Part-time Labor, Work Rules, and Transit Costs

DOT National Transportation Integrated Search

1981-01-01

This report examines two major issues: (1)the impact of labor union work rules : on bus transit operating costs and (2)the magnitude of cost savings that can be : expected from the use of part-time drivers. These issues are examined within : the cont...

Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes.

PubMed

Wheeler, Matthew T; Heidenreich, Paul A; Froelicher, Victor F; Hlatky, Mark A; Ashley, Euan A

2010-03-02

Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness. To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening. Decision-analysis, cost-effectiveness model. Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. Competitive athletes in high school and college aged 14 to 22 years. Lifetime. Societal. Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. Incremental health care cost per life-year gained. Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000). Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. Stanford Cardiovascular Institute and the Breetwor Foundation.

The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

PubMed

Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

2018-04-01

To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient angioplasty.

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

Not Available

Dollars saved through energy efficiency can directly impact your bottom line. Whether you are planning for a major renovation or upgrading individual pieces of building equipment, these improvements can help reduce operating costs, save on utility bills, and boost profits. This fact sheet provides guidelines for SBA lenders to understand the value of financing energy efficiency investments.

Solar Glazing Tips for School Construction

ERIC Educational Resources Information Center

Smith, Jonathan

2012-01-01

Glazing can be optimized to enhance passive solar heating and daylight harvesting by exceeding the prescriptive limits of the energy code. This savings can be garnered without the high cost of external overhangs or expensive glazing products. The majority of savings from solar glazing are attributable to the increase in solar heating and…

Vaccination versus treatment of influenza in working adults: a cost-effectiveness analysis.

PubMed

Rothberg, Michael B; Rose, David N

2005-01-01

To determine the cost-effectiveness of influenza vaccination, antiviral therapy, or no intervention for healthy working adults, accounting for annual variation in vaccine efficacy. We conducted a cost-effectiveness analysis based on published clinical trials of influenza vaccine and antiviral drugs, incorporating 10 years of surveillance data from the World Health Organization. We modeled influenza vaccination, treatment of influenza-like illness with antiviral drugs, or both, as compared with no intervention, targeting healthy working adults under age 50 years in the general community or workplace. Outcomes included costs, illness days, and quality-adjusted days gained. In the base case analysis, the majority of costs incurred for all strategies were related to lost productivity from influenza illness. The least expensive strategy varied from year to year. For the 10-year period, antiviral therapy without vaccination was associated with the lowest overall costs (234 US dollars per person per year). Annual vaccination cost was 239 US dollars per person, and was associated with 0.0409 quality-adjusted days saved, for a marginal cost-effectiveness ratio of 113 US dollars per quality-adjusted day gained or 41,000 US dollars per quality-adjusted life-year saved compared with antiviral therapy. No intervention was the most expensive and least effective option. In sensitivity analyses, lower vaccination costs, higher annual probabilities of influenza, and higher numbers of workdays lost to influenza made vaccination more cost-effective than treatment. If vaccination cost was less than 16 US dollars or time lost from work exceeded 2.4 days per episode of influenza, then vaccination was cost saving compared with all other strategies. Influenza vaccination for healthy working adults is reasonable economically, and under certain circumstances is cost saving. Antiviral therapy is consistently cost saving.

Technical and economic analysis of solvent-based lithium-ion electrode drying with water and NMP

DOE PAGES

Wood, David L.; Quass, Jeffrey D.; Li, Jianlin; ...

2017-05-16

Processing lithium-ion battery (LIB) electrode dispersions with water as the solvent during primary drying offers many advantages over N-methylpyrrolidone (NMP). An in-depth analysis of the comparative drying costs of LIB electrodes is discussed for both NMP- and water-based dispersion processing in terms of battery pack $/kWh. Electrode coating manufacturing and capital equipment cost savings are compared for water vs. conventional NMP organic solvent processing. A major finding of this work is that the total electrode manufacturing costs, whether water- or NMP-based, contribute about 8–9% of the total pack cost. However, it was found that up to a 2 × reductionmore » in electrode processing (drying and solvent recovery) cost can be expected along with a $3–6 M savings in associated plant capital equipment (for a plant producing 100,000 10-kWh Plug-in Hybrid Electric Vehicle (PHEV) batteries) using water as the electrode solvent. This paper shows a different perspective in that the most important benefits of aqueous electrode processing actually revolve around capital equipment savings and environmental stewardship and not processing cost savings.« less

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

PubMed

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

2012-11-01

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

Drug product selection: the Florida experience.

PubMed Central

Vuturo, G J; Krischer, J P; McCormick, W C

1980-01-01

Drug product selection, the act of selecting and dispensing a lower cost generically equivalent product to that prescribed, is made possible in 46 states through recently enacted legislation. Florida's legislation is unique in that it requires pharmacists to product select under certain circumstances. This study reports on the results of a review of the Florida experience approximately one year after enactment of its drug product selection legislation. Nearly 132,000 prescriptions were sampled from 60 pharmacies during a four-month study period. This represents one per cent of all new prescriptions in the state and a three per cent sample of community pharmacies. Study results indicate that drug product selection on the average saves the consumer $1.92 per prescription. Further, under the provisions of this law the majority of cost savings (average reductions in acquisition costs between prescribed and dispensed products) are being passed along as savings to the consumer. During the four-month study period this amounted to a total prescription cost savings of nearly $425,000. Drug product selection occurs in approximately two per cent of all new prescriptions which compares favorably with results reported from other states but also suggests that additional savings can be realized under such legislation. PMID:7377418

TRU Waste Management Program cost/schedule optimization analysis

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

Detamore, J.A.; Raudenbush, M.H.; Wolaver, R.W.

1985-10-01

The cost/schedule optimization task is a necessary function to insure that program goals and plans are optimized from a cost and schedule aspect. Results of this study will offer DOE information with which it can establish, within institutional constraints, the most efficient program for the long-term management and disposal of contact handled transuranic waste (CH-TRU). To this end, a comprehensive review of program cost/schedule tradeoffs has been made, to identify any major cost saving opportunities that may be realized by modification of current program plans. It was decided that all promising scenarios would be explored, and institutional limitations to implementationmore » would be described. Since a virtually limitless number of possible scenarios can be envisioned, it was necessary to distill these possibilities into a manageable number of alternatives. The resultant scenarios were described in the cost/schedule strategy and work plan document. Each scenario was compared with the base case: waste processing at the originating site; transport of CH-TRU wastes in TRUPACT; shipment of drums in 6-Packs; 25 year stored waste workoff; WIPP operational 10/88, with all sites shipping to WIPP beginning 10/88; and no processing at WIPP. Major savings were identified in two alternate scenarios: centralize waste processing at INEL and eliminate rail shipment of TRUPACT. No attempt was made to calculate savings due to combination of scenarios. 1 ref., 5 figs., 1 tab. (MHB)« less

Darbepoetin alfa therapeutic interchange protocol for anemia in dialysis.

PubMed

Brophy, Donald F; Ripley, Elizabeth Bd; Kockler, Denise R; Lee, Seina; Proeschel, Lori A

2005-11-01

Erythropoiesis-stimulating proteins, such as erythropoietin alfa and darbepoetin alfa, have positively impacted anemia management. These medications improve patient outcomes and quality of life. Their costs, however, remain a major barrier for health systems. To evaluate the development, implementation, and cost-effectiveness of an inpatient therapeutic interchange protocol for erythropoiesis-stimulating proteins at a large, tertiary care, university-affiliated health system. Virginia Commonwealth University Health System (VCUHS) developed and implemented a therapeutic interchange program to convert therapy for all inpatients undergoing dialysis from erythropoietin alfa to darbepoetin alfa for treatment of chronic kidney disease-related anemia. An evaluation of the economic impact of this program on drug expenditures over a fiscal quarter (2003) was conducted using historical comparator data (2002). Preliminary evaluation of the program demonstrated cost-savings and reduced drug utilization of erythropoiesis-stimulating proteins in hospitalized dialysis patients. For the first quarter of 2003 compared with the first quarter of 2002, VCUHS realized a cost-savings of nearly 10,000 US dollars, which was related to the program's aggressive screening procedure. When these data were normalized for equal numbers of patients in each group receiving one of the drugs, the actual cost-savings was over 2000 US dollars. These cost-savings are largely due to reduced utilization of these expensive biotechnology products with implementation of a dosing protocol. VCUHS has successfully developed and implemented a darbepoetin alfa therapeutic interchange protocol for hospitalized dialysis patients. This has translated into reduced use of erythropoiesis-stimulating proteins, resulting in cost-savings for the health system.

The economic and operational value of using drones to transport vaccines.

PubMed

Haidari, Leila A; Brown, Shawn T; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L; Lee, Bruce Y

2016-07-25

Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40L) than the currently assumed UAV payload of 1.5L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. Copyright © 2016. Published by Elsevier Ltd.

The economic and operational value of using drones to transport vaccines

PubMed Central

Haidari, Leila A.; Brown, Shawn T.; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L.; Lee, Bruce Y.

2017-01-01

Background Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Methods Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Results Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40 L) than the currently assumed UAV payload of 1.5 L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Conclusion Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. PMID:27340098

Cost savings associated with an alternative payment model for integrating behavioral health in primary care.

PubMed

Ross, Kaile M; Gilchrist, Emma C; Melek, Stephen P; Gordon, Patrick D; Ruland, Sandra L; Miller, Benjamin F

2018-05-23

Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

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

PubMed

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

2015-02-01

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

Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

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

Kermeli, Katerina; Worrell, Ernst; Masanet, Eric

2011-12-01

The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and materialmore » costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.« less

Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

PubMed Central

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

2017-01-01

Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D) and incidence of cardiovascular disease (CVD) following a low glycemic index (GI) or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1) estimate the proportions of individuals who are likely to consume pulses; (2) evaluate the reductions in established risk factors for T2D and CVD; (3) assess the percent reduction in incidences or complications of the diseases of interest; and (4) calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9) to Can$62.4 (95% CI $26–$98.8) and Can$31.6 (95% CI $11.1–$52) to Can$315.5 (95% CI $110.6–$520.4) million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term. PMID:28737688

Hospital cost structure in the USA: what's behind the costs? A business case.

PubMed

Chandra, Charu; Kumar, Sameer; Ghildayal, Neha S

2011-01-01

Hospital costs in the USA are a large part of the national GDP. Medical billing and supplies processes are significant and growing contributors to hospital operations costs in the USA. This article aims to identify cost drivers associated with these processes and to suggest improvements to reduce hospital costs. A Monte Carlo simulation model that uses @Risk software facilitates cost analysis and captures variability associated with the medical billing process (administrative) and medical supplies process (variable). The model produces estimated savings for implementing new processes. Significant waste exists across the entire medical supply process that needs to be eliminated. Annual savings, by implementing the improved process, have the potential to save several billion dollars annually in US hospitals. The other analysis in this study is related to hospital billing processes. Increased spending on hospital billing processes is not entirely due to hospital inefficiency. The study lacks concrete data for accurately measuring cost savings, but there is obviously room for improvement in the two US healthcare processes. This article only looks at two specific costs associated with medical supply and medical billing processes, respectively. This study facilitates awareness of escalating US hospital expenditures. Cost categories, namely, fixed, variable and administrative, are presented to identify the greatest areas for improvement. The study will be valuable to US Congress policy makers and US healthcare industry decision makers. Medical billing process, part of a hospital's administrative costs, and hospital supplies management processes are part of variable costs. These are the two major cost drivers of US hospitals' expenditures that were examined and analyzed.

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

PubMed

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

2017-01-01

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

Comparative cost-effectiveness of HMG-CoA reductase inhibitors in secondary prevention of acute myocardial infarction.

PubMed

Elliott, W J; Weir, D R

1999-09-01

The cost-effectiveness of each of the six hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors currently available was studied. For a cohort of patients between the ages of 60 and 85 years with coronary heart disease (CHD) who were taking atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, or simvastatin, the number of survivors, the annual direct cost per survivor, and the annual indirect cost saving per survivor associated with the predicted reduction in the rate of nonfatal myocardial infarction recurrences were projected. Percent reductions in excess mortality due to CHD were derived from the relative risks of cardiac mortality in treatment versus control groups in the Scandinavian Simvastatin Survival Study (4S). Doses necessary to provide a long-term 35.57% reduction in low-density- lipoprotein (LDL) cholesterol, as seen in 4S, were estimated. One-way sensitivity analyses were performed to assess the importance of the baseline assumptions. The cost per year of life saved ranged from $5,421 with atorvastatin to $15,073 with lovastatin. The patient's age at time of diagnosis of CHD had a major impact on the cost-effectiveness of the drugs; cost-effectiveness per year of life saved was higher for older patients than younger patients. The six currently marketed HMG-CoA reductase inhibitors varied widely in cost and effectiveness in producing reductions in the LDL-cholesterol concentrations that have been shown to prevent recurrent MI; there was an approximately threefold difference in the cost per year of life saved between the most cost-effective and least cost-effective agents.

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

PubMed

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

2018-05-31

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

The impact of a nursing transitions programme on retention and cost savings.

PubMed

Hillman, Lynne; Foster, Rhonda R

2011-01-01

To identify the benefits and essential elements of a new graduate residency programme. Retention of nurses is a global nursing concern. New graduate nurses have the lowest retention rates and, therefore, the present study focused on the unique needs of this group. Valid and reliable tools were utilized to evaluate work satisfaction, clinical decision making, organizational commitment and skill development during and after each residency. We also compared resident retention and associated cost savings. The adoption and implementation of the residency programme represented a change in culture. Hiring and education practices for new nurses changed dramatically. Before the development of a new graduate transition programme, our 1-year retention rate was as low as 50%. Five years after programme adoption, retention increased to 72.5%, resulting in major cost savings to the organization.   Nursing Management must be creative and transformational in their thinking in order to address nursing retention. Implications for nurse managers who are considering residency programmes include the potential for significant cost savings for the hospital, increased resident, nursing and unit satisfaction and a demand for nurses who desire to work at their hospitals. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Why medical savings accounts deserve a closer look.

PubMed

Jensen, G A; Morlock, R J

1994-01-01

Dismissed as a luxury only for the young or wealthy, medical savings accounts could be used by a majority of Americans--who are neither poor or chronically ill--to make cost-conscious choices about their health care. Current federal tax laws and insurers' inability to sell catastrophic group coverage policies pose obstacles to their widespread use and should be removed.

Economic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations.

PubMed

Lodise, Thomas P; Fan, Weihong; Sulham, Katherine A

2016-01-01

Data indicate that acute bacterial skin and skin structure infection (ABSSSI) patients without major comorbidities can be managed effectively in the outpatient setting. Because most patients with ABSSSIs present to the emergency department, it is essential that clinicians identify candidates for outpatient treatment given the substantially higher costs associated with inpatient care. We examined the potential cost avoidance associated with shifting care from inpatient treatment with vancomycin to outpatient treatment with oritavancin for ABSSSI patients without major complications or comorbidities. A decision analytic, cost-minimization model was developed to compare costs of inpatient vancomycin versus outpatient oritavancin treatment of ABSSSI patients with few or no comorbidities (Charlson Comorbidity Index score ≤1) and no life-threatening conditions presenting to emergency department. Hospital discharge data from the Premier Research Database was used to determine the costs associated with inpatient vancomycin treatment. Mean costs for inpatient treatment with vancomycin ranged from $5973 to $9885, depending on Charlson Comorbidity Index score and presence of systemic symptoms. Switching an individual patient from inpatient vancomycin treatment to outpatient oritavancin treatment was estimated to save $1752.46 to $6475.87 per patient, depending on Charlson Comorbidity Index score, presence of systemic symptoms, and use of observation status. Assuming some patients may be admitted to the hospital after treatment with oritavancin, it is estimated that up to 38.12% of patients could be admitted while maintaining budget neutrality. This cost-minimization model indicates that use of oritavancin in the emergency department or observation setting is associated with substantial cost savings compared with inpatient treatment with vancomycin. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

Economics of Employer-Sponsored Workplace Vaccination to Prevent Pandemic and Seasonal Influenza

PubMed Central

Lee, Bruce Y.; Bailey, Rachel R.; Wiringa, Ann E.; Afriyie, Abena; Wateska, Angela R.; Smith, Kenneth J.; Zimmerman, Richard K.

2010-01-01

Employers may be loath to fund vaccination programs without understanding the economic consequences. We developed a decision analytic computational simulation model including dynamic transmission elements that determined the cost-benefit of employer-sponsored workplace vaccination from the employer's perspective. Implementing such programs was relatively inexpensive (<$35/vaccinated employee) and, in many cases, cost saving across diverse occupational groups in all seasonal influenza scenarios. Such programs were cost-saving for a 20% serologic attack rate pandemic scenario (−$15 to −$995) per vaccinated employee) and a 30% serologic attack rate pandemic scenario (range −$39 to −$1,494 per vaccinated employee) across all age and major occupational groups. PMID:20620168

Energy Efficient Engine Program: Technology Benefit/Cost Study, Volume II

NASA Technical Reports Server (NTRS)

Gray, D. E.; Gardner, W. B.

1983-01-01

The Benefit/Cost Study portion of the NASA-sponsored Energy Efficient Engine Component Development and Integration program was successful in achieving its objectives: identification of air transport propulsion system technology requirements for the years 2000 and 2010, and formulation of programs for developing these technologies. It is projected that the advanced technologies identified, when developed to a state of readiness, will provide future commercial and military turbofan engines with significant savings in fuel consumption and related operating costs. These benefits are significant and far from exhausted. The potential savings translate into billions of dollars in annual savings for the airlines. Analyses indicate that a significant portion of the overall savings is attributed to aerodynamic and structure advancements. Another important consideration in acquiring these benefits is developing a viable reference technology base that will permit engines to operate at substantially higher overall pressure ratios and bypass ratios. Results have pointed the direction for future research and a comprehensive program plan for achieving this was formulated. The next major step is initiating the program effort that will convert the advanced technologies into the expected benefits.

Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review.

PubMed

Jacob, Verughese; Chattopadhyay, Sajal K; Proia, Krista K; Hopkins, David P; Reynolds, Jeffrey; Thota, Anilkrishna B; Jones, Christopher D; Lackland, Daniel T; Rask, Kimberly J; Pronk, Nicolaas P; Clymer, John M; Goetzel, Ron Z

2017-09-01

The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars. Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12-13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined. Published by Elsevier Inc.

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

Van Geet, Otto

NREL has developed a methodology to prioritize which data center cooling systems could be upgraded for better efficiency based on estimated cost savings and economics. The best efficiency results are in cool or dry climates where 'free' economizer or evaporative cooling can provide most of the data center cooling. Locations with a high cost of energy and facilities with high power usage effectiveness (PUE) are also good candidates for data center cooling system upgrades. In one case study of a major cable provider's data centers, most of the sites studied had opportunities for cost-effective cooling system upgrades with payback periodmore » of 5 years or less. If the cable provider invested in all opportunities for upgrades with payback periods of less than 15 years, it could save 27% on annual energy costs.« less

Calculating cost savings in utilization management.

PubMed

MacMillan, Donna

2014-01-01

A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios. © 2013.

The cost-effectiveness of air bags by seating position.

PubMed

Graham, J D; Thompson, K M; Goldie, S J; Segui-Gomez, M; Weinstein, M C

1997-11-05

Motor vehicle crashes continue to cause significant mortality and morbidity in the United States. Installation of air bags in new passenger vehicles is a major initiative in the field of injury prevention. To assess the net health consequences and cost-effectiveness of driver's side and front passenger air bags from a societal perspective, taking into account the increased risk to children who occupy the front passenger seat and the diminished effectiveness for older adults. A deterministic state transition model tracked a hypothetical cohort of new vehicles over a 20-year period for 3 strategies: (1) installation of safety belts, (2) installation of driver's side air bags in addition to safety belts, and (3) installation of front passenger air bags in addition to safety belts and driver's side air bags. Changes in health outcomes, valued in terms of quality-adjusted life-years (QALYs) and costs (in 1993 dollars), were projected following the recommendations of the Panel on Cost-effectiveness in Health and Medicine. US population-based and convenience sample data were used. Incremental cost-effectiveness ratios. Safety belts are cost saving, even at 50% use. The addition of driver's side air bags to safety belts results in net health benefits at an incremental cost of $24000 per QALY saved. The further addition of front passenger air bags results in an incremental net benefit at a higher incremental cost of $61000 per QALY saved. Results were sensitive to the unit cost of air bag systems, their effectiveness, baseline fatality rates, the ratio of injuries to fatalities, and the real discount rate. Both air bag systems save life-years at costs that are comparable to many medical and public health practices. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat.

Economic impact of enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke: a hospital perspective of the PREVAIL trial.

PubMed

Pineo, Graham; Lin, Jay; Stern, Lee; Subrahmanian, Tarun; Annemans, Lieven

2012-03-01

The PREVAIL (Prevention of VTE [venous thromboembolism] after acute ischemic stroke with LMWH [low-molecular-weight heparin] and UFH [unfractionated heparin]) study demonstrated a 43% VTE risk reduction with enoxaparin versus UFH in patients with acute ischemic stroke (AIS). A 1% rate of symptomatic intracranial and major extracranial hemorrhage was observed in both groups. To determine the economic impact, from a hospital perspective, of enoxaparin versus UFH for VTE prophylaxis after AIS. A decision-analytic model was constructed and hospital-based costs analyzed using clinical information from PREVAIL. Total hospital costs were calculated based on mean costs in the Premier™ database and from wholesalers acquisition data. Costs were also compared in patients with severe stroke (National Institutes of Health Stroke Scale [NIHSS] score ≥14) and less severe stroke (NIHSS score <14). The average cost per patient due to VTE or bleeding events was lower with enoxaparin versus UFH ($422 vs $662, respectively; net savings $240). The average anticoagulant cost, including drug-administration cost per patient, was lower with UFH versus enoxaparin ($259 vs $360, respectively; net savings $101). However, when both clinical events and drug-acquisition costs were considered, the total hospital cost was lower with enoxaparin versus UFH ($782 vs $922, respectively; savings $140). Hospital cost-savings were greatest ($287) in patients with NIHSS scores ≥14. The higher drug cost of enoxaparin was offset by the reduction in clinical events as compared to the use of UFH for VTE prophylaxis after an AIS, particularly in patients with severe stroke. Copyright © 2011 Society of Hospital Medicine.

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

PubMed Central

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

2017-01-01

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

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

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

Slattery, Bob S.

2015-03-01

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

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

PubMed

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

2017-03-01

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

Statin cost-effectiveness in the United States for people at different vascular risk levels.

PubMed

2009-03-01

Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20,536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by approximately 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15,600 saving to $13,200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216,500 ($123,700 to $460,000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10,990 ($9430 to $14,700) in people aged 70 years and older with a 12% 5-year risk. Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

Patients' view of retail clinics as a source of primary care: boon for nurse practitioners?

PubMed

Ahmed, Arif; Fincham, Jack E

2011-04-01

To estimate consumer utilities associated with major attributes of retail clinics (RCs). A discrete choice experiment (DCE) with 383 adult residents of the metropolitan statistical areas in Georgia conducted via Random Digit Dial survey of households. The DCE had two levels each of four attributes: price ($59; $75), appointment wait time (same day; 1 day or more), care setting-provider combination (nurse practitioner [NP]-RC; physician-private office), and acute illness (urinary tract infection; influenza), resulting in 16 choice scenarios. The respondents indicated whether they would seek care under each scenario. Cost savings and convenience offered by RCs are attractive to urban patients, and given sufficient cost savings they are likely to seek care there. All else equal, one would require cost savings of at least $30.21 to seek care from an NP at RC rather than a physician at private office, and $83.20 to wait one day or more. Appointment wait time is a major determinant of care-seeking decisions for minor illnesses. The size of the consumer utility associated with the convenience feature of RCs indicates that there is likely to be further growth and employment opportunities for NPs in these clinics. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Cost-Savings Analysis of AR-V7 Testing in Patients With Metastatic Castration-Resistant Prostate Cancer Eligible for Treatment With Abiraterone or Enzalutamide.

