets of cruise speed and field length constraints. External variables included wing area, wing aspect ratio and engine sea level static horsepower; tail sizes, climb speed and cruise altitude were varied within the function evaluation program. Direct operating cost was minimized for a 150 n.mi typical mission. Generally, DOC increased with increasing speed and decreasing field length but not by a large amount. Ride roughness, however, increased considerably as speed became higher and field length became shorter.

Cost of lifetime immunosuppression coverage for kidney transplant recipients.

PubMed

Page, Timothy F; Woodward, Robert S

2008-01-01

On January 1, 2000, Medicare extended the coverage of immunosuppression medications from 3 years to life for elderly and disabled kidney transplant recipients. This research estimates the impact of extending this lifetime coverage to all kidney transplant recipients on Medicare's cash flows. The study finds that extending coverage to all kidney transplant recipients would have increased Medicare's net cash outflows if the coverage were extended for patients of all income levels. There is evidence that extending coverage to only patients in the lowest income quartile could have resulted in a net cost savings to Medicare.

Study 2.5 final report. DORCA computer program. Volume 5: Analysis report

NASA Technical Reports Server (NTRS)

Campbell, N.

1972-01-01

A modification of the Dynamic Operational Requirements and Cost Analysis Program to perform traffic analyses of the automated satellite program is described. Inherent in the analyses of the automated satellite program was the assumption that a number of vehicles were available to perform any or all of the missions within the satellite program. The objective of the modification was to select a vehicle or group of vehicles for performing all of the missions at the lowest possible cost. A vehicle selection routine and the capability to simulate ground based vehicle operational modes were incorporated into the program.

Study on store-space assignment based on logistic AGV in e-commerce goods to person picking pattern

NASA Astrophysics Data System (ADS)

Xu, Lijuan; Zhu, Jie

2017-10-01

This paper studied on the store-space assignment based on logistic AGV in E-commerce goods to person picking pattern, and established the store-space assignment model based on the lowest picking cost, and design for store-space assignment algorithm after the cluster analysis based on similarity coefficient. And then through the example analysis, compared the picking cost between store-space assignment algorithm this paper design and according to item number and storage according to ABC classification allocation, and verified the effectiveness of the design of the store-space assignment algorithm.

Investigation of non-hydroxamate scaffolds against HDAC6 inhibition: A pharmacophore modeling, molecular docking, and molecular dynamics simulation approach.

PubMed

Zeb, Amir; Park, Chanin; Son, Minky; Rampogu, Shailima; Alam, Syed Ibrar; Park, Seok Ju; Lee, Keun Woo

2018-06-01

Proteins deacetylation by Histone deacetylase 6 (HDAC6) has been shown in various human chronic diseases like neurodegenerative diseases and cancer, and hence is an important therapeutic target. Since, the existing inhibitors have hydroxamate group, and are not HDAC6-selective, therefore, this study has designed to investigate non-hydroxamate HDAC6 inhibitors. Ligand-based pharmacophore was generated from 26 training set compounds of HDAC6 inhibitors. The statistical parameters of pharmacophore (Hypo1) included lowest total cost of 115.63, highest cost difference of 135.00, lowest RMSD of 0.70 and the highest correlation of 0.98. The pharmacophore was validated by Fischer's Randomization and Test Set validation, and used as screening tool for chemical databases. The screened compounds were filtered by fit value ([Formula: see text]), estimated Inhibitory Concentration (IC[Formula: see text]) ([Formula: see text]), Lipinski's Rule of Five and Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) Descriptors to identify drug-like compounds. Furthermore, the drug-like compounds were docked into the active site of HDAC6. The best docked compounds were selected having goldfitness score [Formula: see text] and [Formula: see text], and hydrogen bond interaction with catalytic active residues. Finally, three inhibitors having sulfamoyl group were selected by Molecular Dynamic (MD) simulation, which showed stable root mean square deviation (RMSD) (1.6-1.9[Formula: see text]Å), lowest potential energy ([Formula: see text][Formula: see text]kJ/mol), and hydrogen bonding with catalytic active residues of HDAC6.

Economic and policy analysis of university-based drug "detailing".