PubMed

Markowski, Mark C; Frick, Kevin D; Eshleman, James R; Luo, Jun; Antonarakis, Emmanuel S

2016-12-01

Identification of cancer biomarkers that inform clinical decisions and reduce the use of ineffective therapies is a major goal of precision oncology. An abnormal splice variant of the androgen receptor, AR-V7, was recently found to confer resistance to novel hormonal therapies (abiraterone and enzalutamide) in men with metastatic castration-resistant prostate cancer (mCRPC), but did not negatively affect responses to taxane chemotherapies, suggesting that early use of chemotherapy may be a more effective option for AR-V7(+) patients. We calculated the cost savings of performing AR-V7 testing in mCRPC patients prior to starting abiraterone/enzalutamide (and avoiding these drugs in AR-V7(+) men) versus treating all mCRPC patients empirically with abiraterone/enzalutamide (without use of the biomarker). We determined that AR-V7 testing would result in substantial cost savings as long as the true prevalence of AR-V7 was >5%. In our prior studies, we estimated that approximately 30% of mCRPC patients may have detectable AR-V7 in circulating tumor cells (CTCs). In this population, upfront testing of AR-V7 status (at a price of $1,000 per test) would result in a net cost savings of $150 Million in the United States per year. AR-V7 testing in mCRPC patients would be cost-beneficial when considering the current price of treatment, and may reduce the ineffective use of abiraterone/enzalutamide, leading to a significant net cost savings to the healthcare system. Clinical-grade AR-V7 testing is currently available at our institution. Prostate 76:1484-1490, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Prophylactic platelet transfusions in patients with blood malignancies: cost analysis of a randomized trial.

PubMed

Campbell, Helen E; Estcourt, Lise J; Stokes, Elizabeth A; Llewelyn, Charlotte A; Murphy, Michael F; Wood, Erica M; Stanworth, Simon J

2014-10-01

This cost analysis uses data from a randomized trial comparing a no prophylaxis versus prophylactic platelet (PLT) transfusion policy (counts <10 × 10(9) /L) in adult patients with hematologic malignancies. Results are presented for all patients and separately for autologous hematopoietic stem cell transplantation (HSCT) (autoHSCT) and chemotherapy/allogeneic HSCT (chemo/alloHSCT) patients. Data were collected to 30 days on PLT and red blood cell (RBC) transfusions, major bleeds, serious adverse events, critical care, and hematology ward stay. Data were costed using 2011 to 2012 UK unit costs and converted into US$. Sensitivity analyses were performed on uncertain cost variables. Across the whole trial no prophylaxis saved costs compared to prophylaxis: -$1760 per patient (95% confidence interval [CI], -$3250 to -$249; p < 0.05). For autoHSCT patients there was no cost difference between arms: -$110 per patient (95% CI, -$1648 to $1565; p = 0.89). For chemo/alloHSCT patients no prophylaxis cost significantly less than prophylaxis: -$5686 per patient (95% CI, -$8580 to -$2853; p < 0.01). The cost impact of no prophylaxis differed significantly between subgroups. Sensitivity analyses varying daily treatment costs and ward stay for chemo/alloHSCT patients reduced cost differences to -$941 per patient (p = 0.21) across the whole trial and -$2927 per patient (p < 0.05) in chemo/alloHSCT subgroup. It is unclear whether a no-prophylaxis policy saves costs overall. In chemo/alloHSCT patients cost savings are apparent but their magnitude is sensitive to a number of variables and must be considered alongside clinical data showing increased bleeding rates. In autoHSCT patients savings generated through lower PLT use in no-prophylaxis arm were offset by cost increases elsewhere, for example, additional RBC transfusions. Cost-effectiveness analyses of alternative PLT transfusion policies simultaneously considering costs and patient-reported outcomes are warranted. © 2014 AABB.

The economic impact of introducing serotonin-noradrenaline reuptake inhibitors into the Brazilian national drug formulary: cost-effectiveness and budget-impact analyses.

PubMed

Machado, Márcio; Iskedjian, Michael; Ruiz, Inés A; Einarson, Thomas R

2007-01-01

To determine the cost effectiveness, from the Brazilian Ministry of Health viewpoint, of three antidepressant classes for major depressive disorder (MDD), and the budget impact of introducing serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) into the current Brazilian national drug formulary, assuming a 6-month treatment duration. An existing decision-tree model was adapted to Brazil, based on local guidelines. Clinical data were obtained from published meta-analyses. Patients included adults aged > or =18 years with MDD, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, third and fourth editions (DSM-III/IV), with moderate-to-severe disease (Hamilton Depression Rating Scale [HAMD] > or =15 or Montgomery-Asberg Depression Rating Scale [MADRS] > or =18), without co-morbidities or co-medications, receiving > or =6 weeks of treatment with SNRIs, selective serotonin reuptake inhibitors (SSRIs) and/or tricyclic antidepressants (TCAs). Clinical outcome was remission (HAMD < or =7 or MADRS < or =12). Direct costs (drugs, physician visits, hospitalisations) were included. Drug costs were obtained from the 2006 Brazilian National Drug Price List, and hospitalisation and physician costs from the 2006 Healthcare System database. Costs were valued in Brazilian Reais ($Brz), year 2006 values ($Brz1 = $US0.47). Univariate and Monte Carlo sensitivity analyses tested model robustness. Expected costs per patient treated were SNRIs $Brz4848; SSRIs $Brz5466; and TCAs $Brz5046, and overall success rates (primary plus secondary treatment across all decision tree branches) were SNRIs 78.1%; SSRIs 74.0%; and TCAs 76.4%. Average costs/success were SNRIs $Brz6209; SSRIs $Brz7385; and TCAs $Brz6602. SNRIs dominated in incremental cost-effectiveness analyses. Monte Carlo analysis confirmed drug classes' relative positions; however, there was considerable uncertainty. Introducing SNRIs into the formulary could generate average savings of 1% of the total budget, with a 52% probability of savings. SNRIs appear to be cost effective against SSRIs and TCAs when prescribed to patients with MDD in Brazil. However, their inclusion into the national drug list would generate minor savings compared with the current formulary of SSRIs and TCAs. Thus, we considered such inclusion as 'cost-neutral', since no major probability of savings or increased expenditures were observed.

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

PubMed

Linden, Ariel; Adams, John L

2007-06-01

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

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation

PubMed Central

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W.E.; Armstrong, Shannon; Jones, David G.; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R.; Foran, John P.; Markides, Vias; Wong, Tom

2016-01-01

Aims The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Methods and results Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162–£7194). Conclusion Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. PMID:26935273

Cost effectiveness of eptifibatide in acute coronary syndromes; an economic analysis of Western European patients enrolled in the PURSUIT trial. The Platelet IIa/IIb in unstable Angina: Receptor Suppression Using Integrilin Therapy.

PubMed

Brown, R E; Henderson, R A; Koster, D; Hutton, J; Simoons, M L

2002-01-01

To assess the direct medical costs and cost effectiveness of routine eptifibatide use amongst patients with unstable angina and myocardial infarction without persistent ST-segment elevation in the Western European subgroup of the PURSUIT trial. Health care resources were collected for the Western European PURSUIT trial patients (n=3697). Unit costs for major resources were developed within six countries using a consistent bottom-up methodology. Resource consumption from the Western European population was used to calculate the average direct medical costs per patient in the eptifibatide and placebo arms of the trial. Eptifibatide was estimated to cost 524 Euros per treatment. Long-term survival estimated from the 6-month trial survival data and combined with the cost data was used to calculate cost-effectiveness ratios. Additionally, cost per death and non-fatal myocardial infarction at 30 days was calculated. Sensitivity analyses were conducted on the discount rate and resource consumption. Cost-effectiveness ratios ranged from 9603 Euros to 18 115 Euros per year of life saved with 3% discount. Using resource consumption based on countries with low coronary arteriography rates, the cost per year of life saved was between 3329 Euros and 10 079 Euros. Using resource consumption based on high coronary arteriography rate countries, the cost per year of life saved was between 17 089 Euros and 24 099 Euros. Assuming no difference in treatment costs except for the addition of eptifibatide, the incremental cost per year of life saved was 23 818 Euros. Routine eptifibatide use was associated with a reduction in the combined end-point of death and myocardial infarction at 30 days, which was sustained at 6 months. Long-term projections indicate a modest increase in survival in eptifibatide patients. These data translate into cost-effectiveness ratios that compare favourably with other new technologies that are currently in use. Copyright 2001 The European Society of Cardiology.

Study of the costs and benefits of composite materials in advanced turbofan engines

NASA Technical Reports Server (NTRS)

Steinhagen, C. A.; Stotler, C. L.; Neitzel, R. E.

1974-01-01

Composite component designs were developed for a number of applicable engine parts and functions. The cost and weight of each detail component was determined and its effect on the total engine cost to the aircraft manufacturer was ascertained. The economic benefits of engine or nacelle composite or eutectic turbine alloy substitutions was then calculated. Two time periods of engine certification were considered for this investigation, namely 1979 and 1985. Two methods of applying composites to these engines were employed. The first method just considered replacing an existing metal part with a composite part with no other change to the engine. The other method involved major engine redesign so that more efficient composite designs could be employed. Utilization of polymeric composites wherever payoffs were available indicated that a total improvement in Direct Operating Cost (DOC) of 2.82 to 4.64 percent, depending on the engine considered, could be attained. In addition, the percent fuel saving ranged from 1.91 to 3.53 percent. The advantages of using advanced materials in the turbine are more difficult to quantify but could go as high as an improvement in DOC of 2.33 percent and a fuel savings of 2.62 percent. Typically, based on a fleet of one hundred aircraft, a percent savings in DOC represents a savings of four million dollars per year and a percent of fuel savings equals 23,000 cu m (7,000,000 gallons) per year.

Keys to the House: Unlocking Residential Savings With Program Models for Home Energy Upgrades

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

Grevatt, Jim; Hoffman, Ian; Hoffmeyer, Dale

After more than 40 years of effort, energy efficiency program administrators and associated contractors still find it challenging to penetrate the home retrofit market, especially at levels commensurate with state and federal goals for energy savings and emissions reductions. Residential retrofit programs further have not coalesced around a reliably successful model. They still vary in design, implementation and performance, and they remain among the more difficult and costly options for acquiring savings in the residential sector. If programs are to contribute fully to meeting resource and policy objectives, administrators need to understand what program elements are key to acquiring residentialmore » savings as cost effectively as possible. To that end, the U.S. Department of Energy (DOE) sponsored a comprehensive review and analysis of home energy upgrade programs with proven track records, focusing on those with robustly verified savings and constituting good examples for replication. The study team reviewed evaluations for the period 2010 to 2014 for 134 programs that are funded by customers of investor-owned utilities. All are programs that promote multi-measure retrofits or major system upgrades. We paid particular attention to useful design and implementation features, costs, and savings for nearly 30 programs with rigorous evaluations of performance. This meta-analysis describes program models and implementation strategies for (1) direct install retrofits; (2) heating, ventilating and air-conditioning (HVAC) replacement and early retirement; and (3) comprehensive, whole-home retrofits. We analyze costs and impacts of these program models, in terms of both energy savings and emissions avoided. These program models can be useful guides as states consider expanding their strategies for acquiring energy savings as a resource and for emissions reductions. We also discuss the challenges of using evaluations to create program models that can be confidently applied in multiple jurisdictions.« less

A framework for improving the cost-effectiveness of DSM program evaluations

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

Sonnenblick, R.; Eto, J.

The prudence of utility demand-side management (DSM) investments hinges on their performance, yet evaluating performance is complicated because the energy saved by DSM programs can never be observed directly but only inferred. This study frames and begins to answer the following questions: (1) how well do current evaluation methods perform in improving confidence in the measurement of energy savings produced by DSM programs; (2) in view of this performance, how can limited evaluation resources be best allocated to maximize the value of the information they provide? The authors review three major classes of methods for estimating annual energy savings: trackingmore » database (sometimes called engineering estimates), end-use metering, and billing analysis and examine them in light of the uncertainties in current estimates of DSM program measure lifetimes. The authors assess the accuracy and precision of each method and construct trade-off curves to examine the costs of increases in accuracy or precision. Several approaches for improving evaluations for the purpose of assessing program cost effectiveness are demonstrated. The methods can be easily generalized to other evaluation objectives, such as shared savings incentive payments.« less

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

PubMed

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

2018-01-01

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

Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents.

PubMed

Gruss, H-J; Cockett, A; Leicester, R J

2012-01-01

With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents. The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products. The sum of costs is based on National Health Service reference costs for bowel cleansing products. Estimations are made for savings achievable when using a 2-litre polyethylene glycol with ascorbate components solution (PEG+ASC) in place of other bowel cleansing solutions. Test data were entered into the model to confirm validity and sensitivity. The model was then applied to a set of audit cost data from a major hospital colonoscopy unit in the UK. Descriptive analysis of the test data showed that the main cost drivers in the colonoscopy process are the procedure costs and costs for bed days rather than drug acquisition costs, irrespective of the cleansing agent. Audit data from a colonoscopy unit in the UK confirmed the finding with a saving of £107,000 per year in favour of PEG+ASC when compared to sodium picosulphate with magnesium citrate solution (NaPic+MgCit). For every patient group the model calculated overall cost savings. This was irrespective of the higher drug expenditure associated with the use of PEG+ASC for bowel preparation. Savings were mainly realized through reduced costs for repeat colonoscopy procedures and associated costs, such as inpatient length of stay. The budget impact model demonstrated that the primary cost driver was the procedure cost for colonoscopy. Savings can be realized through the use of PEG+ASC despite higher drug acquisition costs relative to the comparator products. From a global hospital funding perspective, the acquisition costs of bowel preparations should not be used as the primary reason to select the preferred treatment agent, but should be part of the consideration, with an emphasis on the clinical outcome.

Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer.

PubMed

Limat, Samuel; Bracco-Nolin, Claire-Hélène; Legat-Fagnoni, Christine; Chaigneau, Loic; Stein, Ulrich; Huchet, Bernard; Pivot, Xavier; Woronoff-Lemsi, Marie-Christine

2006-06-01

The cost of chemotherapy has dramatically increased in advanced colorectal cancer patients, and the schedule of fluorouracil administration appears to be a determining factor. This retrospective study compared direct medical costs related to two different de Gramont schedules (standard vs. simplified) given in first-line chemotherapy with oxaliplatin or irinotecan. This cost-minimization analysis was performed from the French Health System perspective. Consecutive unselected patients treated in first-line therapy by LV5FU2 de Gramont with oxaliplatin (Folfox regimen) or with irinotecan (Folfiri regimen) were enrolled. Hospital and outpatient resources related to chemotherapy and adverse events were collected from 1999 to 2004 in 87 patients. Overall cost was reduced in the simplified regimen. The major factor which explained cost saving was the lower need for admissions for chemotherapy. Amount of cost saving depended on the method for assessing hospital stay. In patients treated by the Folfox regimen the per diem and DRG methods found cost savings of Euro 1,997 and Euro 5,982 according to studied schedules; in patients treated by Folfiri regimen cost savings of Euro 4,773 and Euro 7,274 were observed, respectively. In addition, travel costs were also reduced by simplified regimens. The robustness of our results was showed by one-way sensitivity analyses. These findings demonstrate that the simplified de Gramont schedule reduces costs of current first-line chemotherapy in advanced colorectal cancer. Interestingly, our study showed several differences in costs between two costing approaches of hospital stay: average per diem and DRG costs. These results suggested that standard regimen may be considered a profitable strategy from the hospital perspective. The opposition between health system perspective and hospital perspective is worth examining and may affect daily practices. In conclusion, our study shows that the simplified de Gramont schedule in combination with oxaliplatin or irinotecan is an attractive option from the French Health System perspective. This safe and less costly regimen must compared to alternative options such as oral fluoropyrimidines.

Cost-Effective Business Practices of Schools in Massachusetts. A Collaborative Dissemination Project.

ERIC Educational Resources Information Center

Merrimack Education Center, Chelmsford, MA.

The verified successful business practices described in this booklet were being used by Massachusetts schools in the late 1970s. The practices have resulted in cost savings, are generally easy to replicate, and usually do not require major capital outlay. The practices listed are largely conservation practices or relate to food service management,…

Adult depression screening in Saudi primary care: prevalence, instrument and cost

PubMed Central

2014-01-01

Background By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices. Methods A cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach. Results Patients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year. Conclusion The point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving. PMID:24992932

Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain.

PubMed

Rejas-Gutiérrez, J; Bruguera, E; Cedillo, S

2017-09-01

Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD. The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness. The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios. Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

PubMed

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

2012-01-01

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

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

PubMed

Howe, Lynn

2008-06-01

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

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

PubMed

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

2011-07-28

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

The impact of a skilled nursing facility on the cost of surgical treatment of major head and neck tumors.

PubMed

Seikaly, H; Calhoun, K H; Stonestreet, J S; Rassekh, C H; Driscoll, B P; Averyt, P

2001-09-01

The finite resources available for health care and the proliferation of managed care in the United States have forced the head and neck surgeon to critically evaluate the cost of tumor treatment. To determine whether the cost of treating patients with head and neck tumors would be reduced if the patients were to spend a portion of what would otherwise be acute care hospital days in a hospital-based skilled nursing facility (HB/SNF). Retrospective cost-benefit analysis. Tertiary referral center. Twenty-four consecutive hospital admissions for definitive surgical treatment of head and neck tumors were retrospectively reviewed. The postoperative day on which the patient theoretically could have been transferred to the HB/SNF was determined. The charges and cost of each patient's actual hospital stay were compared with the theoretical counterparts had the patient been transferred to the HB/SNF on the determined day. Cost savings. The total hospital stay for the 24 patients was 524 days. One hundred eighty-two of those days could have been spent in the HB/SNF. The total charge and cost savings with the use of an HB/SNF were $201,045 and $84,238, respectively (15% of the total charge and cost). This represents an average charge and cost savings of $8377 and $3510, respectively, per patient. The difference was statistically significant (P<.005). An HB/SNF could reduce the cost of head and neck tumor treatment without compromising patient care.

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

PubMed

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

2012-01-01

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

Evaluation philosophy for shuttle launched payloads

NASA Technical Reports Server (NTRS)

Heuser, R. E.

1975-01-01

Potential benefits of factory-to-pad testing constitute major cost savings and increase test effectiveness. Overall flight performance will be improved. The factory-to-pad approach is compatible with space shuttle processing and the large space telescope program.

Potential applications of paving fabrics to reduce reflective cracking.

DOT National Transportation Integrated Search

2005-02-01

Asphalt concrete overlay on the existing pavement is often used as a cost-saving : surface treatment for deteriorating pavements. A major problem encountered with asphalt : resurfacing is the phenomenon termed reflective cracking, the propagation of ...

Cost-effectiveness analysis of rivaroxaban for treatment and secondary prevention of venous thromboembolism in the Netherlands.

PubMed

Heisen, Marieke; Treur, Maarten J; Heemstra, Harald E; Giesen, Eric B W; Postma, Maarten J

2017-08-01

Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio = 0.54, 95% confidence interval = 0.37-0.79) compared to LMWH/VKA therapy, and does not require regular anticoagulation monitoring. To evaluate the health economic consequences of treating acute VTE patients with rivaroxaban compared to treatment with LMWH/VKA, viewed from the Dutch societal perspective. A life-time Markov model was populated with the findings of the EINSTEIN phase III clinical trial to analyze cost-effectiveness of rivaroxaban therapy in treatment and prevention of VTE from a Dutch societal perspective. Primary model outcomes were total and incremental quality-adjusted life years (QALYs), as well as life expectancy and costs. Over a patient's lifetime, rivaroxaban was shown to be dominant, with health gains of 0.047 QALYs and cost savings of €304 compared to LMWH/VKA therapy. Dominance was robustly present in all sensitivity analyses. Major drivers of the differences between the two treatment arms were related to anticoagulation monitoring (medical costs, travel costs, and loss of productivity) and the occurrence of major bleeds. Rivaroxaban treatment of patients with venous thromboembolism results in health gains and cost savings compared to LMWH/VKA therapy. This conclusion holds for the Dutch setting, both for the societal perspective, as well as the healthcare perspective.

Early Lessons on Bundled Payment at an Academic Medical Center.

PubMed

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

2017-09-01

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

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

PubMed

Kishimoto, Atsuo; Oka, Tosihiro; Nakanishi, Junko

2003-10-01

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

User's manual for the BNW-II optimization code for dry/wet-cooled power plants

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

Braun, D.J.; Bamberger, J.A.; Braun, D.J.

1978-05-01

The User's Manual describes how to operate BNW-II, a computer code developed by the Pacific Northwest Laboratory (PNL) as a part of its activities under the Department of Energy (DOE) Dry Cooling Enhancement Program. The computer program offers a comprehensive method of evaluating the cost savings potential of dry/wet-cooled heat rejection systems. Going beyond simple ''figure-of-merit'' cooling tower optimization, this method includes such items as the cost of annual replacement capacity, and the optimum split between plant scale-up and replacement capacity, as well as the purchase and operating costs of all major heat rejection components. Hence the BNW-II code ismore » a useful tool for determining potential cost savings of new dry/wet surfaces, new piping, or other components as part of an optimized system for a dry/wet-cooled plant.« less

Energy and cost saving results for advanced technology systems from the Cogeneration Technology Alternatives Study (CTAS)

NASA Technical Reports Server (NTRS)

Sagerman, G. D.; Barna, G. J.; Burns, R. K.

1979-01-01

An overview of the organization and methodology of the Cogeneration Technology Alternatives Study is presented. The objectives of the study were to identify the most attractive advanced energy conversion systems for industrial cogeneration applications in the future and to assess the advantages of advanced technology systems compared to those systems commercially available today. Advanced systems studied include steam turbines, open and closed cycle gas turbines, combined cycles, diesel engines, Stirling engines, phosphoric acid and molten carbonate fuel cells and thermionics. Steam turbines, open cycle gas turbines, combined cycles, and diesel engines were also analyzed in versions typical of today's commercially available technology to provide a base against which to measure the advanced systems. Cogeneration applications in the major energy consuming manufacturing industries were considered. Results of the study in terms of plant level energy savings, annual energy cost savings and economic attractiveness are presented for the various energy conversion systems considered.

Innovating the Standard Procurement System Through Electronic Commerce Technologies

DTIC Science & Technology

1999-12-01

commerce are emerging almost daily as businesses continue to realize the overwhelming ability of agent applications to reduce costs and improve ...processed using the SPS. The result may reduce cycle time, assist contracting professionals, improve the acquisition process, save money and aid...of innovation processes, and it offers enormous potential for helping organizations achieve major improvements in terms of process cost , time

The Future of Additive Manufacturing in Air Force Acquisition

DTIC Science & Technology

2017-03-22

manufacturing data - Designing and deploying a virtual aircraft fleet for future conflict - Space-based satellite production for defense capabilities via...changing system design via lower production costs, enhanced performance possibilities, and rapid replenishment. In the Technology Maturation and Risk... manufacturing as well as major cost savings via reduction of required materials, unique tooling, specialized production plans, and segments of the

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

DOE PAGES

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

2017-02-17

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

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

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

Granderson, Jessica; Touzani, Samir; Fernandes, Samuel

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

78 FR 32408 - Collection of Information Under Review by Office of Management and Budget

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

... majority of survey respondents. Consequently, the Coast Guard will explore all cost- saving strategies to... working for the good of all americans, when clearly it is working for corporate profitability. when will...

Simulator fidelity requirements : the case of platform motion

DOT National Transportation Integrated Search

1998-05-01

Today, the use of airplane simulators in pilot training and evaluation is universal. Simulators not only enable savings in training cost, but they have also practically eliminated training accidents for major airlines. They allow the training of emer...

Percutaneous coronary intervention with oral sirolimus and bare metal stents has comparable safety and efficacy to treatment with drug eluting stents, but with significant cost saving: long-term follow-up results from the randomised, controlled ORAR III (Oral Rapamycin in ARgentina) study.

PubMed

Rodriguez, Alfredo E; Maree, Andrew; Tarragona, Sonia; Fernandez-Pereira, Carlos; Santaera, Omar; Rodriguez Granillo, Alfredo M; Rodriguez-Granillo, Gaston A; Russo-Felssen, Miguel; Kukreja, Neville; Antoniucci, David; Palacios, Igor F; Serruys, Patrick W

2009-06-01

Previous randomised studies have shown a significant reduction in restenosis when oral rapamycin (OR) is administered to patients undergoing bare metal stent (BMS) implantation. How this regimen compares to drug eluting stents (DES) is unknown. Two-hundred patients with de novo coronary lesions were randomised to treatment with OR plus BMS (100 pts) or with DES (100 pts). OR was given as a bolus of 10 mg per day before PCI followed by daily doses of 3 mg during following 13 days. Primary endpoints were to compare hospital, follow-up and overall cost at one, two, three and five years of follow-up. The secondary endpoints included death, myocardial infarction (MI) and stroke and were analysed as major adverse cardiovascular events (MACCE). Target vessel (TVR) and target lesion revascularisation (TLR) were independently analysed. Costs included procedural resources, hospitalisation, medications, repeat revascularisation procedures and professional fees. Baseline demographic, clinical and angiographic characteristics were similar. At 18.3 +/- 7 months of follow-up, the initial strategy of OR plus BMS resulted in significant cost saving when compared to DES (p=0.0001). TLR rate was 8.2% with DES and 7.0% with OR plus BMS (p=0.84), similarly no differences in TVR rate in both groups was seen (10.6% and 10.5% in OR and DES group respectively, p=0.86). Non-inferiority testing, determined that DES therapy failed to be cost saving compared to OR in all possible cost scenarios. A strategy of OR plus BMS is cost saving compared to DES in patients undergoing PCI for de novo coronary lesions.

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

DTIC Science & Technology

1992-08-01

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

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

PubMed Central

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

2016-01-01

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

The Diabetes Management Education Program in South Texas: An Economic and Clinical Impact Analysis.

PubMed

Kash, Bita A; Lin, Szu-Hsuan; Baek, Juha; Ohsfeldt, Robert L

2017-01-01

Diabetes is a major chronic disease that can lead to serious health problems and high healthcare costs without appropriate disease management and treatment. In the United States, the number of people diagnosed with diabetes and the cost for diabetes treatment has dramatically increased over time. To improve patients' self-management skills and clinical outcomes, diabetes management education (DME) programs have been developed and operated in various regions. This community case study explores and calculates the economic and clinical impacts of expanding a model DME program into 26 counties located in South Texas. The study sample includes 355 patients with type 2 diabetes and a follow-up hemoglobin A1c level measurement among 1,275 individuals who participated in the DME program between September 2012 and August 2013. We used the Gilmer's cost differentials model and the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine methodology to predict 3-year healthcare cost savings and 10-year clinical benefits of implementing a DME program in the selected 26 Texas counties. Changes in estimated 3-year cost and the estimated treatment effect were based on baseline hemoglobin A1c level. An average 3-year reduction in medical treatment costs per program participant was $2,033 (in 2016 dollars). The total healthcare cost savings for the 26 targeted counties increases as the program participation rate increases. The total projected cost saving ranges from $12 million with 5% participation rate to $185 million with 75% participation rate. A 10-year outlook on additional clinical benefits associated with the implementation and expansion of the DME program at 60% participation is estimated to result in approximately 4,838 avoided coronary heart disease cases and another 392 cases of avoided strokes. The implementation of this model DME program in the selected 26 counties would contribute to substantial healthcare cost savings and clinical benefits. Organizations that provide DME services may benefit from reduction in medical treatment costs and improvement in clinical outcomes for populations with diabetes.

Cost-effectiveness of traffic enforcement: case study from Uganda.

PubMed

Bishai, D; Asiimwe, B; Abbas, S; Hyder, A A; Bazeyo, W

2008-08-01

In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at $72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17% drop in road deaths after the intervention. The average cost-effectiveness of better road safety enforcement in Uganda is $603 per death averted or $27 per life year saved discounted at 3% (equivalent to 9% of Uganda's $300 GDP per capita). The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective.

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

PubMed

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

2017-01-01

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

Advances in Household Appliances- A Review

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

Bansal, Pradeep; Vineyard, Edward Allan; Abdelaziz, Omar

2011-01-01

An overview of options and potential barriers and risks for reducing the energy consumption, peak demand, and emissions for seven key energy consuming residential products (refrigerator-freezers, dishwashers, clothes washers, clothes dryers, electric ovens, gas ovens and microwave ovens) is presented. The paper primarily concentrates on the potential energy savings from the use of advanced technologies in appliances for the U.S. market. The significance and usefulness of each technology was evaluated in order to prioritize the R&D needs to improve energy efficiency of appliances in view of energy savings, cost, and complexity. The paper provides a snapshot of the future R&Dmore » needs for each of the technologies along with the associated barriers. Although significant energy savings may be achieved, one of the major barriers in most cases is high first cost. One way of addressing this issue and promoting the introduction of new technologies is to level the playing field for all manufacturers by establishing Minimum Energy Performance Standards (MEPS) which are not cost prohibitive and promoting energy efficient products through incentives to both manufacturers and consumers.« less

Generic substitution of anti-epileptic drugs. A needed battle?

PubMed

Al-Baradie, Raidah S

2008-07-01

The clinical and economic consequences of generic antiepileptic drug (AED) substitution are not yet fully understood. Generic substitution may increase pharmacy utilization, but it may not always save health care costs for AEDs. The AEDs are relatively cheap, but high volumes of prescriptions mean that substantial drug-budget savings may be possible by switching from innovator brands to cheaper generic drugs. Such savings have been achieved in many other treatment areas. However, more caution may be needed for epilepsy because of the narrow therapeutic index, low solubility, and non-linear pharmacokinetics of some AEDs. This means that the ranges of bioequivalence that are authorized for generic formulations do not offer the same results regarding effectiveness and safety as those obtained by brand name drugs. This is why seizure control should not be sacrificed on the basis of cost alone, as the major endpoint in treating epilepsy with AEDs is seizure control without adverse effects. Switching to the cheapest generic AED may offer drug-budget savings that outweigh any risk to patient safety. But to date, this cost-benefit analysis has not been carried out. We propose that all changes to established principles of treating epilepsy are evidence based and that the risks of switching are clearly defined.

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2013 CFR

2013-01-01

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

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2014 CFR

2014-01-01

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

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

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

Science.gov Websites

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

24 CFR 242.43 - Application of cost savings.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

10 CFR 436.20 - Net savings.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

Energy efficiency and reliability solutions for rail operations and facilities.

DOT National Transportation Integrated Search

2014-11-01

The objectives of the study included examining energy consumption of : the facilities comprising the three major rail yards on the New Haven Rail Line as : well as platform stations and identifying energy efficiency and cost savings : opportunities f...

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

PubMed

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

2018-05-18

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

A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing.

PubMed

Shappell, Eric; Fant, Abra; Schnapp, Benjamin; Craig, Jill P; Ahn, James; Babcock, Christine; Gisondi, Michael A

2017-04-01

Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois. Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season. We used a survey to assess applicant experiences interviewing in Chicago and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside Illinois who completed interviews at both programs. Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data were available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $13,950. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%), and saved them money (71%). Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.

Duration of oral antibiotic therapy for the treatment of adult acne: a retrospective analysis investigating adherence to guideline recommendations and opportunities for cost-savings.

PubMed

Straight, Chelsey E; Lee, Young H; Liu, Guodong; Kirby, Joslyn S

2015-05-01

The duration of oral antibiotic acne therapy for adolescents compared with guidelines was recently investigated; however it was uncertain if duration of antibiotics for adult acne therapy differed. This study aimed to evaluate duration of oral antibiotics for adult acne compared with guidelines and determine possible cost-savings. This was a retrospective cohort study of MarketScan Commercial Claims and Encounters database that incorporated claims data to determine duration and costs of antibiotic treatment among adults ages 21 years and older. Of 17,448 courses, 84.5% (14,737) aligned with duration guidelines, although 12,040 (69.0%) courses did not include concomitant topical retinoid therapy. Mean savings of $592.26 per person could result if prolonged courses met guidelines. Mean (median) costs of generic and branded formulations for the most frequent course duration (90-179 days) were $103.77 ($54.27) and $1421.61 ($1462.25), respectively. Actual patient prescription adherence is uncertain and database lacks information regarding acne severity, patient physical characteristics, and clinical outcomes. The majority of oral antibiotic course durations follow guidelines, although topical retinoids are underused. Costs of antibiotic therapy were lower for shorter courses and those using generic medications; the cost-effectiveness of these modifications has not been investigated. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Implementation of Pharmaceutical Practice Guidelines by a Project Model Based

PubMed Central

Mahmoudi, Laleh; Karamikhah, Razieh; Mahdavinia, Azadeh; Samiei, Hasan; Petramfar, Peyman; Niknam, Ramin

2015-01-01

Abstract All around the world a few studies have been found on the effect of guideline implementation on direct medications’ expenditure. The goal of this study was to evaluate cost savings of guideline implementation among patients who had to receive 3 costly medications including albumin, enoxaparin, and pantoprazole in a tertiary hospital in Shiraz, Iran. An 8-month prospective study was performed in 2 groups; group 1 as an observational group (control group) in 4 months from June to September 2014 and group 2 as an interventional group from October 2014 to January 2015. For group 1 the pattern of costly medications usage was determined without any intervention. For group 2, after guideline implementation, the economic impact was evaluated by making comparisons between the data achieved from the 2 groups. A total of 12,680 patients were evaluated during this study (6470 in group 1; 6210 in group 2). The reduction in the total value of costly administered drugs was 56% after guideline implementation. Such reduction in inappropriate prescribing accounts for the saving of 85,625 United States dollars (USD) monthly and estimated 1,027,500 USD annually. Guideline implementation could improve the adherence of evidence-based drug utilization and resulted in significant cost savings in a major teaching medical center via a decrease in inappropriate prescribing of costly medications. PMID:26496288

Role of the pharmacist in reducing healthcare costs: current insights

PubMed Central

Dalton, Kieran; Byrne, Stephen

2017-01-01

Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists’ work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets. PMID:29354549

Benefits and Costs of Aggressive Energy Efficiency Programs and the Impacts of Alternative Sources of Funding: Case Study of Massachusetts

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

Cappers, Peter; Satchwell, Andrew; Goldman, Charles

2010-08-06

Increased interest by state (and federal) policymakers and regulatory agencies in pursuing aggressive energy efficiency efforts could deliver significant utility bill savings for customers while having long-term implications for ratepayers (e.g. potential rate impacts). Equity and distributional concerns associated with the authorized recovery of energy efficiency program costs may necessitate the pursuit of alternative program funding approaches. In 2008, Massachusetts passed the Green Communities Act which directed its energy efficiency (EE) program administrators to obtain all cost-effective EE resources. This goal has translated into achieving annual electric energy savings equivalent to a 2.4% reduction in retail sales from energy efficiencymore » programs in 2012. Representatives of electricity consumer groups supported the new portfolio of EE programs (and the projected bill savings) but raised concerns about the potential rate impacts associated with achieving such aggressive EE goals, leading policymakers to seek out alternative funding sources which can potentially mitigate these effects. Utility administrators have also raised concerns about under-recovery of fixed costs when aggressive energy efficiency programs are pursued and have proposed ratemaking policies (e.g. decoupling) and business models that better align the utility's financial interests with the state's energy efficiency public policy goals. Quantifying these concerns and identifying ways they can be addressed are crucial steps in gaining the support of major stakeholder groups - lessons that can apply to other states looking to significantly increase savings targets that can be achieved from their own ratepayer-funded energy efficiency programs. We use a pro-forma utility financial model to quantify the bill and rate impacts on electricity customers when very aggressive annual energy efficiency savings goals ({approx}2.4%) are achieved over the long-term and also assess the impact of different cost recovery approaches that integrate alternative revenue sources. We also analyze alternative lost fixed cost recovery approaches to better understand how to mitigate the erosion of utility shareholder returns in states that have adopted (and achieved) very aggressive savings targets.« less

Drawing The Red Line: Cost Benefit Analysis on Large Life Rafts

DTIC Science & Technology

2013-06-13

Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A . APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED. The...Anderson, BS, MS Major, USAF June 2013 DISTRIBUTION STATEMENT A . APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. AFIT-ENS-GRP-13-J-1...AMC has set up a Fuel-Efficiency Office (FEO) in order to analyze costs and make decisions that will save money on operational expenses related to

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation.

PubMed

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W E; Armstrong, Shannon; Jones, David G; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R; Foran, John P; Markides, Vias; Wong, Tom

2016-12-07

The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS 2 2.8 ± 1.2, CHA 2 DS 2 -VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Potential travel cost saving in urban public-transport networks using smartphone guidance.

PubMed

Song, Cuiying; Guan, Wei; Ma, Jihui

2018-01-01

Public transport (PT) is a key element in most major cities around the world. With the development of smartphones, available journey planning information is becoming an integral part of the PT system. Each traveler has specific preferences when undertaking a trip, and these preferences can also be reflected on the smartphone. This paper considers transit assignment in urban public-transport networks in which the passengers receive smartphone-based information containing elements that might influence the travel decisions in relation to line loads, as well as passenger benefits, and the paper discusses the transition from the current widespread choosing approach to a personalized decision-making approach based on smartphone information. The approach associated with smartphone guidance that considers passengers' preference on travel time, waiting time and transfer is proposed in the process of obtaining his/her preferred route from the potential travel routes generated by the Deep First Search (DFS) method. Two other approaches, based on the scenarios reflecting reality, include passengers with access to no real time information, and passengers that only have access to the arrival time at the platform are used as comparisons. For illustration, the same network proposed by Spiess and Florian is utilized on the experiments in an agent-based model. Two experiments are conducted respectively according to whether each passenger's choosing method is consistent. As expected, the results in the first experiment showed that the travel for consistent passengers with smartphone guidance was clearly shorter and that it can reduce travel time exceeding 15% and weighted cost exceeding 20%, and the average saved time approximated 3.88 minutes per passenger. The second experiment presented that travel cost, as well as cost savings, gradually decreased by employing smartphone guidance, and the maximum cost savings accounted for 14.2% of the total weighted cost.

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

PubMed

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

2013-08-01

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

New workers' compensation legislation: expected pharmaceutical cost savings.

PubMed

Wilson, Leslie; Gitlin, Matthew

2005-10-01

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

Value associated with mindfulness meditation and moderate exercise intervention in acute respiratory infection: The MEPARI Study

PubMed Central

2013-01-01

Background and objectives. Acute respiratory infection (ARI) is among the most common, debilitating and expensive human illnesses. The purpose of this study was to assess ARI-related costs and determine if mindfulness meditation or exercise can add value. Methods. One hundred and fifty-four adults ≥50 years from Madison, WI for the 2009–10 cold/flu season were randomized to (i) wait-list control (ii) meditation or (iii) moderate intensity exercise. ARI-related costs were assessed through self-reported medication use, number of missed work days and medical visits. Costs per subject were based on cost of generic medications, missed work days ($126.20) and clinic visits ($78.70). Monte Carlo bootstrap methods evaluated reduced costs of ARI episodes. Results. The total cost per subject for the control group was $214 (95% CI: $105–$358), exercise $136 (95% CI: $64–$232) and meditation $65 (95% CI: $34–$104). The majority of cost savings was through a reduction in missed days of work. Exercise had the highest medication costs at $16.60 compared with $5.90 for meditation (P = 0.004) and $7.20 for control (P = 0.046). Combining these cost benefits with the improved outcomes in incidence, duration and severity seen with the Meditation or Exercise for Preventing Acute Respiratory Infection study, meditation and exercise add value for ARI. Compared with control, meditation had the greatest cost benefit. This savings is offset by the cost of the intervention ($450/subject) that would negate the short-term but perhaps not long-term savings. Conclusions. Meditation and exercise add value to ARI-associated health-related costs with improved outcomes. Further research is needed to confirm results and inform policies on adding value to medical spending. PMID:23515373

Value associated with mindfulness meditation and moderate exercise intervention in acute respiratory infection: the MEPARI Study.

PubMed

Rakel, David; Mundt, Marlon; Ewers, Tola; Fortney, Luke; Zgierska, Aleksandra; Gassman, Michele; Barrett, Bruce

2013-08-01

Acute respiratory infection (ARI) is among the most common, debilitating and expensive human illnesses. The purpose of this study was to assess ARI-related costs and determine if mindfulness meditation or exercise can add value. One hundred and fifty-four adults ≥50 years from Madison, WI for the 2009-10 cold/flu season were randomized to (i) wait-list control (ii) meditation or (iii) moderate intensity exercise. ARI-related costs were assessed through self-reported medication use, number of missed work days and medical visits. Costs per subject were based on cost of generic medications, missed work days ($126.20) and clinic visits ($78.70). Monte Carlo bootstrap methods evaluated reduced costs of ARI episodes. The total cost per subject for the control group was $214 (95% CI: $105-$358), exercise $136 (95% CI: $64-$232) and meditation $65 (95% CI: $34-$104). The majority of cost savings was through a reduction in missed days of work. Exercise had the highest medication costs at $16.60 compared with $5.90 for meditation (P = 0.004) and $7.20 for control (P = 0.046). Combining these cost benefits with the improved outcomes in incidence, duration and severity seen with the Meditation or Exercise for Preventing Acute Respiratory Infection study, meditation and exercise add value for ARI. Compared with control, meditation had the greatest cost benefit. This savings is offset by the cost of the intervention ($450/subject) that would negate the short-term but perhaps not long-term savings. Meditation and exercise add value to ARI-associated health-related costs with improved outcomes. Further research is needed to confirm results and inform policies on adding value to medical spending.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-06-23

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

2018-04-01

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

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

PubMed

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

2018-05-15

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

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

2013-12-01

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

Economic modeling of new stent platforms to evaluate cost effectiveness: analysis of the TAXUS Liberté versus TAXUS express stents.

PubMed

Turco, Mark A; Kansal, Anuraag R; Stern, Sean; Amorosi, Stacey L; Underwood, Paul L; Lissovoy, Greg D E; Dawkins, Keith D

2012-08-01

With the changing health care environment, cost effectiveness is an important adjunct to clinical investigation when assessing new medical devices. This study presents an economic model to evaluate cost effectiveness of coronary stents. Markov modeling was developed comparing total costs (Medicare payer perspective) between TAXUS Liberté and TAXUS Express based on 3-year clinical outcomes from the TAXUS ATLAS Small Vessel and Long Lesion trials. The TAXUS Liberté 2.25-mm stent provided cost savings relative to TAXUS Express from a payer perspective ($17,605 vs. $20,281), driven by reduced target vessel revascularization (0.16 events/patient vs. 0.33 events/patient). In probabilistic sensitivity analyses, TAXUS Liberté was less costly with fewer major adverse cardiac events in over 99% of parameter sets. The TAXUS Liberté Long (38 mm) stent was cost neutral relative to TAXUS Express from a payer perspective ($18,545 vs. $18,551) with fewer myocardial infarctions and cardiac deaths. Accounting for angiography-driven revascularizations, TAXUS Liberté 2.25 mm still provided cost savings relative to TAXUS Express ($16,822 vs. $19,139), although TAXUS Liberté Long was more expensive than TAXUS Express ($17,886 vs. $17,652). From a hospital perspective, TAXUS Liberté Long provided cost savings up to a price premium of $671/stent, driven by fewer stents employed per patient. This analysis confirms the utility of economic modeling in assessing new stent platforms. TAXUS Liberté 2.25 mm is economically dominant relative to TAXUS Express when treating small vessels. TAXUS Liberté Long is cost neutral to modestly more costly than TAXUS Express 2.25 mm from a payer perspective. ©2012, Wiley Periodicals, Inc.

The Impact of Electronic Health Records on Ambulatory Costs Among Medicaid Beneficiaries

PubMed Central

Adler-Milstein, Julia; Salzberg, Claudia; Franz, Calvin; Orav, E. John; Bates, David Westfall

2013-01-01

Background Broad adoption of electronic health records (EHRs) is a potential strategy for curbing healthcare cost growth, which is particularly vital for Medicaid. Despite limited evidence for EHR-related cost savings, the 2009 HITECH Act included incentives for providers to become meaningful users of EHRs. We evaluated a large Massachusetts EHR pilot to obtain early insight into the potential for the national strategy to reduce short-run healthcare costs in the Medicaid population. Methods We calculated monthly ambulatory cost and visit measures from Medicaid claims data for beneficiaries receiving the majority of their care in the three Massachusetts eHealth Collaborative (MAeHC) pilot communities or in six matched control communities. Using a difference-in-differences of slope analysis, we assessed whether cost and visit trajectories differed in the pre-implementation period compared to the post-implementation period for intervention and control community members. Results We found evidence that EHR adoption impacted ambulatory medical cost in two of the three communities, but the effects were in opposite directions. Ambulatory medical costs increased more slowly in one intervention compared to its control communities in the pre-to-post period (difference-in-differences=-1.98%, p<0.001; PMPM savings of $41.60). In contrast, for a second pilot community, ambulatory medical cost increased more slowly in the control communities (difference-in-differences=2.56%, p=0.005; PMPM increase of $43.34). Conclusions As a stand-alone approach, adoption of commercially-available EHRs in community practices did not consistently impact Medicaid costs in the short-run. This suggests that future meaningful use criteria may need to specifically target cost savings and coordinate with payment reform efforts. PMID:24753965

A cost-benefit analysis of twice-daily consultant ward rounds and clinical input on investigation and pharmacy costs in a major teaching hospital in the UK.

PubMed

Ahmad, Aftab; Weston, Philip J; Ahmad, Mahin; Sharma, Dushyant; Purewal, Tejpal

2015-04-08

Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit. The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments. The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards. We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention. Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention. Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Healthcare costs and obesity prevention: drug costs and other sector-specific consequences.

PubMed

Rappange, David R; Brouwer, Werner B F; Hoogenveen, Rudolf T; Van Baal, Pieter H M

2009-01-01

Obesity is a major contributor to the overall burden of disease (also reducing life expectancy) and associated with high medical costs due to obesity-related diseases. However, obesity prevention, while reducing obesity-related morbidity and mortality, may not result in overall healthcare cost savings because of additional costs in life-years gained. Sector-specific financial consequences of preventing obesity are less well documented, for pharmaceutical spending as well as for other healthcare segments. To estimate the effect of obesity prevention on annual and lifetime drug spending as well as other sector-specific expenditures, i.e. the hospital segment, long-term care segment and primary healthcare. The RIVM (Dutch National Institute for Public Health and the Environment) Chronic Disease Model and Dutch cost of illness data were used to simulate, using a Markov-type model approach, the lifetime expenditures in the pharmaceutical segment and three other healthcare segments for a hypothetical cohort of obese (body mass index [BMI] >or=30 kg/m2), non-smoking people with a starting age of 20 years. In order to assess the sector-specific consequences of obesity prevention, these costs were compared with the costs of two other similar cohorts, i.e. a 'healthy-living' cohort (non-smoking and a BMI >or=18.5 and <25 kg/m2) and a smoking cohort. To assert whether preventing obesity results in cost savings in any of the segments, net present values were estimated using different discount rates. Sensitivity analyses were conducted across key input values and using a broader definition of healthcare. Lifetime drug expenditures are higher for obese people than for 'healthy-living' people, despite shorter life expectancy for the obese. Obesity prevention results in savings on drugs for obesity-related diseases until the age of 74 years, which outweigh additional drug costs for diseases unrelated to obesity in life-years gained. Furthermore, obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Discounting costs more heavily or using lower relative mortality risks for obesity would make obesity prevention a relatively more attractive strategy in terms of healthcare costs, especially for the long-term care segment. Application of a broader definition of healthcare costs has the opposite effect. Obesity prevention will likely result in savings in the pharmaceutical segment, but substantial additional costs for long-term care. These are important considerations for policy makers concerned with the future sustainability of the healthcare system.

Off-Site Indexing: A Cottage Industry.

ERIC Educational Resources Information Center

Fay, Catherine H.

1984-01-01

Briefly describes use of off-site staffing--indexers, abstractors, editors--in the production of two major databases: Management Contents and The Computer Data Base. Discussion covers the production sequence; database administrator; off-site indexer; savings (office space, furniture and equipment costs, salaries, and overhead); and problems…

Health and Economic Impacts of Eight Different Dietary Salt Reduction Interventions

PubMed Central

Nghiem, Nhung; Blakely, Tony; Cobiac, Linda J.; Pearson, Amber L.; Wilson, Nick

2015-01-01

Background Given the high importance of dietary sodium (salt) as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation. Methods Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ) (2.3 million citizens, aged 35+ years) which has detailed individual-level administrative cost data. Results Of the most feasible interventions, the largest health gains were from (in descending order): (i) mandatory 25% reduction in sodium levels in all processed foods; (ii) the package of interventions performed in the United Kingdom (UK); (iii) mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv) media campaign (as per a previous UK one); (v) voluntary food labelling as currently used in NZ; (vi) dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a “sinking lid” on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000 – 255,000), and from a salt tax. All the interventions produced net cost savings (except counselling – albeit still cost-effective). Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion). Also the salt tax would raise revenue (up to NZ$ 452 million/year). Health gain per person was greater for Māori (indigenous population) men and women compared to non-Māori. Conclusions This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions). They could also reduce ethnic inequalities in health. PMID:25910259

Creating mold-free buildings: a key to avoiding health effects of indoor molds.

PubMed

Small, Bruce M

2003-08-01

In view of the high costs of building diagnostics and repair subsequent to water damage--as well as the large medical diagnostic and healthcare costs associated with mold growth in buildings--commitment to a philosophy of proactive preventive maintenance for home, apartment, school, and commercial buildings could result in considerable cost savings and avoidance of major health problems among building occupants. The author identifies common causes of mold growth in buildings and summarizes key building design and construction principles essential for preventing mold contamination indoors. Physicians and healthcare workers must be made aware of conditions within buildings that can give rise to mold growth, and of resulting health problems. Timely advice provided to patients already sensitized by exposure to molds could save these individuals, and their families, from further exposures as a result of inadequate building maintenance or an inappropriate choice of replacement housing.