PubMed

Soumerai, S B; Avorn, J

1986-04-01

The cost-effectiveness of quality assurance programs is often poorly documented, especially for innovative approaches. The authors analyzed the economic effects of an experimental educational outreach program designed to reduce inappropriate drug prescribing, based on a four-state randomized controlled trial (N = 435 physicians). Primary care physicians randomized into the face-to-face group were offered two individualized educational sessions with clinical pharmacists, lasting an average of 18 minutes each, concerning optimal use of three drug groups that are often used inappropriately. After the program, expenditures for target drugs prescribed by these physicians to Medicaid patients decreased by 13%, compared with controls (P = 0.002); this effect was stable over three quarters. Implementation of this program for 10,000 physicians would lead to projected drug savings (to Medicaid only) of $2,050,000, compared with resource costs of $940,000. Net savings remain high, even after adjustment for use of substitution medications. Although there was a ninefold difference in average preintervention prescribing levels between the highest and lowest thirds of the sample, all groups reduced target drug expenditures at the same rate. Targeting of higher-volume prescribers would thus further raise the observed benefit-to-cost ratio from approximately 1.8 to at least 3.0. Net benefits would also increase further if non-Medicaid savings were added, or if the analysis included quality-of-care considerations. Although print materials alone may be marginally cost-effective, print plus face-to-face approaches offer greater net benefits. The authors conclude that a program of brief, face-to-face "detailing" visits conducted by academic rather than commercial sources can be a highly cost-effective method for improving drug therapy decisions. Such an approach makes possible the enhancement of physicians' clinical expertise without relying on restriction of drug choices.

Effect of heliostat size on the levelized cost of electricity for power towers

NASA Astrophysics Data System (ADS)

Pidaparthi, Arvind; Hoffmann, Jaap

2017-06-01

The objective of this study is to investigate the effects of heliostat size on the levelized cost of electricity (LCOE) for power tower plants. These effects are analyzed in a power tower with a net capacity of 100 MWe, 8 hours of thermal energy storage and a solar multiple of 1.8 in Upington, South Africa. A large, medium and a small size heliostat with a total area of 115.56 m2, 43.3 m2 and 15.67 m2 respectively are considered for comparison. A radial-staggered pattern and an external cylindrical receiver are considered for the heliostat field layouts. The optical performance of the optimized heliostat field layouts has been evaluated by the Hermite (analytical) method using SolarPILOT, a tool used for the generation and optimization of the heliostat field layout. The heliostat cost per unit is calculated separately for the three different heliostat sizes and the effects due to size scaling, learning curve benefits and the price index is included. The annual operation and maintenance (O&M) costs are estimated separately for the three heliostat fields, where the number of personnel required in the field is determined by the number of heliostats in the field. The LCOE values are used as a figure of merit to compare the different heliostat sizes. The results, which include the economic and the optical performance along with the annual O&M costs, indicate that lowest LCOE values are achieved by the medium size heliostat with an area of 43.3 m2 for this configuration. This study will help power tower developers determine the optimal heliostat size for power tower plants currently in the development stage.

Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

PubMed Central

Epstein, Nancy E.

2012-01-01

Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

Development and Multi-laboratory Verification of US EPA ...

EPA Pesticide Factsheets

A drinking water method for seven pesticides and pesticide degradates is presented that addresses the occurrence monitoring needs of the US Environmental Protection Agency (EPA) for a future Unregulated Contaminant Monitoring Regulation (UCMR). The method employs online solid phase extraction-liquid chromatography–tandem mass spectrometry (SPE-LC–MS-MS). Online SPE-LC–MS-MS has the potential to offer cost-effective, faster, more sensitive and more rugged methods than the traditional offline SPE approach due to complete automation of the SPE process, as well as seamless integration with the LC–MS-MS system. The method uses 2-chloroacetamide, ascorbic acid and Trizma to preserve the drinking water samples for up to 28 days. The mean recoveries in drinking water (from a surface water source) fortified with method analytes are 87.1–112% with relative standard deviations of <14%. Single laboratory lowest concentration minimum reporting levels of 0.27–1.7 ng/L are demonstrated with this methodology. Multi-laboratory data are presented that demonstrate method ruggedness and transferability. The final method meets all of the EPA's UCMR survey requirements for sample collection and storage, precision, accuracy, and sensitivity. The journal article describes the development of drinking water Method 543 for analysis of selected CCL 3 chemicals. It is anticipated this method may be used in a future Unregulated Contaminant Monitoring Regulation to gather nationw