Automated external defibrillators in schools?

PubMed

Cornelis, Charlotte; Calle, Paul; Mpotos, Nicolas; Monsieurs, Koenraad

2015-06-01

Automated external defibrillators (AEDs) placed in public locations can save lives of cardiac arrest victims. In this paper, we try to estimate the cost-effectiveness of AED placement in Belgian schools. This would allow school policy makers to make an evidence-based decision about an on-site AED project. We developed a simple mathematical model containing literature data on the incidence of cardiac arrest with a shockable rhythm; the feasibility and effectiveness of defibrillation by on-site AEDs and the survival benefit. This was coupled to a rough estimation of the minimal costs to initiate an AED project. According to the model described above, AED projects in all Belgian schools may save 5 patients annually. A rough estimate of the minimal costs to initiate an AED project is 660 EUR per year. As there are about 6000 schools in Belgium, a national AED project in all schools would imply an annual cost of at least 3960 000 EUR, resulting in 5 lives saved. As our literature survey shows that AED use in schools is feasible and effective, the placement of these devices in all Belgian schools is undoubtedly to be considered. The major counter-arguments are the very low incidence and the high costs to set up a school-based AED programme. Our review may fuel the discussion about Whether or not school-based AED projects represent good value for money and should be preferred above other health care interventions.

An Evaluation of the Consumer Costs and Benefits of Energy Efficiency Resource Standards

NASA Astrophysics Data System (ADS)

Lessans, Mark D.

Of the modern-day policies designed to encourage energy efficiency, one with a significant potential for impact is that of Energy Efficiency Resource Standards (EERS). EERS policies place the responsibility for meeting an efficiency target on the electric and gas utilities, typically setting requirements for annual reductions in electricity generation or gas distribution to customers as a percentage of sales. To meet these requirements, utilities typically implement demand-side management (DSM) programs, which encourage energy efficiency at the customer level through incentives and educational initiatives. In Maryland, a statewide EERS has provided for programs which save a significant amount of energy, but is ultimately falling short in meeting the targets established by the policy. This study evaluates residential DSM programs offered by Pepco, a utility in Maryland, for cost-effectiveness. However, unlike most literature on the topic, analysis focuses on the costs-benefit from the perspective of the consumer, and not the utility. The results of this study are encouraging: the majority of programs analyzed show that the cost of electricity saved, or levelized cost of saved energy (LCSE), is less expensive than the current retail cost of electricity cost in Maryland. A key goal of this study is to establish a metric for evaluating the consumer cost-effectiveness of participation in energy efficiency programs made available by EERS. In doing so, the benefits of these programs can be effectively marketed to customers, with the hope that participation will increase. By increasing consumer awareness and buy-in, the original goals set out through EERS can be realized and the policies can continue to receive support.

Energy Savings Measure Packages. Existing Homes

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

Casey, Sean; Booten, Chuck

2011-11-01

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

Weatherization Works--Summary of Findings from the Retrospective Evaluation of the U.S. DOE's Weatherization Assistance Program

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

Tonn, Bruce Edward; Carroll, David; Pigg, Scott

This report presents a summary of the studies and analyses that compose the retrospective evaluation of the U.S. Department of Energy s low-income Weatherization Assistance Program (WAP). WAP provides grants to Grantees (i.e., states) that then provide grants to Subgrantees (i.e., local weatherization agencies) to weatherize low-income homes. This evaluation focused on the WAP Program Year 2008. The retrospective evaluation produced twenty separate reports, including this summary. Four separate reports address the energy savings, energy cost savings, and cost effectiveness of WAP across four housing types: single family, mobile home, small multifamily, and large multifamily. Other reports address the environmentalmore » emissions, macroeconomic, and health and household-related benefits attributable to WAP, and characterize the program, its recipients, and those eligible for the program. Major field studies are also summarized, including a major indoor air quality study and a follow-up ventilation study, an in-depth in-field assessment of weatherization work and quality, and a study that assesses reasons for variations in energy savings across homes. Results of surveys of weatherization staff, occupants, occupants satisfaction with weatherization services provided, and weatherization trainees are summarized. Lastly, this report summarizes a set of fifteen case studies of high-performing and unique local weatherization agencies.« less

An economic evaluation of the costs and benefits of heparin rationalisation in a hospital pharmacy.

PubMed

Reeves, Penny; Cooke, Jonathan; Lloyd, Adam; Hutchings, Adam

2004-06-01

To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.

The International Database of Efficient Appliances (IDEA): A New Resource for Global Efficiency Policy

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

Gerke, Brian F; McNeil, Michael A; Tu, Thomas

A major barrier to effective appliance efficiency program design and evaluation is a lack of data for determination of market baselines and cost-effective energy savings potential. The data gap is particularly acute in developing countries, which may have the greatest savings potential per unit GDP. To address this need, we are developing the International Database of Efficient Appliances (IDEA), which automatically compiles data from a wide variety of online sources to create a unified repository of information on efficiency, price, and features for a wide range of energy-consuming products across global markets. This paper summarizes the database framework and demonstratesmore » the power of IDEA as a resource for appliance efficiency research and policy development. Using IDEA data for refrigerators in China and India, we develop robust cost-effectiveness indicators that allow rapid determination of savings potential within each market, as well as comparison of that potential across markets and appliance types. We discuss implications for future energy efficiency policy development.« less

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

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

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

2013-08-01

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

Cost-effectiveness Analysis for Apixaban in the Acute Treatment and Prevention of Venous Thromboembolism in the Netherlands.

PubMed

de Jong, Lisa A; Dvortsin, Evgeni; Janssen, Kristel J; Postma, Maarten J

2017-02-01

Low-molecular weight heparin (LMWH) followed by vitamin K antagonists (VKAs) are the current standard treatment of acute venous thromboembolism (VTE) and prevention of recurrent VTE. The direct oral anticoagulant apixaban was recently found noninferior in efficacy and superior in preventing major bleeding compared with LMWH/VKAs in the AMPLIFY (Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy) trial. The objective of this study was to calculate the cost-effectiveness of apixaban compared with LMWH/VKA in the treatment of acute VTE and prevention of recurrent VTE in the Netherlands. A Markov model was designed to simulate a cohort of 1,000 VTE patients receiving either apixaban or LMWH/VKA. Transition probabilities, costs, and utilities were obtained from the AMPLIFY trial and other literature. The incremental cost-effectiveness ratio (ICER) was calculated from the societal perspective; therefore, the model included both direct (inside and outside the health care sector) and indirect costs. In the univariate and probabilistic sensitivity analyses (PSAs) the robustness of the results was tested, and various additional scenario analyses were conducted. In the base-case analysis, apixaban saved €236 and 0.044 quality-adjusted life years (QALYs) and 0.039 LYs were gained compared with LMWH/VKA. In the univariate sensitivity analysis the model appeared to be robust. The results of 2,000 iterations in the PSA found that the probability of apixaban being cost-effective at a willingness-to-pay threshold of €20,000/QALY was 100% and cost-saving was 94%. The scenario of 18-month treatment duration was the only scenario not indicating cost-savings with an ICER of €425/QALY. In acute anticoagulation use apixaban was found to be cost-saving. A longer anticoagulation period (18 months) resulted in a higher difference in drug costs, indicating a higher ICER. The cost-effectiveness of long-term or life-long use should be examined in future research. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Prevention of venous thromboembolism in hospitalized patients: analysis of reduced cost and improved clinical outcomes.

PubMed

Duff, Jed; Walker, Kim; Omari, Abdullah; Stratton, Charlie

2013-03-01

The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of $245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving. Copyright © 2013 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

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

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

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

2013-02-01

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

Economic Outcomes Associated with a Pharmacist-Adjudicated Formulary Consult Service in a Veterans Affairs Medical Center.

PubMed

Britt, Rachel B; Hashem, Mohamed G; Bryan, William E; Kothapalli, Radhika; Brown, Jamie N

2016-09-01

Several cost analysis studies have been conducted looking at clinical and economic outcomes associated with clinical pharmacist services in a variety of health care settings. However, there is a paucity of data regarding the economic impact of clinical pharmacist involvement in formulary management at the hospital level. To evaluate economic outcomes of a pharmacist-adjudicated formulary management consult service in a Veterans Affairs (VA) medical center offering outpatient and inpatient services. This VA medical center uses a pharmacist-adjudicated formulary management system for review of restricted drug consults. A retrospective review of electronic medical records was conducted to identify restricted drug consults at this institution between January 1, 2014, and March 31, 2014. Only restricted drug consults that were not approved were included for evaluation in order to best characterize the effects of formulary interventions by pharmacists. Economic outcomes were determined as direct cost savings by comparing the cost of requested drug with the recommended drug and accounting for the cost of pharmacist review. Characteristics of consults that were not approved and pharmacist rationale were also evaluated. Of 1,802 restricted drug consults adjudicated by a pharmacist during the study period, 198 consults in 190 individual patients met criteria for inclusion and were evaluated. The most commonly requested indications were dyslipidemia, pain, and diabetes, while the most commonly requested drugs were rosuvastatin, insulin pens, tamsulosin, varenicline, ezetimibe, and rivaroxaban. The majority of consults were requested for outpatient use. Total cost savings among 195 evaluable consults was $420,324.05, while mean cost savings per consult was $2,229.43 (range: -$3,009.27-$65,982.36). The highest cost savings were seen with outpatient use. A pharmacist-adjudicated formulary consult service in a VA medical center was associated with a substantial cost savings after adjustment for cost of pharmacist review. Future research should assess clinical outcomes associated with a restrictive formulary management system. No outside funding supported this study. None of the authors report any financial interests or potential conflict of interest with regard to this work. Study concept and design were created by all authors. Data were collected and interpreted by Britt, with input from all authors. The manuscript was written by Britt and revised by all authors.

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

PubMed

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

2016-12-01

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

Turning waste medicines to cost savings: A pilot study on the feasibility of medication recycling as a solution to drug wastage.

PubMed

Toh, Ming Ren; Chew, Lita

2017-01-01

Unused medicines represent a major source of wastage in healthcare systems around the world. Previous studies have suggested the potential cost savings from recycling the waste medicines. However, issues of product safety and integrity often deter healthcare institutions from recycling donated medications. To evaluate the feasibility of medication recycling and to assess the actual cost savings from recycling waste medicines and whether reusability of waste medicines differed among various drug classes and donor sources. Donated medications from hospitals, private medical clinics and patients were collected and assessed using a medication recycling protocol in a hospice care setting from November 2013 through January 2014. Costs were calculated using a reference pricing list from a public hospital. A total of 244 donations, amounting to 20,759 dosage units, were collected during the study period. Most donations (90.8%) were reusable, providing a total of S$5266 in cost savings. Less than 2 h daily was spent by a single pharmacy technician on the sorting and distributing processes. Medications donated by health facilities were thrice more likely to be reusable than those by patients (odds ratio = 3.614, 95% confidence interval = 3.127, 4.176). Medications belonging to Anatomical Therapeutic Chemical class G (0.0%), H (8.2%) and L (30.0%) were the least reusable. Most donated medications were reusable. The current protocol can be further streamlined to focus on the more reusable donor sources and drug classes and validated in other settings. Overall, we opine that it is feasible to practise medication recycling on a larger scale to reduce medication wastage.

The cost-effectiveness of therapies to treat alcohol use disorders.

PubMed

Rehm, J; Barbosa, C

2018-02-01

Alcohol use is a major risk factor for mortality and morbidity burden, and alcohol use disorders contribute markedly to this burden. Effective interventions for alcohol use disorders improve health, and are potentially cost-effective or even cost saving. Areas covered: We searched the literature for the cost-effectiveness of alcohol interventions. We included behavioral, pharmacological and combined interventions, and research from both a health care provider and a societal perspective. Overall, many economic research studies pointed towards existing cost-beneficial therapies from the perspective of a health care provider; i.e. the costs for interventions were smaller than the savings in services delivery in the years thereafter. Even if this was not the case, the interventions proved to be cost-effective with a threshold below $20,000 per quality-adjusted life year. Expert Commentary: While most of the economic research to date shows promising results, such research is relatively scarce and not always rigorous. More, and more rigorous economic research is needed to fully understand the potential impact of alcohol interventions. However, even with this research, something needs to be done to reduce stigmatization of alcohol use disorders in order to fully reap the benefits of alcohol interventions.

Evaluating the economic impact of screening and treatment for depression in the workplace.

PubMed

Evans-Lacko, Sara; Koeser, Leonardo; Knapp, Martin; Longhitano, Calogero; Zohar, Joseph; Kuhn, Karl

2016-06-01

Depression is the most common psychiatric illness and cause of disability, and associated with durable impacts on productivity and represents one of the major causes of workplace absenteeism and presenteeism. Few studies, however, examine the economic impact of treatment of depression in the workplace, particularly from the perspective of the employer. We estimated the relative cost-effectiveness of treatment for employees with depression in the workplace. We used a decision-analytic model to estimate the relative cost-effectiveness of (i) psychotherapy, (ii) pharmacotherapy and (iii) combination of psychotherapy and pharmacotherapy and whether they reduce sickness, absenteeism and presenteeism for people with depression. Costs and savings to the employer were also estimated, and policy recommendations made about how best to translate this evidence into practice. Both pharmacotherapy treatment and psychotherapy treatment were found to be cost-saving from the perspective of the employer. Psychotherapy was found to be the most cost-effective option with an incremental cost-effectiveness ratio of €22,225. This study provides evidence that screening and treatment for depression in the workplace is cost-effective and represents a worthwhile investment from the business perspective. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

California drug courts: outcomes, costs and promising practices: an overview of Phase II in a statewide study.

PubMed

Carey, Shannon M; Finigan, Michael; Crumpton, Dave; Waller, Mark

2006-11-01

The rapid expansion of drug courts in California and the state's uncertain fiscal climate highlighted the need for definitive cost information on drug court programs. This study focused on creating a research design that can be utilized for statewide and national cost-assessment of drug courts by conducting in-depth case studies of the costs and benefits in nine adult drug courts in California. A Transactional Institutional Costs Analysis (TICA) approach was used, allowing researchers to calculate costs based on every individual's transactions within the drug court or the traditional criminal justice system. This methodology also allows the calculation of costs and benefits by agency (e.g., Public Defender's office, court, District Attorney). Results in the nine sites showed that the majority of agencies save money in processing an offender though drug court. Overall, for these nine study sites, participation in drug court saved the state over 9 million dollars in criminal justice and treatment costs due to lower recidivism in drug court participants. Based on the lessons learned in Phases I and II, Phase III of this study focuses on the creation of a web-based drug court cost self-evaluation tool (DC-CSET) that drug courts can use to determine their own costs and benefits.

Cost-efficacy in interventional cardiology; results from the EPISTENT study. Evaluation of Platelet IIb/IIIa Inhibitor For Stenting Trial.

PubMed

Zwart-van Rijkom, J E; van Hout, B A

2001-08-01

The EPISTENT study has demonstrated that the combined use of abciximab and stenting as an adjunct to PTCA leads to increased event-free survival compared to either using abciximab or stenting alone. However, this combined strategy may be costly and the additional costs have to be weighted against the additional effects. The 6-months efficacy data from the EPISTENT study are combined with Dutch estimates of unit costs. Adding a stent to a procedure with abciximab further decreases the number of revascularizations at an extra cost of Euros 12,000 (95% upper limit (u.l.) Euros 31,000) per additional major adverse cardiac event-free survivor. Adding abciximab to a stenting procedure decreases the incidence of myocardial infarctions at an extra cost of Euros 13,000 (95% u.l. Euros 27,000) per additional myocardial infarction-free survivor. In the subgroup of diabetics, adding abciximab improves revascularization rates as well, resulting in a cost-efficacy rate of Euros 2000 (95% u.l. Euros 25,000) per additional MACE-free survivor, with uncertainty regions indicating potential costs savings. The combination of stenting and abciximab costs about Euros 13,000 to avoid one event after PTCA. In diabetic patients the strategy may be cost-saving. Copyright 2001 The European Society of Cardiology.

Alternative Fuels Data Center: Minnesota School District Finds Cost

Science.gov Websites

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

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

NASA Technical Reports Server (NTRS)

1972-01-01

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

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

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

NONE

1987-10-22

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

Paralegal Assistants. Hearing Before the Subcommittee on Representation of Citizen Interests of the Committee on the Judiciary, United States Senate, Ninety-third Congress, Second Session on Paralegal Assistants.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on the Judiciary.

Testimony of various witnesses, including representatives from a paralegal training institute, paralegals, educators, lawyers, and bar associations, respond to the assertions that because they save from one-quarter to one-half of the cost of a lawyer's time, paralegals can be a major factor in lowering the cost and increasing the availability of…

Cost-Effectiveness of Dabigatran Compared to Vitamin-K Antagonists for the Treatment of Deep Venous Thrombosis in the Netherlands Using Real-World Data.

PubMed

van Leent, Merlijn W J; Stevanović, Jelena; Jansman, Frank G; Beinema, Maarten J; Brouwers, Jacobus R B J; Postma, Maarten J

2015-01-01

Vitamin-K antagonists (VKAs) present an effective anticoagulant treatment in deep venous thrombosis (DVT). However, the use of VKAs is limited because of the risk of bleeding and the necessity of frequent and long-term laboratory monitoring. Therefore, new oral anticoagulant drugs (NOACs) such as dabigatran, with lower rates of (major) intracranial bleeding compared to VKAs and not requiring monitoring, may be considered. To estimate resource utilization and costs of patients treated with the VKAs acenocoumarol and phenprocoumon, for the indication DVT. Furthermore, a formal cost-effectiveness analysis of dabigatran compared to VKAs for DVT treatment was performed, using these estimates. A retrospective observational study design in the thrombotic service of a teaching hospital (Deventer, The Netherlands) was applied to estimate real-world resource utilization and costs of VKA monitoring. A pooled analysis of data from RE-COVER and RE-COVER II on DVT was used to reflect the probabilities for events in the cost-effectiveness model. Dutch costs, utilities and specific data on coagulation monitoring levels were incorporated in the model. Next to the base case analysis, univariate probabilistic sensitivity and scenario analyses were performed. Real-world resource utilization in the thrombotic service of patients treated with VKA for the indication of DVT consisted of 12.3 measurements of the international normalized ratio (INR), with corresponding INR monitoring costs of €138 for a standardized treatment period of 180 days. In the base case, dabigatran treatment compared to VKAs in a cohort of 1,000 DVT patients resulted in savings of €18,900 (95% uncertainty interval (UI) -95,832, 151,162) and 41 (95% UI -18, 97) quality-adjusted life-years (QALYs) gained calculated from societal perspective. The probability that dabigatran is cost-effective at a conservative willingness-to pay threshold of €20,000 per QALY was 99%. Sensitivity and scenario analyses also indicated cost savings or cost-effectiveness below this same threshold. Total INR monitoring costs per patient were estimated at minimally €138. Inserting these real-world data into a cost-effectiveness analysis for patients diagnosed with DVT, dabigatran appeared to be a cost-saving alternative to VKAs in the Netherlands in the base case. Cost savings or favorable cost-effectiveness were robust in sensitivity and scenario analyses. Our results warrant confirmation in other settings and locations.

The Expanded Food and Nutrition Education Program (EFNEP)

ERIC Educational Resources Information Center

National Institute of Food and Agriculture, 2010

2010-01-01

Obesity, poor health, and limited physical activity are major health concerns. The Expanded Food and Nutrition Education Program (EFNEP) improves the health and well-being of limited resource families and youth. Additionally, EFNEP leads to public savings. Research shows that better health is associated with reduced health care costs, less…

Cost comparative study of autologous peripheral blood progenitor cells (PBPC) and bone marrow (ABM) transplantations for non-Hodgkin's lymphoma patients.

PubMed

Woronoff-Lemsi, M C; Arveux, P; Limat, S; Deconinck, E; Morel, P; Cahn, J Y

1997-12-01

Intensive high-dose chemotherapy with autologous stem-cell support has become a common treatment strategy for non-Hodgkin's lymphomas. A cost-identification analysis was conducted comparing 10 patients autografted with PBSC to 10 others autografted with BM. The analysis included harvest and graft until graft day +100 and was carried out from the point of view of the hospital setting. Resources used, logistic and direct medical costs per patient were identified, and sensitivity analyses performed. The cost distribution was different. Stem cell harvest was more expensive for PBPC ($9030) and BM ($4745); on the other hand, hospitalization from graft to discharge from hospital cost savings with PBSC were about $10666. After discharge from hospital, costs were similar and cheaper in both groups. For the overall study the PBPC procedure was less expensive than ABMT, $35381 and $41759 respectively, with cost savings of $6378. The number of days spent in hospital and blood bank costs were the major cost factors. This study was based on a single pathology, non-Hodgkin's lymphoma, and the actual hospital records for each patient situation as opposed to a clinical trial, and our results were consistent with different previous studies carried out in different health care systems.

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

PubMed

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

2017-02-01

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

Space system production cost benefits from contemporary philosophies in management and manufacturing

NASA Technical Reports Server (NTRS)

Rosmait, Russell L.

1991-01-01

The cost of manufacturing space system hardware has always been expensive. The Engineering Cost Group of the Program Planning office at Marshall is attempting to account for cost savings that result from new technologies in manufacturing and management. The objective is to identify and define contemporary philosophies in manufacturing and management. The seven broad categories that make up the areas where technological advances can assist in reducing space system costs are illustrated. Included within these broad categories is a list of the processes or techniques that specifically provide the cost savings within todays design, test, production and operations environments. The processes and techniques listed achieve savings in the following manner: increased productivity; reduced down time; reduced scrap; reduced rework; reduced man hours; and reduced material costs. In addition, it should be noted that cost savings from production and processing improvements effect 20 to 40 pct. of production costs whereas savings from management improvements effects 60 to 80 of production cost. This is important because most efforts in reducing costs are spent trying to reduce cost in the production.

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

PubMed

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

2005-11-01

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

Modelling the cost effectiveness of antidepressant treatment in primary care.

PubMed

Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D

1995-12-01

The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine treatment (estimated discounted lifetime medical costs were $Can50,664 vs $Can50,678) and produces slightly more QALYs (13.90 vs 13.79). In the sensitivity analyses, the cost-effectiveness ratios comparing nefazodone with imipramine ranged from cost saving to $Can17,326 per QALY gained. The cost-effectiveness ratios comparing nefazodone with fluoxetine ranged from cost saving to $Can7327 per QALY gained. The model was most sensitive to assumptions about treatment compliance rates and recurrence rates. The findings suggest that nefazodone may be a cost-effective treatment for major depression compared with imipramine or fluoxetine. The basic findings and conclusions do not change even after modifying model parameters within reasonable ranges.

Crushing leads to waste disposal savings for FUSRAP

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

Darby, J.

1997-02-01

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

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

PubMed Central

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

2015-01-01

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

Polio immunization policy in Mexico: economic assessment of current practice and future alternatives.

PubMed

Mascareñas, A; Salinas, J; Tasset-Tisseau, A; Mascareñas, C; Khan, M M

2005-06-01

The World Health Organization recommends that all children aged less than 5 years should be vaccinated against polio through intensive immunization programmes as well as routine immunization. A national immunization week (NIW) was held in February 2002 in the Monterrey district of Mexico. A prospective micro-costing study was conducted to measure the total cost to the state of the NIW, the cost profile, and the ratio of cost per immunization contact to cost per dose of oral polio vaccine (OPV), and to compare OPV and inactive polio vaccine (IPV) in economic terms. Two scenarios were used as the basis for calculation. The cost of volunteers was excluded from the "lower-cost scenario" and included in the "upper-cost scenario". The total cost of the NIW was USD 100,454 for the lower-cost scenario and USD 156,614 for the upper-cost scenario. The major part of the costs was personnel costs (67.30 and 77.53% of the total costs in the lower- and upper-cost scenario, respectively). The ratio of cost per immunization contact to cost per dose of OPV was 6.45 for the lower-cost scenario and 10.05 for the upper-cost scenario. Changing from the current OPV-based intensive and routine schedule to a sequential IPV-OPV routine schedule would save USD 14.52 per vaccinated child, and changing to a full IPV routine schedule would save USD 9.41 per vaccinated child.

Can disease management reduce health care costs by improving quality?

PubMed

Fireman, Bruce; Bartlett, Joan; Selby, Joe

2004-01-01

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

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

PubMed

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

2014-08-01

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

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

PubMed

Emanuel, E J

1996-06-26

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

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

PubMed

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

2016-12-01

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

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

PubMed

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

2012-01-01

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

Comparison of software models for energy savings from cool roofs

DOE PAGES

New, Joshua; Miller, William A.; Huang, Yu; ...

2015-06-07

For this study, a web-based Roof Savings Calculator (RSC) has been deployed for the United States Department of Energy as an industry-consensus tool to help building owners, manufacturers, distributors, contractors and researchers easily run complex roof and attic simulations. RSC simulates multiple roof and attic technologies for side-by-side comparison including reflective roofs, different roof slopes, above sheathing ventilation, radiant barriers, low-emittance roof surfaces, duct location, duct leakage rates, multiple substrate types, and insulation levels. Annual simulations of hour-by-hour, whole-building performance are used to provide estimated annual energy and cost savings from reduced HVAC use. While RSC reported similar cooling savingsmore » to other simulation engines, heating penalty varied significantly. RSC results show reduced cool roofing cost-effectiveness, thus mitigating expected economic incentives for this countermeasure to the urban heat island effect. This paper consolidates comparison of RSC's projected energy savings to other simulation engines including DOE-2.1E, AtticSim, Micropas, and EnergyPlus. Also included are comparisons to previous simulation-based studies, analysis of RSC cooling savings and heating penalties, the role of radiative heat exchange in an attic assembly, and changes made for increased accuracy of the duct model. Finally, radiant heat transfer and duct interaction not previously modeled is considered a major contributor to heating penalties.« less

Performance and Economic Modeling of Horizontally Drilled Ground-Source Heat Pumps in Select California Climates

NASA Astrophysics Data System (ADS)

Wiryadinata, Steven

Service life modeling was performed to gage the viability of unitary 3.5 kWt, ground-source terminal heat pumps (GTHP) employing horizontal directionally drilled geothermal heat exchangers (GHX) over air-source terminal heat pumps (PTHP) in hotels and motels and residential apartment building sectors in California's coastal and inland climates. Results suggest the GTHP can reduce hourly peak demand for the utility by 7%-25% compared to PTHP, depending on the climate and building type. The annual energy savings, which range from -1% to 5%, are highly dependent on the GTHP pump energy use relative to the energy savings attributed to the difference in ground and air temperatures (DeltaT). In mild climates with small ?T, the pump energy use may overcome any advantage to utilizing a GHX. The majority of total levelized cost savings - ranging from 0.18/ft2 to 0.3/ft 2 - are due to reduced maintenance and lifetime capital cost normally associated with geothermal heat pump systems. Without these reductions (not validated for the GTHP system studied), the GTHP technology does not appear to offer significant advantages over PTHP in the climate zones studied here. The GTHP levelized cost was most sensitive to variations in installed cost and in some cases, energy use (influenced by climate zone choice), which together highlights the importance of climate selection for installation, and the need for larger market penetration of ground-source systems in order to bring down installed costs as the technology matures.

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

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

Liu, Xiaobing; Malhotra, Mini; Xiong, Zeyu

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

Advanced technology commercial fuselage structure

NASA Technical Reports Server (NTRS)

Ilcewicz, L. B.; Smith, P. J.; Walker, T. H.; Johnson, R. W.

1991-01-01

Boeing's program for Advanced Technology Composite Aircraft Structure (ATCAS) has focused on the manufacturing and performance issues associated with a wide body commercial transport fuselage. The primary goal of ATCAS is to demonstrate cost and weight savings over a 1995 aluminum benchmark. A 31 foot section of fuselage directly behind the wing to body intersection was selected for study purposes. This paper summarizes ATCAS contract plans and review progress to date. The six year ATCAS program will study technical issues for crown, side, and keel areas of the fuselage. All structural details in these areas will be included in design studies that incorporate a design build team (DBT) approach. Manufacturing technologies will be developed for concepts deemed by the DBT to have the greatest potential for cost and weight savings. Assembly issues for large, stiff, quadrant panels will receive special attention. Supporting technologies and mechanical tests will concentrate on the major issues identified for fuselage. These include damage tolerance, pressure containment, splices, load redistribution, post-buckled structure, and durability/life. Progress to date includes DBT selection of baseline fuselage concepts; cost and weight comparisons for crown panel designs; initial panel fabrication for manufacturing and structural mechanics research; and toughened material studies related to keel panels. Initial ATCAS studies have shown that NASA's Advanced Composite Technology program goals for cost and weight savings are attainable for composite fuselage.

Economic burden of mucormycosis in the United States: can a vaccine be cost-effective?

PubMed

Ibrahim, Ashraf S; Edwards, John E; Bryant, Richard; Spellberg, Brad

2009-01-01

Mucormycosis is a life-threatening infection which causes unacceptably high morbidity and mortality despite treatment. Therefore, a vaccine to prevent mucormycosis is desirable. A major barrier to developing an anti-mucormycosis vaccine is the perception that such a vaccine would not be cost-effective to deploy because the disease is rare. We used data from a recent retrospective study to calculate the annual cost to the US healthcare system caused by mucormycosis infections. We created a model to estimate the cost-efficacy of a niche, anti-mucormycosis vaccine deployed in a targeted manner to high-risk patients. We found that each case of mucormycosis results in an average direct cost to the US healthcare system of $97,743, for an overall cost of mucormycosis of $50 million per year. In the base case scenario, targeted deployment of an anti-mucormycosis vaccine would result in a net cost per quality adjusted life year saved (QUALY) of $17,249. Variations in the price of the vaccine, its market penetration, or the cost of infection could dramatically decrease the net cost, and could even result in net savings per QUALY. In conclusion, mucormycosis causes considerable cost to the US health care system. Targeted deployment of a niche vaccine could decrease infection rates and mortality from mucormycosis in a cost-effective manner.

A cost analysis for the implementation of commonality in the family of commuter airplanes, revised

NASA Technical Reports Server (NTRS)

Creighton, Tom; Haddad, Rafael; Hendrich, Louis; Hensley, Doug; Morgan, Louise; Russell, Mark; Swift, Jerry

1987-01-01

The acquisition costs determined for the NASA family of commute airplanes are presented. The costs of the baseline designs are presented along with the calculated savings due to the commonality in the family. A sensitivity study is also presented to show the major drivers in the acquisition cost calculations. The baseline costs are calculated with the Nicolai method. A comparison is presented of the estimated costs for the commuter family with the actual price for existing commuters. The cost calculations for the engines and counter-rotating propellers are reported. The effects of commonality on acquisition costs are calculated. The sensitivity calculations of the cost to various costing parameters are shown. The calculations for the direct operating costs, with and without commonality are presented.

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

PubMed

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

2010-04-01

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

Potential travel cost saving in urban public-transport networks using smartphone guidance

PubMed Central

2018-01-01

Public transport (PT) is a key element in most major cities around the world. With the development of smartphones, available journey planning information is becoming an integral part of the PT system. Each traveler has specific preferences when undertaking a trip, and these preferences can also be reflected on the smartphone. This paper considers transit assignment in urban public-transport networks in which the passengers receive smartphone-based information containing elements that might influence the travel decisions in relation to line loads, as well as passenger benefits, and the paper discusses the transition from the current widespread choosing approach to a personalized decision-making approach based on smartphone information. The approach associated with smartphone guidance that considers passengers’ preference on travel time, waiting time and transfer is proposed in the process of obtaining his/her preferred route from the potential travel routes generated by the Deep First Search (DFS) method. Two other approaches, based on the scenarios reflecting reality, include passengers with access to no real time information, and passengers that only have access to the arrival time at the platform are used as comparisons. For illustration, the same network proposed by Spiess and Florian is utilized on the experiments in an agent-based model. Two experiments are conducted respectively according to whether each passenger’s choosing method is consistent. As expected, the results in the first experiment showed that the travel for consistent passengers with smartphone guidance was clearly shorter and that it can reduce travel time exceeding 15% and weighted cost exceeding 20%, and the average saved time approximated 3.88 minutes per passenger. The second experiment presented that travel cost, as well as cost savings, gradually decreased by employing smartphone guidance, and the maximum cost savings accounted for 14.2% of the total weighted cost. PMID:29746528

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

NASA Astrophysics Data System (ADS)

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

2017-08-01

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

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

Desroches, Louis-Benoit; Garbesi, Karina

It is well established that energy efficiency is most often the lowest cost approach to reducing national energy use and minimizing carbon emissions. National investments in energy efficiency to date have been highly cost-effective. The cumulative impacts (out to 2050) of residential energy efficiency standards are expected to have a benefit-to-cost ratio of 2.71:1. This project examined energy end-uses in the residential, commercial, and in some cases the industrial sectors. The scope is limited to appliances and equipment, and does not include building materials, building envelopes, and system designs. This scope is consistent with the scope of DOE's appliance standardsmore » program, although many products considered here are not currently subject to energy efficiency standards. How much energy could the United States save if the most efficient design options currently feasible were adopted universally? What design features could produce those savings? How would the savings from various technologies compare? With an eye toward identifying promising candidates and strategies for potential energy efficiency standards, the Max Tech and Beyond project aims to answer these questions. The analysis attempts to consolidate, in one document, the energy savings potential and design characteristics of best-on-market products, best-engineered products (i.e., hypothetical products produced using best-on-market components and technologies), and emerging technologies in research & development. As defined here, emerging technologies are fundamentally new and are as yet unproven in the market, although laboratory studies and/or emerging niche applications offer persuasive evidence of major energy-savings potential. The term 'max tech' is used to describe both best-engineered and emerging technologies (whichever appears to offer larger savings). Few best-on-market products currently qualify as max tech, since few apply all available best practices and components. The three primary analyses presented in this report are: Nevertheless, it is important to analyze best-on-market products, since data on truly max tech technologies are limited. (1) an analysis of the cross-cutting strategies most promising for reducing appliance and equipment energy use in the U.S.; (2) a macro-analysis of the U.S. energy-saving potential inherent in promising ultra-efficient appliance technologies; and (3) a product-level analysis of the energy-saving potential.« less

Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission.

PubMed

Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

2015-01-01

Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.

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

PubMed

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

2009-01-01

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

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

PubMed

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

2016-05-01

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

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

PubMed

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

2013-09-16

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

Costs and benefits of bicycling investments in Portland, Oregon.

PubMed

Gotschi, Thomas

2011-01-01

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

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

PubMed

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

2009-10-21

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

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

PubMed Central

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

2018-01-01

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

Building Commissioning: A Golden Opportunity for Reducing Energy Costs and Greenhouse-gas Emissions

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

Mills, Evan

2009-07-16

The aim of commissioning new buildings is to ensure that they deliver, if not exceed, the performance and energy savings promised by their design. When applied to existing buildings, commissioning identifies the almost inevitable 'drift' from where things should be and puts the building back on course. In both contexts, commissioning is a systematic, forensic approach to quality assurance, rather than a technology per se. Although commissioning has earned increased recognition in recent years - even a toehold in Wikipedia - it remains an enigmatic practice whose visibility severely lags its potential. Over the past decade, Lawrence Berkeley National Laboratorymore » has built the world's largest compilation and meta-analysis of commissioning experience in commercial buildings. Since our last report (Mills et al. 2004) the database has grown from 224 to 643 buildings (all located in the United States, and spanning 26 states), from 30 to 100 million square feet of floorspace, and from $17 million to $43 million in commissioning expenditures. The recorded cases of new-construction commissioning took place in buildings representing $2.2 billion in total construction costs (up from 1.5 billion). The work of many more commissioning providers (18 versus 37) is represented in this study, as is more evidence of energy and peak-power savings as well as cost-effectiveness. We now translate these impacts into avoided greenhouse gases and provide new indicators of cost-effectiveness. We also draw attention to the specific challenges and opportunities for high-tech facilities such as labs, cleanrooms, data centers, and healthcare facilities. The results are compelling. We developed an array of benchmarks for characterizing project performance and cost-effectiveness. The median normalized cost to deliver commissioning was $0.30/ft2 for existing buildings and $1.16/ft2 for new construction (or 0.4% of the overall construction cost). The commissioning projects for which data are available revealed over 10,000 energy-related problems, resulting in 16% median whole-building energy savings in existing buildings and 13% in new construction, with payback time of 1.1 years and 4.2 years, respectively. In terms of other cost-benefit indicators, median benefit-cost ratios of 4.5 and 1.1, and cash-on-cash returns of 91% and 23% were attained for existing and new buildings, respectively. High-tech buildings were particularly cost-effective, and saved higher amounts of energy due to their energy-intensiveness. Projects with a comprehensive approach to commissioning attained nearly twice the overall median level of savings and five-times the savings of the least-thorough projects. It is noteworthy that virtually all existing building projects were cost-effective by each metric (0.4 years for the upper quartile and 2.4 years for the lower quartile), as were the majority of new-construction projects (1.5 years and 10.8 years, respectively). We also found high cost-effectiveness for each specific measure for which we have data. Contrary to a common perception, cost-effectiveness is often achieved even in smaller buildings. Thanks to energy savings valued more than the cost of the commissioning process, associated reductions in greenhouse gas emissions come at 'negative' cost. In fact, the median cost of conserved carbon is negative - -$110 per tonne for existing buildings and -$25/tonne for new construction - as compared with market prices for carbon trading and offsets in the +$10 to +$30/tonne range. Further enhancing the value of commissioning, its non-energy benefits surpass those of most other energy-management practices. Significant first-cost savings (e.g., through right-sizing of heating and cooling equipment) routinely offset at least a portion of commissioning costs - fully in some cases. When accounting for these benefits, the net median commissioning project cost was reduced by 49% on average, while in many cases they exceeded the direct value of the energy savings. Commissioning also improves worker comfort, mitigates indoor air quality problems, increases the competence of in-house staff, plus a host of other non-energy benefits. These findings demonstrate that commissioning is arguably the single-most cost-effective strategy for reducing energy, costs, and greenhouse gas emissions in buildings today. Energy savings tend to persist well over at least a 3- to 5-year timeframe, but data over longer time horizons are not available. It is thus important to 'Trust but Verify,' and indeed the field is moving towards a monitoring-based paradigm in which instrumentation is used not only to confirm savings, but to identify opportunities that would otherwise go undetected. On balance, we view the findings here as conservative, in the sense that they underestimate the actual performance of projects when all costs and benefits are considered. They underestimate the technical potential for a scenario in which best practices are applied.« less

49 CFR 526.1 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed

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

2017-01-01

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

Hypothetical: The Case for an Australian "Group of Seven"

ERIC Educational Resources Information Center

Turner, Michael; Brown, Alistair

2013-01-01

This paper examines the hypothetical cost-savings that might ensue from a merger of most of Australia's major research universities. The results of the textual analysis show that a merger of these universities has the potential to reduce expenses and professional and support staff salaries, increase comprehensive income returns and improve…

Ready-to-use pre-filled syringes of atropine for anaesthesia care in French hospitals - a budget impact analysis.

PubMed

Benhamou, Dan; Piriou, Vincent; De Vaumas, Cyrille; Albaladejo, Pierre; Malinovsky, Jean-Marc; Doz, Marianne; Lafuma, Antoine; Bouaziz, Hervé

2017-04-01

Patient safety is improved by the use of labelled, ready-to-use, pre-filled syringes (PFS) when compared to conventional methods of syringe preparation (CMP) of the same product from an ampoule. However, the PFS presentation costs more than the CMP presentation. To estimate the budget impact for French hospitals of switching from atropine in ampoules to atropine PFS for anaesthesia care. A model was constructed to simulate the financial consequences of the use of atropine PFS in operating theatres, taking into account wastage and medication errors. The model tested different scenarios and a sensitivity analysis was performed. In a reference scenario, the systematic use of atropine PFS rather than atropine CMP yielded a net one-year budget saving of €5,255,304. Medication errors outweighed other cost factors relating to the use of atropine CMP (€9,425,448). Avoidance of wastage in the case of atropine CMP (prepared and unused) was a major source of savings (€1,167,323). Significant savings were made by means of other scenarios examined. The sensitivity analysis suggests that the results obtained are robust and stable for a range of parameter estimates and assumptions. The financial model was based on data obtained from the literature and expert opinions. The budget impact analysis shows that even though atropine PFS is more expensive than atropine CMP, its use would lead to significant cost savings. Savings would mainly be due to fewer medication errors and their associated consequences and the absence of wastage when atropine syringes are prepared in advance. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Potential savings from an evidence-based consumer-oriented public education campaign on prescription drugs.

PubMed

Donohue, Julie M; Fischer, Michael A; Huskamp, Haiden A; Weissman, Joel S

2008-10-01

To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15-65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. © Health Research and Educational Trust.

Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription Drugs

PubMed Central

Donohue, Julie M; Fischer, Michael A; Huskamp, Haiden A; Weissman, Joel S

2008-01-01

Objective To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs’ prices were 15–65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. PMID:18479406

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

PubMed

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

2013-09-01

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

Managing prices for hospital pharmaceuticals: a successful strategy for New Zealand?

PubMed

Tordoff, June M; Norris, Pauline T; Reith, David M

2005-01-01

In 2002, as part of a National Hospital Pharmaceutical Strategy, the New Zealand (NZ) government agency PHARMAC commenced a 3-year period of negotiating prices for 90% of hospital pharmaceuticals on behalf of all NZ public hospitals. The present study was undertaken to determine the effects of this first year of "pooled procurement." Using price changes and volume data for each of their top 150 pharmaceutical items, chief pharmacists at 11 public hospitals calculated projected cost savings for the financial year July 2003 to June 2004. Researchers calculated total projected savings for all 11 hospitals, and for three types of hospitals. Estimates of projected savings were made for all 29 major public hospitals by using savings per bed and savings per bed-day. A sensitivity analysis was undertaken. Items showing savings were categorized by using the Anatomical Therapeutic Chemical classification system. For the 11 hospitals, the top 150 items comprised 612 different items. Projected savings for 2003 to 2004 were NZ dollar 2,652,814, NZ dollar 658,984, and NZ dollar 127,952 for tertiary, secondary, and rural/special hospitals, respectively. Percentage savings as a median (range) of the total top 150 expenditure were: tertiary 5.28% (3.09-16.05%), secondary 7.41% (4.67-12.85%), and rural/special 9.55% (6.27-10.09%). For all 29 hospitals, estimated projected savings were NZ dollar 5,234,919 (NZ dollar 3,304,606-NZ dollar 8,044,482) by savings per bed, and NZ dollar 5,255,781 (NZ dollar 2,936,850-NZ dollar 8,693,239) by savings per bed-day. The main contributors to savings were: agents for infections, the nervous system, musculoskeletal system, and blood/blood-forming organs. The first year of pooled procurement under the National Hospital Pharmaceutical Strategy (2002-2003) has resulted in moderate savings. For all 29 major public hospitals, savings of around NZ dollar 5.2 million (dollar 2.9 million-dollar 8.7 million) or 3.7% were projected for 2003 to 2004. Longer-term effects, however, on patient outcomes and availability of pharmaceuticals, as well as on pharmaceutical expenditure, have yet to be evaluated.

Are labour-intensive efforts to prevent pressure ulcers cost-effective?

PubMed

Mathiesen, Anne Sofie Mølbak; Nørgaard, Kamilla; Andersen, Marie Frederikke Bruun; Møller, Klaus Meyer; Ehlers, Lars Holger

2013-10-01

Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13-43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement. To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care. A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty. Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was -€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)'s dominance for both prevented pressure ulcers and saved lives with the PUB. This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care. The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.

Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

PubMed

Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

2014-01-01

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.

Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure.

PubMed

Pil, Lore; Hoorens, Isabelle; Vossaert, Katrien; Kruse, Vibeke; Tromme, Isabelle; Speybroeck, Niko; Brochez, Lieve; Annemans, Lieven

2016-12-01

Skin cancer (melanoma- and non-melanoma skin cancer) is one of the most rapidly increasing cancers worldwide. This study analysed the current and future economic burden of skin cancer in Belgium and the cost-effectiveness of primary prevention of skin cancer. A retrospective bottom-up cost-of-illness study was performed, together with a Markov model in order to analyse the cost-effectiveness and the budget impact analysis of primary prevention of skin cancer in Belgium. Total prevalence of skin cancer in Belgium was estimated to triple in the next 20years. The total economic burden of skin cancer in 2014 in Belgium was estimated at €106 million, with a cumulative cost of €3 billion in 2034. The majority of this total cost was due to melanoma (65%). Over a period of 50years, both a sensitisation campaign and a total ban on sunbed use would lead to a gain in quality-adjusted life-years and cost-savings. For every euro invested in the campaign, €3.6 would be saved on the long-term for the healthcare payer. Policy makers and clinicians should promote UV protection strategies, as they were estimated to be dominant strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town.

PubMed

Smit, Ida; Zemlin, Annalise E; Erasmus, Rajiv T

2015-07-01

Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £ 25,387. The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

24 CFR 221.1 - Savings clause.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Comparison of Software Models for Energy Savings from Cool Roofs

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

New, Joshua Ryan; Miller, William A; Huang, Yu

2014-01-01

A web-based Roof Savings Calculator (RSC) has been deployed for the United States Department of Energy as an industry-consensus tool to help building owners, manufacturers, distributors, contractors and researchers easily run complex roof and attic simulations. This tool employs modern web technologies, usability design, and national average defaults as an interface to annual simulations of hour-by-hour, whole-building performance using the world-class simulation tools DOE-2.1E and AtticSim in order to provide estimated annual energy and cost savings. In addition to cool reflective roofs, RSC simulates multiple roof and attic configurations including different roof slopes, above sheathing ventilation, radiant barriers, low-emittance roofmore » surfaces, duct location, duct leakage rates, multiple substrate types, and insulation levels. A base case and energy-efficient alternative can be compared side-by-side to estimate monthly energy. RSC was benchmarked against field data from demonstration homes in Ft. Irwin, California; while cooling savings were similar, heating penalty varied significantly across different simulation engines. RSC results reduce cool roofing cost-effectiveness thus mitigating expected economic incentives for this countermeasure to the urban heat island effect. This paper consolidates comparison of RSC s projected energy savings to other simulation engines including DOE-2.1E, AtticSim, Micropas, and EnergyPlus, and presents preliminary analyses. RSC s algorithms for capturing radiant heat transfer and duct interaction in the attic assembly are considered major contributing factors to increased cooling savings and heating penalties. Comparison to previous simulation-based studies, analysis on the force multiplier of RSC cooling savings and heating penalties, the role of radiative heat exchange in an attic assembly, and changes made for increased accuracy of the duct model are included.« less

Energy Savings Lifetimes and Persistence

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

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

2016-02-01

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

Economic impact of thermostable vaccines.

PubMed

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

2017-05-25

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

Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

PubMed

Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

2013-07-01

In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

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

PubMed Central

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

1987-01-01

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

Advanced vehicles: Costs, energy use, and macroeconomic impacts

NASA Astrophysics Data System (ADS)

Wang, Guihua

Advanced vehicles and alternative fuels could play an important role in reducing oil use and changing the economy structure. We developed the Costs for Advanced Vehicles and Energy (CAVE) model to investigate a vehicle portfolio scenario in California during 2010-2030. Then we employed a computable general equilibrium model to estimate macroeconomic impacts of the advanced vehicle scenario on the economy of California. Results indicate that, due to slow fleet turnover, conventional vehicles are expected to continue to dominate the on-road fleet and gasoline is the major transportation fuel over the next two decades. However, alternative fuels could play an increasingly important role in gasoline displacement. Advanced vehicle costs are expected to decrease dramatically with production volume and technological progress; e.g., incremental costs for fuel cell vehicles and hydrogen could break even with gasoline savings in 2028. Overall, the vehicle portfolio scenario is estimated to have a slightly negative influence on California's economy, because advanced vehicles are very costly and, therefore, the resulting gasoline savings generally cannot offset the high incremental expenditure on vehicles and alternative fuels. Sensitivity analysis shows that an increase in gasoline price or a drop in alternative fuel prices could offset a portion of the negative impact.

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

PubMed

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

2011-09-01

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

Using adhesives as a means to reduce costs and increase performance in the production of photovoltaic electricity.

PubMed

Thorey, Claire

2013-01-01

Although adhesives have been used for many years to manufacture cars in more efficient ways, their potential has not yet been fully exploited by the renewable energy industry. We argue in this article that photovoltaic module manufacturers can save costs and differentiate from competition by careful selection and use of their bonding systems. Clever adhesives can enable new, more effective product designs and can play a major role in the longevity of the complete product.

Results of the Joint DoD/OFPP Competition Workshop Held 12-13 May 1981, Washington, DC.

DTIC Science & Technology

1981-05-01

major system level. a Competition status on programs - how do we tell how well we are doing? 3 e Mission vs. individual objectives - individuals may be...procuring a system and an economic analysis to calculate the actual savings of competition on a system (8). e The interaction of competition and multiyear...included: * The relationship of cost growth and competition , a net assessment. e The causes and costs of turbulence in Government contracts. * The

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

PubMed

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

2017-04-01

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

Dedicated Orthogeriatric Service Saves the HSE a Million Euro.

PubMed

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

2016-04-11

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

Cost-effectiveness of adherence-enhancing interventions: a systematic review.

PubMed

Simon-Tuval, Tzahit; Neumann, Peter J; Greenberg, Dan

2016-01-01

Low patient adherence to health-related interventions is a major barrier to achieving healthcare goals and is associated with very high avoidable costs. Although several studies suggest that adherence-enhancing interventions can improve health outcomes, economic evaluations of these interventions are scarce. Systematic reviews published to date are limited to interventions to enhance adherence to pharmaceuticals or to specific diseases and interventions. The authors' objective was to examine the evidence regarding the cost-effectiveness of adherence-enhancing interventions in healthcare and what conclusion could be drawn about these interventions. The present systematic review included 43 original studies and assessed the current evidence regarding the cost-effectiveness of a broad array of interventions aimed at enhancing adherence to medications, medical devices, screening tests and lifestyle behaviors. The authors found that although the majority of adherence-enhancing interventions were cost-effective or cost-saving, variation exists within different intervention types. Further research on the sustainability of adherence improvements is needed in order to accurately evaluate interventions' long-term benefits.

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

DTIC Science & Technology

2014-05-01

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

Water Conservation Measures

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

Ian Metzger, Jesse Dean

2010-12-31

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

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

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

Slattery, Bob S.

2017-01-01

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

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

PubMed

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

2018-05-01

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

Evaluating Thin Client Computers for Use by the Polish Army

DTIC Science & Technology

2006-06-01

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

Cooperative vehicle routing problem: an opportunity for cost saving

NASA Astrophysics Data System (ADS)

Zibaei, Sedighe; Hafezalkotob, Ashkan; Ghashami, Seyed Sajad

2016-09-01

In this paper, a novel methodology is proposed to solve a cooperative multi-depot vehicle routing problem. We establish a mathematical model for multi-owner VRP in which each owner (i.e. player) manages single or multiple depots. The basic idea consists of offering an option that owners cooperatively manage the VRP to save their costs. We present cooperative game theory techniques for cost saving allocations which are obtained from various coalitions of owners. The methodology is illustrated with a numerical example in which different coalitions of the players are evaluated along with the results of cooperation and cost saving allocation methods.

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

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

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

2012-06-15

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

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

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

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

2012-06-15

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

Rational Prescribing in Primary Care (RaPP): Economic Evaluation of an Intervention to Improve Professional Practice

PubMed Central

Fretheim, Atle; Aaserud, Morten; Oxman, Andrew D

2006-01-01

Background Interventions designed to narrow the gap between research findings and clinical practice may be effective, but also costly. Economic evaluations are necessary to judge whether such interventions are worth the effort. We have evaluated the economic effects of a tailored intervention to support the implementation of guidelines for the use of antihypertensive and cholesterol-lowering drugs. The tailored intervention was evaluated in a randomized trial, and was shown to significantly increase the use of thiazides for patients started on antihypertensive medication, but had little or no impact on other outcomes. The increased use of thiazides was not expected to have an impact on health outcomes. Methods and Findings We performed cost-minimization and cost-effectiveness analyses on data from a randomized trial involving 146 general practices from two geographical areas in Norway. Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or control group (69 practices; 244 physicians). Only patients that were being started on antihypertensive medication were included in the analyses. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computerized reminders. Pharmacists conducted the visits. A cost-minimization framework was adopted, where the costs of intervention were set against the reduced treatment costs (principally due to increased use of thiazides rather than more expensive medication). The cost-effectiveness of the intervention was estimated as the cost per additional patient being started on thiazides. The net annual cost (cost minimization) in our study population was US$53,395, corresponding to US$763 per practice. The cost per additional patient started on thiazides (cost-effectiveness) was US$454. The net annual savings in a national program was modeled to be US$761,998, or US$540 per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted, and the cost-effectiveness was estimated to be US$183. Conclusions We found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial. A major reason to promote the use of thiazides is their lower price compared to other drugs. The cost of the intervention was more than twice the savings within the time frame of our study. However, we predict modest savings over a 2-y period. PMID:16737349

Effect of environmental parameters on habitat structural weight and cost

NASA Technical Reports Server (NTRS)

Bock, E.; Lambrou, F., Jr.; Simon, M.

1979-01-01

Space-settlement conceptual designs were previously accomplished using earth-normal physiological conditions. The habitat weight and cost penalties associated with this conservative design approach are quantified. These penalties are identified by comparison of conservative earth-normal designs with habitats designed to less than earth-normal conditions. Physiological research areas are also recommended as a necessary prerequisite to realizing these potential weight and cost savings. Major habitat structural elements, that is, pressure shell and radiation shielding, for populations of 100, 10,000, and 1,000,000, are evaluated for effects of atmospheric pressure, pseudogravity level, radiation shielding thickness, and habitat configuration.

Union Carbide's PECOP cops $500,000 fuel cut

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

Crawford, E.

1979-10-29

Union Carbide's Plant Energy Cost Optimization Program (POCOP) is saving $500,000 a year at a Taft, Louisiana chemical complex. Day-to-day decisions affecting fuel costs and plant operations are based on a system of computerized data-gathering and processing. Although Carbide's system is not unique, it is more extensive and more comprehensive than the systems used by other chemical companies. The plant has decreased its energy consumption 12% below the 1972 level while increasing production by 30%. The system was initiated in response to the shift from raw materials to energy as the major production cost.

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

PubMed

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

1996-01-01

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

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

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

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

2012-07-03

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

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

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

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

2012-07-03

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

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

PubMed

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

2010-03-01

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

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

PubMed

Motheral, Brenda R

2011-01-01

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

Retrospective Assessment of Cost Savings From Prevention

PubMed Central

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

2016-01-01

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

Reducing Operating Costs and Energy Consumption at Water Utilities

EPA Pesticide Factsheets

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

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

NASA Technical Reports Server (NTRS)

Shiokari, T.

1975-01-01

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

Case Study - Propane Bakery Delivery Step Vans

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

Laughlin, M.; Burnham, A.

2016-04-01

A switch to propane from diesel by a major Midwest bakery fleet showed promising results, including a significant displacement of petroleum, a drop in greenhouse gases and a fuel cost savings of seven cents per mile, according to a study recently completed by the U.S. Department of Energy's Argonne National Laboratory for the Clean Cities program.

Municipal Bond Insurance Might Enhance Your Next School Bond.

ERIC Educational Resources Information Center

Shapiro, Eric J.

1989-01-01

School systems with a rating of "A" or lower can save money by insuring their bonds because, in almost every instance, the reduced borrowing cost more than offsets the bond insurance premium. Included is a list compiled by Donna Harrington-Lueker of the four major players in the bond insurance field and elements to consider in choosing…

The Potential Economic Benefits of Improved Postfracture Care: A Cost-Effectiveness Analysis of a Fracture Liaison Service in the US Health-Care System

PubMed Central

Solomon, Daniel H; Patrick, Amanda R; Schousboe, John; Losina, Elena

2014-01-01

Fractures related to osteoporosis are associated with $20 billion in cost in the United States, with the majority of cost born by federal health-care programs, such as Medicare and Medicaid. Despite the proven fracture reduction benefits of several osteoporosis treatments, less than one-quarter of patients older than 65 years of age who fracture receive such care. A postfracture liaison service (FLS) has been developed in many health systems but has not been widely implemented in the United States. We developed a Markov state-transition computer simulation model to assess the cost-effectiveness of an FLS using a health-care system perspective. Using the model, we projected the lifetime costs and benefits of FLS, with or without a bone mineral density test, in men and women who had experienced a hip fracture. We estimated the costs and benefits of an FLS, the probabilities of refracture while on osteoporosis treatment, as well as the utilities associated with various health states from published literature. We used multi-way sensitivity analyses to examine impact of uncertainty in input parameters on cost-effectiveness of FLS. The model estimates that an FLS would result in 153 fewer fractures (109 hip, 5 wrist, 21 spine, 17 other), 37.43 more quality-adjusted life years (QALYs), and save $66,879 compared with typical postfracture care per every 10,000 postfracture patients. Doubling the cost of the FLS resulted in an incremental cost-effectiveness ratio (ICER) of $22,993 per QALY. The sensitivity analyses showed that results were robust to plausible ranges of input parameters; assuming the least favorable values of each of the major input parameters results in an ICER of $112,877 per QALY. An FLS targeting patients post-hip fracture should result in cost savings and reduced fractures under most scenarios. PMID:24443384

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

PubMed

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

2017-10-01

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

Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission

PubMed Central

Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

2015-01-01

Introduction Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. Methods We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. Results An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. Conclusions A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country. PMID:26406889

Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities.

PubMed

Wang, Ting-Ting; Li, Jin-Mei; Zhu, Cai-Rong; Hong, Zhen; An, Dong-Mei; Yang, Hong-Yu; Ren, Jie-Chuan; Zou, Xue-Mei; Huang, Cheng; Chi, Xiao-Sa; Chen, Jia-Ni; Hong, Zhen; Wang, Wen-Zhi; Xu, Cai-Gang; He, Li; Li, Wei-Min; Zhou, Dong

2016-11-01

The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China. In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis. Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals). The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.

Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

PubMed

Cecchini, Michele; Sassi, Franco

2015-07-01

With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

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

PubMed

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

2017-01-01

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

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

PubMed Central

Birke, Andrea; Williams, Trevor; Aluja, Martín

2017-01-01

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

The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.

PubMed

Vonlanthen, René; Slankamenac, Ksenija; Breitenstein, Stefan; Puhan, Milo A; Muller, Markus K; Hahnloser, Dieter; Hauri, Dimitri; Graf, Rolf; Clavien, Pierre-Alain

2011-12-01

To assess the impact of postoperative complications on full in-hospital costs per case. Rising expenses for complex medical procedures combined with constrained resources represent a major challenge. The severity of postoperative complications reflects surgical outcomes. The magnitude of the cost created by negative outcomes is unclear. Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary, high-volume center was assessed by a validated, complication score system. Full in-hospital costs were collected for each patient. Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders. This study population included 393 complex liver/bile duct surgeries, 110 major pancreas operations, 389 colon resections, and 308 Roux-en-Y gastric bypasses. The overall 30-day mortality rate was 1.8%, whereas morbidity was 53.8%. Patients with an uneventful course had mean costs per case of US$ 27,946 (SD US$ 15,106). Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 (SD US$ 151,191) for grade IV complications. This increase in costs, up to 5 times the cost of a similar operation without complications, was observed for all types of investigated procedures, although the magnitude of the increase varied, with the highest costs in patients undergoing pancreas surgery. This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs. Furthermore, the study highlights a relevant savings capacity for major surgical procedures, and supports all efforts to lower negative events in the postoperative course.

Time-varying value of electric energy efficiency

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

Mims, Natalie A.; Eckman, Tom; Goldman, Charles

Electric energy efficiency resources save energy and may reduce peak demand. Historically, quantification of energy efficiency benefits has largely focused on the economic value of energy savings during the first year and lifetime of the installed measures. Due in part to the lack of publicly available research on end-use load shapes (i.e., the hourly or seasonal timing of electricity savings) and energy savings shapes, consideration of the impact of energy efficiency on peak demand reduction (i.e., capacity savings) has been more limited. End-use load research and the hourly valuation of efficiency savings are used for a variety of electricity planningmore » functions, including load forecasting, demand-side management and evaluation, capacity and demand response planning, long-term resource planning, renewable energy integration, assessing potential grid modernization investments, establishing rates and pricing, and customer service. This study reviews existing literature on the time-varying value of energy efficiency savings, provides examples in four geographically diverse locations of how consideration of the time-varying value of efficiency savings impacts the calculation of power system benefits, and identifies future research needs to enhance the consideration of the time-varying value of energy efficiency in cost-effectiveness screening analysis. Findings from this study include: -The time-varying value of individual energy efficiency measures varies across the locations studied because of the physical and operational characteristics of the individual utility system (e.g., summer or winter peaking, load factor, reserve margin) as well as the time periods during which savings from measures occur. -Across the four locations studied, some of the largest capacity benefits from energy efficiency are derived from the deferral of transmission and distribution system infrastructure upgrades. However, the deferred cost of such upgrades also exhibited the greatest range in value of all the components of avoided costs across the locations studied. -Of the five energy efficiency measures studied, those targeting residential air conditioning in summer-peaking electric systems have the most significant added value when the total time-varying value is considered. -The increased use of rooftop solar systems, storage, and demand response, and the addition of electric vehicles and other major new electricity-consuming end uses are anticipated to significantly alter the load shape of many utility systems in the future. Data used to estimate the impact of energy efficiency measures on electric system peak demands will need to be updated periodically to accurately reflect the value of savings as system load shapes change. -Publicly available components of electric system costs avoided through energy efficiency are not uniform across states and utilities. Inclusion or exclusion of these components and differences in their value affect estimates of the time-varying value of energy efficiency. -Publicly available data on end-use load and energy savings shapes are limited, are concentrated regionally, and should be expanded.« less

A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: investigating practice gaps and potential cost-savings.

PubMed

Lee, Young H; Liu, Guodong; Thiboutot, Diane M; Leslie, Douglas L; Kirby, Joslyn S

2014-07-01

Duration of oral antibiotic therapy in acne has not been widely studied. Recent guidelines suggest it should be limited to 3 to 6 months. We sought to compare the duration of oral antibiotic use with recent guidelines and determine the potential cost-savings related to shortened durations. This is a retrospective cohort study from the MarketScan Commercial Claims and Encounters database. Claims data were used to determine duration and costs of antibiotic therapy. The mean course duration was 129 days. The majority (93%) of courses were less than 9 months. Among the 31,634 courses, 18,280 (57.8%) did not include concomitant topical retinoid therapy. The mean (95% confidence interval) duration with and without topical retinoid use was 133 (131.5-134.7) days and 127 (125.4-127.9) days, respectively. The mean excess direct cost of antibiotic treatment for longer than 6 months was $580.99/person. Claims cannot be attributed to a specific diagnosis or provider. The database does not provide information on acne severity. Duration of antibiotic use is decreasing when compared with previous data. However, 5547 (17.53%) courses exceeded 6 months, highlighting an opportunity for reduced antibiotic use. If courses greater than 6 months were shortened to 6 months, savings would be $580.99/person. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

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

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

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

2012-06-15

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

Minimum savings requirements in shared savings provider payment.

PubMed

Pope, Gregory C; Kautter, John

2012-11-01

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

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

ERIC Educational Resources Information Center

Claffey, George F., Jr.

2009-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2017-02-01

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

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

PubMed

McKay, Niccie L

2006-01-01

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

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

PubMed

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

2010-06-01

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

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

PubMed

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

2016-05-01

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

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

PubMed

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

2015-04-14

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

Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany.

PubMed

Schädlich, Peter K; Kentsch, Michael; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, Eduard

2006-01-01

To estimate, from the hospital perspective in Germany, the cost effectiveness of the low-molecular-weight heparin (LMWH) subcutaneous enoxaparin sodium 40 mg once daily (ENOX) relative to no pharmacological prophylaxis (NPP) and relative to subcutaneous unfractionated heparin (UFH) 5,000 IU three times daily (low-dose UFH [LDUFH]). Each is used in addition to elastic bandages/compression stockings and physiotherapy in the prevention of venous thromboembolic events (VTE) in immobilised acutely ill medical inpatients without impaired renal function or extremes of body weight. The incremental cost-effectiveness ratios (ICERs) of the 'additional cost for ENOX per clinical VTE avoided versus NPP' and 'additional cost for ENOX per episode of major bleeding avoided versus LDUFH' were chosen as target variables. The target variables were quantified using a modelling approach based on the decision-tree technique. Resource use during thromboprophylaxis, diagnosis and treatment of VTEs, episode of major bleeding and secondary pneumonia after pulmonary embolism (PE) was collected from a hospital survey. Costs were exclusively those to hospitals incurred by staff expenses, drugs, devices, disposables, laboratory tests and equipment for diagnostic procedures. These costs were determined by multiplying utilised resource items by the price or tariff of each item as of the first quarter of 2003. Safety and efficacy values of the comparators were taken from the MEDENOX (prophylaxis in MEDical patients with ENOXaparin) and the THE-PRINCE (THromboEmbolism-PRevention IN Cardiac or respiratory disease with Enoxaparin) trials and from a meta-analysis. The evaluation encompassed 8 (6-14) days of thromboprophylaxis plus time to treat VTE and episode of major bleeding in hospital. Point estimates of all model parameters were applied exclusively in the base-case analysis. There were incremental costs of euro 1,106 for ENOX per clinical VTE avoided versus NPP (1 euro approximately equals 1.07 US dollars; average of the first quarter of 2003). ENOX dominated LDUFH: cost savings of euro 55,825 were obtained and 7.7 episodes of major bleeding were avoided by ENOX compared with LDUFH, each per 1000 patients. In comprehensive sensitivity analyses, the robustness of the model and its results was shown. Results of this evaluation suggest that, in immobilised acutely ill medical inpatients, ENOX may offer hospitals in Germany a very cost-effective option for thromboprophylaxis compared with NPP and a cost-saving alternative compared with LDUFH.

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

PubMed

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

2017-06-01

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

Composite Material Application to Liquid Rocket Engines

NASA Technical Reports Server (NTRS)

Judd, D. C.

1982-01-01

The substitution of reinforced plastic composite (RPC) materials for metal was studied. The major objectives were to: (1) determine the extent to which composite materials can be beneficially used in liquid rocket engines; (2) identify additional technology requirements; and (3) determine those areas which have the greatest potential for return. Weight savings, fabrication costs, performance, life, and maintainability factors were considered. Two baseline designs, representative of Earth to orbit and orbit to orbit engine systems, were selected. Weight savings are found to be possible for selected components with the substitution of materials for metal. Various technology needs are identified before RPC material can be used in rocket engine applications.

Preliminary engineering analysis for clothes washers

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

Biermayer, Peter J.

1996-10-01

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

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

PubMed

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

2018-01-01

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

Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination.

PubMed

Garrison, Louis P; Bauch, Chris T; Bresnahan, Brian W; Hazlet, Tom K; Kadiyala, Srikanth; Veenstra, David L

2011-07-01

Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2013 CFR

2013-01-01

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

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2014 CFR

2014-01-01

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

10 CFR 435.8 - Life-cycle costing.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

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

PubMed

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

2011-01-01

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

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

PubMed

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

1994-08-01

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

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

PubMed

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

2018-03-01

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

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

PubMed

Shanahan, Christopher J; de Lorimier, Robert

2016-01-01

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

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

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

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

2012-04-01

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

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

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

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

2012-04-01

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

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

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

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

2012-04-01

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

Innovations in cost management.

PubMed

Daly, Rich

2014-03-01

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

Economic Evaluation of Telemedicine for Patients in ICUs.

PubMed

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

2016-02-01

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

Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada.

PubMed

Joffres, Michel R; Campbell, Norm R C; Manns, Braden; Tu, Karen

2007-05-01

Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.

Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada

PubMed Central

Joffres, Michel R; Campbell, Norm RC; Manns, Braden; Tu, Karen

2007-01-01

BACKGROUND: Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. OBJECTIVES: To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. METHODS: Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. RESULTS: Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. CONCLUSIONS: Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada. PMID:17487286

Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands.

PubMed

Stevanović, J; de Jong, L A; Kappelhoff, B S; Dvortsin, E P; Voorhaar, M; Postma, M J

2016-01-01

Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RE-SONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving €1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at €2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at €33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands.

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

PubMed Central

Peck, Richard M.; Babb, Stephen D.

2014-01-01

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

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

PubMed

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

2014-10-02

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

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

PubMed

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

2011-10-01

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

The High Cost of Saving Energy Dollars.

ERIC Educational Resources Information Center

Rose, Patricia

1985-01-01

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

Do hospital mergers reduce costs?

PubMed

Schmitt, Matt

2017-03-01

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

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

PubMed Central

Towey, Michael P.

2012-01-01

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

An Economic History of Medicare Part C

PubMed Central

Mcguire, Thomas G; Newhouse, Joseph P; Sinaiko, Anna D

2011-01-01

Context: Twenty-five years ago, private insurance plans were introduced into the Medicare program with the stated dual aims of (1) giving beneficiaries a choice of health insurance plans beyond the fee-for-service Medicare program and (2) transferring to the Medicare program the efficiencies and cost savings achieved by managed care in the private sector. Methods: In this article we review the economic history of Medicare Part C, known today as Medicare Advantage, focusing on the impact of major changes in the program's structure and of plan payment methods on trends in the availability of private plans, plan enrollment, and Medicare spending. Additionally, we compare the experience of Medicare Advantage and of employer-sponsored health insurance with managed care over the same time period. Findings: Beneficiaries' access to private plans has been inconsistent over the program's history, with higher plan payments resulting in greater choice and enrollment and vice versa. But Medicare Advantage generally has cost more than the traditional Medicare program, an overpayment that has increased in recent years. Conclusions: Major changes in Medicare Advantage's payment rules are needed in order to simultaneously encourage the participation of private plans, the provision of high-quality care, and to save Medicare money. PMID:21676024

Cost-Effectiveness of Haemophilus inuenzae Type b Conjugate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assessment of Major Determinants

PubMed Central

Griffiths, Ulla Kou; Clark, Andrew; Hajjeh, Rana

2017-01-01

Objectives To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low-and middle-income countries and identify the model variables, which are most important for the result. Study design A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. Results From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%–53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. Conclusions Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae. PMID:23773595

Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants.

PubMed

Griffiths, Ulla Kou; Clark, Andrew; Hajjeh, Rana

2013-07-01

To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low- and middle-income countries and identify the model variables, which are most important for the result. A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%-53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae. Copyright © 2013. Published by Mosby, Inc.

David Grant Medical Center energy use baseline and integrated resource assessment

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

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

1993-04-01

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

David Grant Medical Center energy use baseline and integrated resource assessment

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

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

1993-04-01

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

Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure

PubMed Central

Kottmair, Stefan; Frye, Christian; Ziegenhagen, Dieter J.

2005-01-01

Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health care costs. A comprehensive disease management program for CHF was developed for private and statutory health insurance companies in order to improve health outcomes and reduce rehospitalization rates and costs. The program comprises care calls, written training material, telemetric monitoring, and health reports. Currently, 909 members from six insurance companies are enrolled. Routine evaluation, based on medical data warehouse software, demonstrates benefits in terms of improved health outcomes and processes of care. Economical evaluation of claims data indicates significant cost savings in a pre/post study design. PMID:17288080

New Opportunities for the Management and Therapy of Hepatitis C in Correctional Settings

PubMed Central

Hostetter, Jeffrey E.; Hagan, John J.

2010-01-01

Hepatitis C in prison populations is now a major public health problem, and large numbers of correctional facilities have no comprehensive management program, often because of formidable projected costs and tightening budget constraints. The North Dakota Department of Corrections and Rehabilitation has operated a management and therapy program since 2002 using consensus interferon and ribavirin with 45% cost savings. The program has provided excellent sustained viral responses: 54.2% for genotype 1 hepatitis C, 75% for genotypes 2 and 3, and 63.6% overall. PMID:20007626

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

PubMed Central

Kibicho, Jennifer; Pinkerton, Steven D.

2014-01-01

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

Self-monitoring induced savings on type 2 diabetes patients' travel and healthcare costs.

PubMed

Leminen, Aapeli; Tykkyläinen, Markku; Laatikainen, Tiina

2018-07-01

Type 2 diabetes (T2DM) is a major health concern in most regions. In addition to direct healthcare costs, diabetes causes many indirect costs that are often ignored in economic analyses. Patients' travel and time costs associated with the follow-up of T2DM patients have not been previously calculated systematically over an entire healthcare district. The aim of the study was to develop a georeferenced cost model that could be used to measure healthcare accessibility and patient travel and time costs in a sparsely populated healthcare district in Finland. Additionally, the model was used to test whether savings in the total costs of follow-up of T2DM patients are achieved by increasing self-monitoring and implementing electronic feedback practices between healthcare staff and patients. Patient data for this study was obtained from the regional electronic patient database Mediatri. A georeferenced cost model of linear equations was developed with ESRI ArcGIS 10.3 software and ModelBuilder tool. The Model utilizes OD Cost Matrix method of network analysis to calculate optimal routes for primary-care follow-up visits. In the study region of North Karelia, the average annual total costs of T2DM follow-up screening of HbA1c (9070 patients) conforming to the national clinical guidelines are 280 EUR/297 USD per patient. Combined travel and time costs are 21 percent of the total costs. Implementing self-monitoring for a half of the follow-up still within the guidelines, the average annual total costs of HbA1c screening could be reduced by 57 percent from 280 EUR/297 USD to 121 EUR/129 USD per patient. Travel costs related to HbA1c screening of T2DM patients constitute a substantial cost item, the consideration of which in healthcare planning would enable the societal cost-efficiency of T2DM care to be improved. Even more savings in both travel costs and healthcare costs of T2DM can be achieved by utilizing more self-monitoring and electronic feedback practices. Additionally, the cost model composed in the study can be developed and expanded further to address other healthcare processes and patient groups. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

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

PubMed

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

2018-01-02

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

Saving Energy. Managing School Facilities, Guide 3.

ERIC Educational Resources Information Center

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

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

Changing of the Bulbs.

ERIC Educational Resources Information Center

Baba, Keith

1995-01-01

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

The economic benefits of reducing physical inactivity: an Australian example

PubMed Central

2011-01-01

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

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

PubMed

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

2011-09-24

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

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

PubMed Central

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

2009-01-01

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

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

PubMed

Lopes, G de L

2013-09-01

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

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

PubMed

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

2014-06-01

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

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

PubMed

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

2013-08-01

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

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

PubMed

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

2013-03-01

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

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

PubMed

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

2017-04-01

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

User's manual for the BNW-I optimization code for dry-cooled power plants. Volume I

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

Braun, D.J.; Daniel, D.J.; De Mier, W.V.

1977-01-01

This User's Manual provides information on the use and operation of three versions of BNW-I, a computer code developed by Battelle, Pacific Northwest Laboratory (PNL) as a part of its activities under the ERDA Dry Cooling Tower Program. These three versions of BNW-I were used as reported elsewhere to obtain comparative incremental costs of electrical power production by two advanced concepts (one using plastic heat exchangers and one using ammonia as an intermediate heat transfer fluid) and a state-of-the-art system. The computer program offers a comprehensive method of evaluating the cost savings potential of dry-cooled heat rejection systems and componentsmore » for power plants. This method goes beyond simple ''figure-of-merit'' optimization of the cooling tower and includes such items as the cost of replacement capacity needed on an annual basis and the optimum split between plant scale-up and replacement capacity, as well as the purchase and operating costs of all major heat rejection components. Hence, the BNW-I code is a useful tool for determining potential cost savings of new heat transfer surfaces, new piping or other components as part of an optimized system for a dry-cooled power plant.« less

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

Im, Piljae; Liu, Xiaobing

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

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

PubMed

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

2003-02-10

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

Thrombosis prevention in lower extremity arthroplasty: mobile compression device or pharmacological therapy.

PubMed

Colwell, Clifford W

2014-11-01

Venous thromboembolic (VTE) events, either deep vein thromboses (DVT) or pulmonary emboli (PE), are important complications in patients undergoing knee or hip arthroplasty. Symptomatic VTE rates observed in total joint arthroplasty patients using the mobile compression device with home use capability were non-inferior to rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran. Major bleeding in total hip arthroplasty was less using the mobile compression device than using low molecular weight heparin. A cost analysis demonstrated a cost savings based on decreased major bleeding. Use of a mobile compression device with or without aspirin for patients undergoing total joint arthroplasty provides a non-inferior risk for developing VTE compared with current pharmacological protocols.

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

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

Im, Piljae; Liu, Xiaobing

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

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

ERIC Educational Resources Information Center

Scigliano, Marisa

2002-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2015-12-01

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

Cost-effectiveness analysis of mammography and clinical breast examination strategies

PubMed Central

Ahern, Charlotte Hsieh; Shen, Yu

2009-01-01

Purpose Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. Methods We used a microsimulation model to generate women’s life histories, and assessed screening and treatment impacts on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALYs) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were performed by varying some of the assumptions. Results Compared to guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 was a cost-effective alternative compared to the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared to the above alternative. Conclusion Screening strategies with lower costs and benefits comparable to those currently recommended should be considered for implementation in practice and for future guidelines. PMID:19258473

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

PubMed

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

2008-06-01

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

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

PubMed

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

2016-07-01

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

Estimation of cost savings between 2011 and 2014 attributed to infliximab biosimilar in the South Korean healthcare market: real-world evidence using a nationwide database.

PubMed

Kim, Jiyoun; Ha, Dongmun; Song, Inmyung; Park, Haesun; Lee, Sang-Won; Lee, Eui-Kyung; Shin, Ju-Young

2018-06-01

The introduction of biosimilars is expected to reduce the cost of biologic drugs, but the actual cost savings have not yet been quantified in Korea. The aim of this study was to estimate the annual cost savings attributed to the introduction of infliximab biosimilar. We conducted a retrospective analysis using data from the Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) between 2011 and 2014. The study subjects were patients who were treated with infliximab, adalimumab or etanercept. We compared the drug costs before and after the introduction of infliximab biosimilar in December 2012 (2011-2012 and 2013-2014) to estimate the annual drug cost savings attributed to this and the number of patients who could additionally benefit from the biosimilar in 2013 and 2014. A total of 10 986 prescriptions were identified: 2620 for infliximab. The cost savings were estimated at $262 270 for 133 patients in 2013 and $395 220 for 174 patients in 2014. Among the patients who underwent a 1-year maintenance course of infliximab therapy, the annual expenditure on infliximab was lower in 2014 than in 2011. If the cost savings were used to treat additional patients, 13.3%-38.6% more patients per year could be treated by indication. The introduction of infliximab biosimilar reduced direct medical costs for both patients and the payer, which could then be used to increase patient access to biologic medicines. The entry of infliximab biosimilar could result in further reductions in healthcare costs. © 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

[Measures to reduce lighting-related energy use and costs at hospital nursing stations].

PubMed

Su, Chiu-Ching; Chen, Chen-Hui; Chen, Shu-Hwa; Ping, Tsui-Chu

2011-06-01

Hospitals have long been expected to deliver medical services in an environment that is comfortable and bright. This expectation keeps hospital energy demand stubbornly high and energy costs spiraling due to escalating utility fees. Hospitals must identify appropriate strategies to control electricity usage in order to control operating costs effectively. This paper proposes several electricity saving measures that both support government policies aimed at reducing global warming and help reduce energy consumption at the authors' hospital. The authors held educational seminars, established a website teaching energy saving methods, maximized facility and equipment use effectiveness (e.g., adjusting lamp placements, power switch and computer saving modes), posted signs promoting electricity saving, and established a regularized energy saving review mechanism. After implementation, average nursing staff energy saving knowledge had risen from 71.8% to 100% and total nursing station electricity costs fell from NT$16,456 to NT$10,208 per month, representing an effective monthly savings of 37.9% (NT$6,248). This project demonstrated the ability of a program designed to slightly modify nursing staff behavior to achieve effective and meaningful results in reducing overall electricity use.

The relationships between OHS prevention costs, safety performance, employee satisfaction and accident costs.

PubMed

Bayram, Metin; Ünğan, Mustafa C; Ardıç, Kadir

2017-06-01

Little is known about the costs of safety. A literature review conducted for this study indicates there is a lack of survey-based research dealing with the effects of occupational health and safety (OHS) prevention costs. To close this gap in the literature, this study investigates the interwoven relationships between OHS prevention costs, employee satisfaction, OHS performance and accident costs. Data were collected from 159 OHS management system 18001-certified firms operating in Turkey and analyzed through structural equation modeling. The findings indicate that OHS prevention costs have a significant positive effect on safety performance, employee satisfaction and accident costs savings; employee satisfaction has a significant positive effect on accident costs savings; and occupational safety performance has a significant positive effect on employee satisfaction and accident costs savings. Also, the results indicate that safety performance and employee satisfaction leverage the relationship between prevention costs and accident costs.

Cost-effectiveness analysis of the use of high-flow oxygen through nasal cannula in intensive care units in NHS England.

PubMed

Eaton Turner, Emily; Jenks, Michelle

2018-06-01

To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective. Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted. When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this. For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.

Cost effectiveness of recycling: A systems model

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

Tonjes, David J., E-mail: david.tonjes@stonybrook.edu; Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000; Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044

Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have alsomore » found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.« less

Hepatitis C Cure Is Associated with Decreased Healthcare Costs in Cirrhotics in Retrospective Veterans Affairs Cohort.

PubMed

Maier, Marissa M; Zhou, Xiao-Hua; Chapko, Michael; Leipertz, Steven L; Wang, Xuan; Beste, Lauren A

2018-06-01

Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined. To measure downstream healthcare costs in a national population of HCV-infected patients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences. This is a retrospective cohort study (2004-2014) of hepatitis C-infected patients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment. For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosis patients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient. Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.

Lower HVAC Costs | Efficient Windows Collaborative

Science.gov Websites

system. Smaller HVAC systems cost less and as such can offset some of the cost of the efficient windows dehumidification. First cost savings - Smaller HVAC units cost less. If, for example, down-sizing the HVAC system by half a ton saves $275, the cost premium of energy-efficient windows does not present as big an up

Invisible costs, visible savings.

PubMed

Lefever, G

1999-08-01

By identifying hidden inventory costs, nurse managers can save money for the organization. Some measures include tracking and standardizing supplies, accurately evaluating patients' needs, and making informed purchasing decisions.

Reflector Technology Development and System Design for Concentrating Solar Power Technologies

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

Adam Schaut

2011-12-30

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

Guide to resource conservation and cost savings opportunities in the soap, detergents and related products sector

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

NONE

1998-10-01

This guide was prepared to help those involved in the manufacturing of soap, detergent, and related products to identify potential process improvements that will reduce production costs and conserve resources. The guide offers a series of generic process descriptions and checklists of improvement opportunities specific to each of five major processes used in the industry: Soap production, surfactant production, solid cake product formulation, liquid product formulation, and granulated powdered product formulation. The checklists identify thermal, electrical, environmental, water use, and low- or no-cost measures that can be implemented, as well as retrofit technology options. A variety of new technologies thatmore » may exhibit future potential are also described. Appendices include a glossary, background information on the Ontario soap/detergent industry, and description of the four major categories of ingredients used in the industry.« less

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

PubMed

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

1993-01-01

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

Cost Avoidance vs. Utility Bill Accounting - Explaining theDiscrepancy Between Guaranteed Savings in ESPC Projects and UtilityBills

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

Kumar, S.; Sartor, D.

2005-08-15

Federal agencies often ask if Energy Savings PerformanceContracts (ESPCs) result in the energy and cost savings projected duringthe project development phase. After investing in ESPCs, federal agenciesexpect a reduction in the total energy use and energy cost at the agencylevel. Such questions about the program are common when implementing anESPC project. But is this a fair or accurate perception? Moreimportantly, should the federal agencies evaluate the success or failureof ESPCs by comparing the utility costs before and after projectimplementation?In fact, ESPC contracts employ measurement andverification (M&V) protocols to measure and ensure kilowatt-hour orBTU savings at the project level. In mostmore » cases, the translation toenergy cost savings is not based on actual utility rate structure, but acontracted utility rate that takes the existing utility rate at the timethe contract is signed with a clause to escalate the utility rate by afixed percentage for the duration of the contract. Reporting mechanisms,which advertise these savings in dollars, may imply an impact to budgetsat a much higher level depending on actual utility rate structure. FEMPhas prepared the following analysis to explain why the utility billreduction may not materialize, demonstrate its larger implication onagency s energy reduction goals, and advocate setting the rightexpectations at the outset to preempt the often asked question why I amnot seeing the savings in my utility bill?« less

Glider kits cut truck ownership costs

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

Smiley, C.H.

1983-06-01

A glider kit consists of a new truck without the power train, with the customer supplying the engine, transmission, clutch, driveline and rear axles for mounting in a new frame and cab complete with steering axle, wiring harnesses, exhaust system and cooling system. Glider kits have long been regarded as a cost effective means of replacing accident or fire damaged late model vehicles. The financial advantages, assembly and remanufacturing are discussed. Points out that at a basic cost about one third of a new truck, a glider kit offers lower cost of borrowed capital, tax savings, and elimination of highmore » maintenance and downtime costs. The paper concludes that use of glider kits as an alternative to major repair or reconditioning or outright replacement of coal haulers presents some interesting options.« less

Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial

PubMed Central

Lattimer, Val; Sassi, Franco; George, Steve; Moore, Michael; Turnbull, Joanne; Mullee, Mark; Smith, Helen

2000-01-01

Objective To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. Design Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. Setting General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. Subjects All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). Main outcome measures Costs and savings to the NHS during the trial year. Results The cost of providing nurse telephone consultation was £81 237 per annum. This, however, determined a £94 422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to £123 824 per annum. Savings of only £3728 would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of £16 928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call. Conclusions Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis. PMID:10764368

32 CFR Appendix to Part 162 - Reporting Procedures

Code of Federal Regulations, 2014 CFR

2014-07-01

... generated. e. Projected Life-Cycle Savings. For each PIF project provide the estimated amount of savings the project is projected to earn over the project's economic life. f. Projected Life-Cycle Cost Avoidance. For... Projected Life-Cycle Savings. e. Total Projected Life-Cycle Cost Avoidance. 3. CSI. Each DoD Component that...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

10 CFR 433.8 - Life-cycle costing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Life-cycle costing. 433.8 Section 433.8 Energy DEPARTMENT... HIGH-RISE RESIDENTIAL BUILDINGS § 433.8 Life-cycle costing. Each Federal agency shall determine life... choose to use any of four methods, including lower life-cycle costs, positive net savings, savings-to...

Cost-Savings Analysis of the Better Beginnings, Better Futures Community-Based Project for Young Children and Their Families: A 10-Year Follow-up.

PubMed

Peters, Ray DeV; Petrunka, Kelly; Khan, Shahriar; Howell-Moneta, Angela; Nelson, Geoffrey; Pancer, S Mark; Loomis, Colleen

2016-02-01

This study examined the long-term cost-savings of the Better Beginnings, Better Futures (BBBF) initiative, a community-based early intervention project for young children living in socioeconomically disadvantaged neighborhoods during their transition to primary school. A quasi-experimental, longitudinal two-group design was used to compare costs and outcomes for children and families in three BBBF project neighborhoods (n = 401) and two comparison neighborhoods (n = 225). A cost-savings analysis was conducted using all project costs for providing up to 4 years of BBBF programs when children were in junior kindergarten (JK) (4 years old) to grade 2 (8 years old). Data on 19 government service cost measures were collected from the longitudinal research sample from the time the youth were in JK through to grade 12 (18 years old), 10 years after ending project participation. The average family incremental net savings to government of providing the BBBF project was $6331 in 2014 Canadian dollars. When the BBBF monetary return to government as a ratio of savings to costs was calculated, for every dollar invested by the government, a return of $2.50 per family was saved. Findings from this study have important implications for government investments in early interventions focused on a successful transition to primary school as well as parenting programs and community development initiatives in support of children's development.

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

PubMed Central

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

2018-01-01

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million–$1.6 billion for CVD and AUD$18.2 million–$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia. PMID:29301298

Energy saving effects of wireless sensor networks: a case study of convenience stores in Taiwan.

PubMed

Chen, Chih-Sheng; Lee, Da-Sheng

2011-01-01

Wireless sensor network (WSN) technology has been successfully applied to energy saving applications in many places, and plays a significant role in achieving power conservation. However, previous studies do not discuss WSN costs and cost-recovery. The application of WSNs is currently limited to research and laboratory experiments, and not mass industrial production, largely because business owners are unfamiliar with the possible favorable return and cost-recovery on WSN investments. Therefore, this paper focuses on the cost-recovery of WSNs and how to reduce air conditioning energy consumption in convenience stores. The WSN used in this study provides feedback to the gateway and adopts the predicted mean vote (PMV) and computational fluid dynamics (CFD) methods to allow customers to shop in a comfortable yet energy-saving environment. Four convenience stores in Taipei have used the proposed WSN since 2008. In 2008, the experiment was initially designed to optimize air-conditioning for energy saving, but additions to the set-up continued beyond 2008, adding the thermal comfort and crowds peak, off-peak features in 2009 to achieve human-friendly energy savings. Comparison with 2007 data, under the same comfort conditions, shows that the power savings increased by 40% (2008) and 53% (2009), respectively. The cost of the WSN equipment was 500 US dollars. Experimental results, including three years of analysis and calculations, show that the marginal energy conservation benefit of the four convenience stores achieved energy savings of up to 53%, recovering all costs in approximately 5 months. The convenience store group participating in this study was satisfied with the efficiency of energy conservation because of the short cost-recovery period.

Energy Saving Effects of Wireless Sensor Networks: A Case Study of Convenience Stores in Taiwan

PubMed Central

Chen, Chih-Sheng; Lee, Da-Sheng

2011-01-01

Wireless sensor network (WSN) technology has been successfully applied to energy saving applications in many places, and plays a significant role in achieving power conservation. However, previous studies do not discuss WSN costs and cost-recovery. The application of WSNs is currently limited to research and laboratory experiments, and not mass industrial production, largely because business owners are unfamiliar with the possible favorable return and cost-recovery on WSN investments. Therefore, this paper focuses on the cost-recovery of WSNs and how to reduce air conditioning energy consumption in convenience stores. The WSN used in this study provides feedback to the gateway and adopts the predicted mean vote (PMV) and computational fluid dynamics (CFD) methods to allow customers to shop in a comfortable yet energy-saving environment. Four convenience stores in Taipei have used the proposed WSN since 2008. In 2008, the experiment was initially designed to optimize air-conditioning for energy saving, but additions to the set-up continued beyond 2008, adding the thermal comfort and crowds peak, off-peak features in 2009 to achieve human-friendly energy savings. Comparison with 2007 data, under the same comfort conditions, shows that the power savings increased by 40% (2008) and 53% (2009), respectively. The cost of the WSN equipment was 500 US dollars. Experimental results, including three years of analysis and calculations, show that the marginal energy conservation benefit of the four convenience stores achieved energy savings of up to 53%, recovering all costs in approximately 5 months. The convenience store group participating in this study was satisfied with the efficiency of energy conservation because of the short cost-recovery period. PMID:22319396

Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

PubMed

Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

2013-01-01

Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

Semuloparin for prevention of venous thromboembolism after major orthopedic surgery: results from three randomized clinical trials, SAVE-HIP1, SAVE-HIP2 and SAVE-KNEE.

PubMed

Lassen, M R; Fisher, W; Mouret, P; Agnelli, G; George, D; Kakkar, A; Mismetti, P; Turpie, A G G

2012-05-01

Semuloparin is a novel ultra-low-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10 days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles. © 2012 International Society on Thrombosis and Haemostasis.

Financial Impact of Cancer Drug Wastage and Potential Cost Savings From Mitigation Strategies.

PubMed

Leung, Caitlyn Y W; Cheung, Matthew C; Charbonneau, Lauren F; Prica, Anca; Ng, Pamela; Chan, Kelvin K W

2017-07-01

Cancer drug wastage occurs when a parenteral drug within a fixed vial is not administered fully to a patient. This study investigated the extent of drug wastage, the financial impact on the hospital budget, and the cost savings associated with current mitigation strategies. We conducted a cross-sectional study in three University of Toronto-affiliated hospitals of various sizes. We recorded the actual amount of drug wasted over a 2-week period while using current mitigation strategies. Single-dose vial cancer drugs with the highest wastage potentials were identified (14 drugs). To calculate the hypothetical drug wastage with no mitigation strategies, we determined how many vials of drugs would be needed to fill a single prescription. The total drug costs over the 2 weeks ranged from $50,257 to $716,983 in the three institutions. With existing mitigation strategies, the actual drug wastage over the 2 weeks ranged from $928 to $5,472, which was approximately 1% to 2% of the total drug costs. In the hypothetical model with no mitigation strategies implemented, the projected drug cost wastage would have been $11,232 to $149,131, which accounted for 16% to 18% of the total drug costs. As a result, the potential annual savings while using current mitigation strategies range from 15% to 17%. The financial impact of drug wastage is substantial. Mitigation strategies lead to substantial cost savings, with the opportunity to reinvest those savings. More research is needed to determine the appropriate methods to minimize risk to patients while using the cost-saving mitigation strategies.

Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction.

PubMed

Rwagitinywa, Joseph; Sommet, Agnès; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

2018-03-01

Simulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life. ARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings. Between 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124-388) to 385 (229-670). The median cost increased from €3751/1000 inhabitants/year (1109-4681) to €9158 (3269-10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France. Overall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself. Copyright © 2018 Elsevier B.V. All rights reserved.

Building a Better Learning Environment.

ERIC Educational Resources Information Center

Dentch, Matthew

2000-01-01

Explains how an environmentally friendly (Green Building) educational facility can be cost effective and enhance student performance. The concepts behind a Green Building, the areas where cost savings are possible, and some examples of realized cost savings are highlighted. Green Building funding issues are discussed. (GR)

Save Energy Now Assessments Results 2008 Summary Report

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

Wright, Anthony L; Martin, Michaela A; Nimbalkar, Sachin U

In October 2005, U.S. Department of Energy Secretary Bodman launched his Easy Ways to Save Energy campaign with a promise to provide energy assessments to 200 of the largest U.S. manufacturing plants. DOE's Industrial Technologies Program (ITP) responded to the Secretary's campaign with its Save Energy Now initiative, featuring a new and highly cost-effective form of energy savings assessment. The approach for these assessments drew heavily on the existing resources of ITP's technology delivery component. Over the years, ITP Technology Delivery has worked with industry partners to assemble a suite of respected software tools, proven assessment protocols, training curricula, certified energy experts, and strong partnerships for deployment. The Save Energy Now assessments conducted in calendar year 2006 focused on natural gas savings and targeted many of the nation's largest manufacturing plants - those that consume at least 1 TBtu of energy annually. The 2006 Save Energy Now assessments focused primarily on assessments of steam and process heating systems, which account for an estimated 74% of all natural gas use by U.S. manufacturing plants. Because of the success of the Save Energy Now assessments conducted in 2006 and 2007, the program was expanded and enhanced in two major ways in 2008: (1) a new goal was set to perform at least 260 assessments; and (2) the assessment focus was expanded to include pumping, compressed air, and fan systems in addition to steam and process heating. DOE ITP also has developed software tools to assess energy efficiency improvement opportunities in pumping, compressed air, and fan systems. The Save Energy Now assessments integrate a strong training component designed to teach industrial plant personnel how to use DOE's opportunity assessment software tools. This approach has the advantages of promoting strong buy-in of plant personnel for the assessment and its outcomes and preparing them better to independently replicate the assessment process at the company's other facilities. Another important element of the Save Energy Now assessment process is the follow-up process used to identify how many of the recommended savings opportunities from individual assessments have been implemented in the industrial plants. Plant personnel involved with the Save Energy Now assessments are contacted 6 months, 12 months, and 24 months after individual assessments are completed to determine implementation results. A total of 260 Save Energy Now assessments were successfully completed in calendar year 2008. This means that a total of 718 assessments were completed in 2006, 2007, and 2008. As of July 2009, we have received a total of 239 summary reports from the ESAs that were conducted in year 2008. Hence, at the time that this report was prepared, 680 final assessment reports were completed (200 from year 2006, 241 from year 2007, and 239 from year 2008). The total identified potential cost savings from these 680 assessments ismore » $$1.1 billion per year, including natural gas savings of about 98 TBtu per year. These results, if fully implemented, could reduce CO{sub 2} emissions by about 8.9 million metric tons annually. When this report was prepared, data on implementation of recommended energy and cost savings measures from 488 Save Energy Now assessments were available. For these 488 plants, measures saving a total of $$147 million per year have been implemented, measures that will save $169 million per year are in the process of being implemented, and plants are planning implementation of measures that will save another $239 million per year. The implemented recommendations are already achieving total CO{sub 2} reductions of about 1.8 million metric tons per year. This report provides a summary of the key results for the Save Energy Now assessments completed in 2008; details of the 6-month, 12-month, and 24-month implementation results obtained to date; and an evaluation of these implementation results. This report also summarizes key accomplishments, findings, and lessons learned from all the Save Energy Now assessments completed to date. A separate report (Wright et al. 2010) provides more detailed information on key results for all of the 2008 assessments of steam, process heating, pumping, compressed air, and fan systems. Two prior reports (Wright et al. 2007 and Wright et al. 2009) detail the results from the 2006 and 2007 assessments and discuss the major components of the assessment process and improvements in the process made in 2007.« less

Save Energy Now Assessments Results 2008 Detailed Report

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

Wright, Anthony L; Martin, Michaela A; Nimbalkar, Sachin U

In October 2005, U.S. Department of Energy Secretary Bodman launched his Easy Ways to Save Energy campaign with a promise to provide energy assessments to 200 of the largest U.S. manufacturing plants. DOE's Industrial Technologies Program (ITP) responded to the Secretary's campaign with its Save Energy Now initiative, featuring a new and highly cost-effective form of energy savings assessment. The approach for these assessments drew heavily on the existing resources of ITP's technology delivery component. Over the years, ITP Technology Delivery has worked with industry partners to assemble a suite of respected software tools, proven assessment protocols, training curricula, certified energy experts, and strong partnerships for deployment. The Save Energy Now assessments conducted in calendar year 2006 focused on natural gas savings and targeted many of the nation's largest manufacturing plants - those that consume at least 1 TBtu of energy annually. The 2006 Save Energy Now assessments focused primarily on assessments of steam and process heating systems, which account for an estimated 74% of all natural gas use by U.S. manufacturing plants. Because of the success of the Save Energy Now assessments conducted in 2006 and 2007, the program was expanded and enhanced in two major ways in 2008: (1) a new goal was set to perform at least 260 assessments; and (2) the assessment focus was expanded to include pumping, compressed air, and fan systems in addition to steam and process heating. DOE ITP also has developed software tools to assess energy efficiency improvement opportunities in pumping, compressed air, and fan systems. The Save Energy Now assessments integrate a strong training component designed to teach industrial plant personnel how to use DOE's opportunity assessment software tools. This approach has the advantages of promoting strong buy-in of plant personnel for the assessment and its outcomes and preparing them better to independently replicate the assessment process at the company's other facilities. Another important element of the Save Energy Now assessment process is the follow-up process used to identify how many of the recommended savings opportunities from individual assessments have been implemented in the industrial plants. Plant personnel involved with the Save Energy Now assessments are contacted 6 months, 12 months, and 24 months after individual assessments are completed to determine implementation results. A total of 260 Save Energy Now assessments were successfully completed in calendar year 2008. This means that a total of 718 assessments were completed in 2006, 2007, and 2008. As of July 2009, we have received a total of 239 summary reports from the ESAs that were conducted in year 2008. Hence, at the time that this report was prepared, 680 final assessment reports were completed (200 from year 2006, 241 from year 2007, and 239 from year 2008). The total identified potential cost savings from these 680 assessments ismore » $$1.1 billion per year, including natural gas savings of about 98 TBtu per year. These results, if fully implemented, could reduce CO{sub 2} emissions by about 8.9 million metric tons annually. When this report was prepared, data on implementation of recommended energy and cost savings measures from 488 Save Energy Now assessments were available. For these 488 plants, measures saving a total of $$147 million per year have been implemented, measures that will save $169 million per year are in the process of being implemented, and plants are planning implementation of measures that will save another $239 million per year. The implemented recommendations are already achieving total CO{sub 2} reductions of about 1.8 million metric tons per year. This report provides a summary of the key results for the Save Energy Now assessments completed in 2008; details of the 6-month, 12-month, and 24-month implementation results obtained to date; and an evaluation of these implementation results. This report also summarizes key accomplishments, findings, and lessons learned from all the Save Energy Now assessments completed to date. A separate report (Wright et al. 2010) provides more detailed information on key results for all of the 2008 assessments of steam, process heating, pumping, compressed air, and fan systems. Two prior reports (Wright et al. 2007 and Wright et al. 2009) detail the results from the 2006 and 2007 assessments and discuss the major components of the assessment process and improvements in the process made in 2007.« less

[Influenza vaccination in the elderly population in Mexico: economic considerations].

PubMed

Gutiérrez, Juan Pablo; Bertozzi, Stefano M

2005-01-01

To estimate costs and health outcomes that could be attained by an influenza vaccination program in adults 65 years of age and older in Mexico. Between June and October 2004, a model was constructed to estimate the number of life years lost due to influenza and the fraction that could be prevented by vaccination among adults 65 years of age and older. The model also allowed the estimation of the net cost of a vaccination program, including both the cost of delivering the vaccine and savings from prevented infections and their treatment costs. Using two scenarios of vaccine effectiveness, between 7 454 and 11 169 life years could saved by the vaccine if given to all adults 65 years and older in Mexico, with a net cost per life year saved between 13 301 and 21 037 Mexican pesos (about dollar 1 210 and dollar 1 910 US dollars). Influenza vaccination among the elderly in Mexico would result in savings per life year saved well below the Mexican gross domestic product (GDP) per capita, suggesting, even without examining alternative uses for these resources, that this is a cost effective intervention in Mexico and probably also in other middle-income developing countries.

Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

DOE PAGES

Cui, Borui; Gao, Dian-ce; Xiao, Fu; ...

2016-12-23

This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. Inmore » the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.« less

Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

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

Cui, Borui; Gao, Dian-ce; Xiao, Fu

This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. Inmore » the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.« less

Transaction costs and sequential bargaining in transferable discharge permit markets.

PubMed

Netusil, N R; Braden, J B

2001-03-01

Market-type mechanisms have been introduced and are being explored for various environmental programs. Several existing programs, however, have not attained the cost savings that were initially projected. Modeling that acknowledges the role of transactions costs and the discrete, bilateral, and sequential manner in which trades are executed should provide a more realistic basis for calculating potential cost savings. This paper presents empirical evidence on potential cost savings by examining a market for the abatement of sediment from farmland. Empirical results based on a market simulation model find no statistically significant change in mean abatement costs under several transaction cost levels when contracts are randomly executed. An alternative method of contract execution, gain-ranked, yields similar results. At the highest transaction cost level studied, trading reduces the total cost of compliance relative to a uniform standard that reflects current regulations.

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

PubMed

Miller, T R; Levy, D T

2000-06-01

The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

Alcoa World Alumina: Plant-Wide Assessment at Arkansas Operations Reveals More than$900,000 in Potential Annual Savings

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

Not Available

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of$925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at$271,200. The average payback period for all five projects would be approximately 8 months.

Alcoa World Alumina: Plant Wide Assessment at Arkansas Operation Reveals More than $900,000 in Potential Annual Savings

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

None

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of $925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at $271,200. The average payback period for all five projects would be approximately 8 months.

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

PubMed

Prada, Sergio I

2017-12-01

The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of methodology transparency, which is important, because lack of transparency hinders states from learning from each other. Ultimately, the federal government needs to evaluate and improve its DUR program.

Costs and financial feasibility of malaria elimination

PubMed Central

Sabot, Oliver; Cohen, Justin M; Hsiang, Michelle S; Kahn, James G; Basu, Suprotik; Tang, Linhua; Zheng, Bin; Gao, Qi; Zou, Linda; Tatarsky, Allison; Aboobakar, Shahina; Usas, Jennifer; Barrett, Scott; Cohen, Jessica L; Jamison, Dean T; Feachem, Richard GA

2010-01-01

Summary The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework—potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed. PMID:21035839

The Impact of an Electronic Expensive Test Notification.

PubMed

Riley, Jacquelyn D; Stanley, Glenn; Wyllie, Robert; Kottke-Marchant, Kandice; Procop, Gary W

2018-04-25

The impact of clinical decision support tools (CDSTs) that display test cost information has been variable. We retrospectively analyzed the 3-year impact of a passive CDST that notified providers when the test order cost was $1,000 or more. We determined the most common expensive tests ordered, the frequency with which providers abandoned the order after notification, and the costs saved through this intervention. The average monthly abandonment rate was 12.5% (2014), 12.9% (2015), and 14.3% (2016). The cost savings from tests not performed for this 3-year period was $696,007. Molecular hematopathology assays were the most frequently ordered tests, with variable abandonment rates. Although this CDST was passive (ie, could be overridden at the point of order entry) and was associated with a relatively low abandonment rate, it achieved a considerable cost savings each year since each abandoned test saved the institution $1,000 or more.

The Cost-Benefit Balance of Statins in Hawai'i: A Moving Target.

PubMed

Lum, Corey J; Nakagawa, Kazuma; Shohet, Ralph V; Seto, Todd B; Taira, Deborah A

2017-04-01

Statins are lipid-lowering medications used for primary and secondary prevention of atherosclerotic disease and represent a substantial portion of drug costs in the United States. A better understanding of prescribing patterns and drug costs should lead to more rational utilization and help constrain health care expenditures in the United States. The 2013 Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for the State of Hawai'i was analyzed. The number of prescriptions for statins, total annual cost, and daily cost were calculated by prescriber specialty and drug. Potential savings from substituting the highest-cost statin with lower-cost statins were calculated. Over 421,000 prescriptions for statins were provided to Medicare Part D beneficiaries in Hawai'i in 2013, which cost $17.6M. The three most commonly prescribed statins were simvastatin (33.4%), atorvastatin (33.4%), and lovastatin (13.9%). Although rosuvastatin comprised 5.4% of the total statin prescriptions, it represented 30.1% of the total cost of statins due to a higher daily cost ($5.53/day) compared to simvastatin ($0.25/day) and atorvastatin ($1.10/day). Cardiologists and general practitioners prescribed the highest percentage of rosuvastatin (8% each). Hypothetical substitution of rosuvastatin would have resulted in substantial annual cost savings (Simvastatin would have saved $1.3M for 25% substitution and $5.1M for 100% substitution, while atorvastatin would have saved $1.1M for 25% substitution and $4.3M for 100% substitution). Among Medicare Part D beneficiaries in Hawai'i, prescribing variation for statins between specialties were observed. Substitution of higher-cost with lower-cost statins may lead to substantial cost savings.

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

PubMed

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

2017-02-20

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

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

PubMed Central

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

2011-01-01

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

Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception

PubMed Central

Henry, Nathaniel; Schlueter, Max; Lowin, Julia; Lekander, Ingrid; Filonenko, Anna; Trussell, James; Skjeldestad, Finn Egil

2015-01-01

Objectives The objective of this study was to quantify the cost burden of unintended pregnancies (UPs) in Norway, and to estimate the proportion of costs due to imperfect contraceptive adherence. Potential cost savings that could arise from increased uptake of long-acting reversible contraception (LARC) were also investigated. Methods An economic model was constructed to estimate the total number of UPs and associated costs in women aged 15–24 years. Adherence-related UP was estimated using ‘perfect use’ and ‘typical use’ contraceptive failure rates. Potential savings from increased use of LARC were projected by comparing current costs to projected costs following a 5% increase in LARC uptake. Results Total costs from UP in women aged 15–24 years were estimated to be 164 million Norwegian Kroner (NOK), of which 81.7% were projected to be due to imperfect contraceptive adherence. A 5% increase in LARC uptake was estimated to generate cost savings of NOK 7.2 million in this group. Conclusions The cost of UP in Norway is substantial, with a large proportion of this cost arising from imperfect contraceptive adherence. Increased LARC uptake may reduce the UP incidence and generate cost savings for both the health care payer and contraceptive user. PMID:25537792

Building energy information systems: Synthesis of costs, savings, and best-practice uses

DOE PAGES

Granderson, Jessica; Lin, Guanjing

2016-02-19

Building energy information systems (EIS) are a powerful customer-facing monitoring and analytical technology that can enable up to 20% site energy savings for buildings. Few technologies are as heavily marketed, but in spite of their potential, EIS remain an under-adopted emerging technology. One reason is the lack of information on purchase costs and associated energy savings. While insightful, the growing body of individual case studies has not provided industry the information needed to establish the business case for investment. Vastly different energy and economic metrics prevent generalizable conclusions. This paper addresses three common questions concerning EIS use: what are themore » costs, what have users saved, and which best practices drive deeper savings? We present a large-scale assessment of the value proposition for EIS use based on data from over two-dozen organizations. Participants achieved year-over-year median site and portfolio savings of 17% and 8%, respectively; they reported that this performance would not have been possible without the EIS. The median five-year cost of EIS software ownership (up-front and ongoing costs) was calculated to be $1,800 per monitoring point (kilowatt meter points were most common), with a median portfolio-wide implementation size of approximately 200 points. In this paper, we present an analysis of the relationship between key implementation factors and achieved energy reductions. Extent of efficiency projects, building energy performance prior to EIS installation, depth of metering, and duration of EIS were strongly correlated with greater savings. As a result, we also identify the best practices use of EIS associated with greater energy savings.« less

Building energy information systems: Synthesis of costs, savings, and best-practice uses

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

Granderson, Jessica; Lin, Guanjing

Building energy information systems (EIS) are a powerful customer-facing monitoring and analytical technology that can enable up to 20% site energy savings for buildings. Few technologies are as heavily marketed, but in spite of their potential, EIS remain an under-adopted emerging technology. One reason is the lack of information on purchase costs and associated energy savings. While insightful, the growing body of individual case studies has not provided industry the information needed to establish the business case for investment. Vastly different energy and economic metrics prevent generalizable conclusions. This paper addresses three common questions concerning EIS use: what are themore » costs, what have users saved, and which best practices drive deeper savings? We present a large-scale assessment of the value proposition for EIS use based on data from over two-dozen organizations. Participants achieved year-over-year median site and portfolio savings of 17% and 8%, respectively; they reported that this performance would not have been possible without the EIS. The median five-year cost of EIS software ownership (up-front and ongoing costs) was calculated to be $1,800 per monitoring point (kilowatt meter points were most common), with a median portfolio-wide implementation size of approximately 200 points. In this paper, we present an analysis of the relationship between key implementation factors and achieved energy reductions. Extent of efficiency projects, building energy performance prior to EIS installation, depth of metering, and duration of EIS were strongly correlated with greater savings. As a result, we also identify the best practices use of EIS associated with greater energy savings.« less

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

A cost-benefit analysis of a deposit-refund program for beverage containers in Israel.

PubMed

Lavee, Doron

2010-02-01

The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program--storage, collection, and treatment costs of empty containers, and all potential benefits--savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearly economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.

A Business Case for Tele-Intensive Care Units

PubMed Central

Coustasse, Alberto; Deslich, Stacie; Bailey, Deanna; Hairston, Alesia; Paul, David

2014-01-01

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. Conclusions: Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU. PMID:25662529

Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

PubMed

Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

2015-04-01

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. Project HOPE—The People-to-People Health Foundation, Inc.

A Cost Analysis of Kidney Replacement Therapy Options in Palestine

PubMed Central

Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16 277 for the first year; the estimated cost of HD per patient averaged US$16 085 per year—nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. PMID:25765018

Cost-effectiveness evaluation of voriconazole versus liposomal amphotericin B as empirical therapy for febrile neutropenia in Australia.

PubMed

Al-Badriyeh, Daoud; Liew, Danny; Stewart, Kay; Kong, David C M

2009-01-01

A major randomized clinical trial, evaluating voriconazole versus liposomal amphotericin B (LAMB) as empirical therapy in febrile neutropenia, recommended voriconazole as a suitable alternative to LAMB. The current study sought to investigate the health economic impact of using voriconazole and LAMB for febrile neutropenia in Australia. A decision analytic model was constructed to capture downstream consequences of empirical antifungal therapy with each agent. The main outcomes were: success, breakthrough fungal infection, persistent baseline fungal infection, persistent fever, premature discontinuation and death. Underlying transition probabilities and treatment patterns were derived directly from trial data. Resource use was estimated using an expert panel. Cost inputs were obtained from the latest Australian representative published sources. The perspective adopted was that of the Australian hospital. Uncertainty and sensitivity analyses were undertaken via the Monte Carlo simulation. Compared with voriconazole, LAMB was associated with a net cost saving of AU$1422 (2.9%) per patient. A similar trend was observed with the cost per death prevented and successful treatment. LAMB dominated voriconazole as it resulted in higher efficacy and lower costs when compared with voriconazole. The results were most sensitive to the duration of therapy and the alternative therapy used post discontinuations. In uncertainty analysis, LAMB had 99.8% chance of costing less than voriconazole. In this study, which used the current standard five component endpoint to assess the impact of empirical antifungal therapy, LAMB was associated with cost savings relative to voriconazole.

A cost analysis of kidney replacement therapy options in Palestine.

PubMed

Younis, Mustafa; Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16,277 for the first year; the estimated cost of HD per patient averaged US$16,085 per year--nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. © The Author(s) 2015.

Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis

PubMed Central

John-Baptiste, A.; Sowerby, L.J.; Chin, C.J.; Martin, J.; Rotenberg, B.W.

2016-01-01

Background: When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). Methods: We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. Results: The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Interpretation: Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems. PMID:27975045

Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis.

PubMed

John-Baptiste, A; Sowerby, L J; Chin, C J; Martin, J; Rotenberg, B W

2016-01-01

When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.

A cost-consequences analysis of a primary care librarian question and answering service.

PubMed

McGowan, Jessie; Hogg, William; Zhong, Jianwei; Zhao, Xue

2012-01-01

Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

How to Cut Costs by Saving School Bus Fuel.

ERIC Educational Resources Information Center

Seiff, Hank

A program started in Washington County, Maryland in 1980 has been successful in saving school bus fuel and bringing down transportation costs incurred by its fleet of 200 buses. Driver training and motivation, as well as a partial transfer to diesel buses, are at the heart of the program. The drivers are taught five fuel saving techniques: cut…

Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries.

PubMed

Mewes, Janne C; Steuten, Lotte M G; Groeneveld, Iris F; de Boer, Angela G E M; Frings-Dresen, Monique H W; IJzerman, Maarten J; van Harten, Wim H

2015-11-12

Return-to-work (RTW)-interventions support cancer survivors in resuming work, but come at additional healthcare costs. The objective of this study was to assess the budget impact of a RTW-intervention, consisting of counselling sessions with an occupational physician and an exercise-programme. The secondary objective was to explore how the costs of RTW-interventions and its financial revenues are allocated among the involved stakeholders in several EU-countries. The budget impact (BI) of a RTW-intervention versus usual care was analysed yearly for 2015-2020 from a Dutch societal- and from the perspective of a large cancer centre. The allocation of the expected costs and financial benefits for each of the stakeholders involved was compared between the Netherlands, Belgium, England, France, Germany, Italy, and Sweden. The average intervention costs in this case were €1,519/patient. The BI for the Netherlands was €-14.7 m in 2015, rising to €-71.1 m in 2020, thus the intervention is cost-saving as the productivity benefits outweigh the intervention costs. For cancer centres the BI amounts to €293 k in 2015, increasing to €1.1 m in 2020. Across European countries, we observed differences regarding the extent to which stakeholders either invest or receive a share of the benefits from offering a RTW-intervention. The RTW-intervention is cost-saving from a societal perspective. Yet, the total intervention costs are considerable and, in many European countries, mainly covered by care providers that are not sufficiently reimbursed.

The economic value of Quebec's water fluoridation program.

PubMed

Tchouaket, Eric; Brousselle, Astrid; Fansi, Alvine; Dionne, Pierre Alexandre; Bertrand, Elise; Fortin, Christian

2013-01-01

Dental caries is a major public health problem worldwide, with very significant deleterious consequences for many people. The available data are alarming in Canada and the province of Quebec. The water fluoridation program has been shown to be the most effective means of preventing caries and reducing oral health inequalities. This article analyzes the cost-effectiveness of Quebec's water fluoridation program to provide decision-makers with economic information for assessing its usefulness. An approach adapted from economic evaluation was used to: (1) build a logic model for Quebec's water fluoridation program; (2) determine its implementation cost; and (3) analyze its cost-effectiveness. Documentary analysis was used to build the logic model. Program cost was calculated using data from 13 municipalities that adopted fluoridation between 2002 and 2010 and two that received only infrastructure grants. Other sources were used to collect demographic data and calculate costs for caries treatment including costs associated with travel and lost productivity. The analyses showed the water fluoridation program was cost-effective even with a conservatively estimated 1 % reduction in dental caries. The benefit-cost ratio indicated that, at an expected average effectiveness of 30 % caries reduction, one dollar invested in the program saved $71.05-$82.83 per Quebec's inhabitant in dental costs (in 2010) or more than $560 million for the State and taxpayers. The results showed that the drinking-water fluoridation program produced substantial savings. Public health decision-makers could develop economic arguments to support wide deployment of this population-based intervention whose efficacy and safety have been demonstrated and acknowledged.

Man power/cost estimation model: Automated planetary projects

NASA Technical Reports Server (NTRS)

Kitchen, L. D.

1975-01-01

A manpower/cost estimation model is developed which is based on a detailed level of financial analysis of over 30 million raw data points which are then compacted by more than three orders of magnitude to the level at which the model is applicable. The major parameter of expenditure is manpower (specifically direct labor hours) for all spacecraft subsystem and technical support categories. The resultant model is able to provide a mean absolute error of less than fifteen percent for the eight programs comprising the model data base. The model includes cost saving inheritance factors, broken down in four levels, for estimating follow-on type programs where hardware and design inheritance are evident or expected.

How low can you go? The impact of reduced benefits and increased cost sharing.

PubMed

Lee, Jason S; Tollen, Laura

2002-01-01

Amid escalating health care costs and a managed care backlash, employers are considering traditional cost control methods from the pre-managed care era. We use an actuarial model to estimate the premium-reducing effects of two such methods: increasing employee cost sharing and reducing benefits. Starting from a baseline plan with rich benefits and low cost sharing, estimated premium savings as a result of eliminating five specific benefits were about 22 percent. The same level of savings was also achieved by increasing cost sharing from a 15 dollars copayment with no deductible to 20 percent coinsurance and a 250 dollars deductible. Further increases in cost sharing produced estimated savings of up to 50 percent. We discuss possible market- and individual-level effects of the proliferation of plans with high cost sharing and low benefits.

Evaluation plan for state gas heating system retrofit pilot programs

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

Berry, L.; Vineyard, T.

This report presents a detailed plan for the evaluation of state gas heating system retrofit pilot programs. The major goals of the evaluation procedures are to document the fuel savings and cost effectiveness of (1) the programs implemented by the states and (2) the four retrofit types installed. The major tasks involved in the evaluation include identification of program-eligible households, screening for data quality, assignment of eligible households to treatment or control groups, assembling cost data, collecting pre- and postretrofit consumption data, obtainin pre- and postretrofit weather data, checking for data quality, and analyzing the data. Data analysis relies onmore » the calculation of weather-adjusted normalized annual consumption (NAC) figures for pre- and postretrofit years for treatment and control groups. The differences between the treatment and control groups' NACs for the pre- and postretrofit years are the measure of the program's impact. Cost effectiveness analysis will combine the NAC results with cost data and with a variety of assumptions concerning future fuel prices, retrofit lifetimes, and discount rates to produce benefit/cost indicators.« less

Oilwell Power Controller (OPC)

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

Not Available

1993-08-01

The Oil Well Power Controller (OPC) prototype units is nearing completion. This device is an oilwell beam pump controller and data logger. Applications for this device have been for an electrical power saving device, pump off control, parafffin detection, demand power load control, chemical treatment data, dynamometer and pump efficiency data. Preliminary results appear vary promising. A total of ten OPC rod pump controllers were assembled and installed on oilwells in several areas of Central and Western United States. Data was analyzed on these wells and forwarded to the participating oil companies. Cost savings on each individual oil well participatingmore » in the OPC testing vary considerably, savings on some situations have been outstanding. In situations where the pump efficiency was determined to be low, the cost savings have been considerable. Cost savings due to preventive maintenance are also present, but are difficult to pin point an exact dollar amount at the present time. A break out of actual cost data obtained on some of the oilwells controlled and monitored with the oilwell power controller.« less

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

PubMed

Meier, Toni; Senftleben, Karolin; Deumelandt, Peter; Christen, Olaf; Riedel, Katja; Langer, Martin

2015-01-01

Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

Regional Variation in Residential Heat Pump Water Heater Performance in the U.S.

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

Maguire, Jeff; Burch, Jay; Merrigan, Tim

2014-01-01

Residential heat pump water heaters (HPWHs) have recently re-emerged on the U.S. market, and they have the potential to provide homeowners significant cost and energy savings. However, actual in use performance of a HPWH will vary significantly with climate, installation location, HVAC equipment, and hot water use. To determine the actual energy consumption of a HPWH in different U.S. regions, annual simulations of both 50 and 80 gallon HPWHs as well as a standard electric water heater were performed for over 900 locations across the United States. The simulations included a benchmark home to take into account interactions between themore » space conditioning equipment and the HPWH and a realistic hot water draw profile. It was found that the HPWH will always save some source energy when compared to a standard electric resistance water heater, although savings varies widely with location. In addition to looking at source energy savings, the breakeven cost (the net installed cost a HPWH would have to have to be a cost neutral replacement for a standard water heater) was also examined. The highest breakeven costs were seen in cases with high energy savings, such as the southeastern U.S., or high energy costs, such as New England and California. While the breakeven cost is higher for 80 gallon units than 50 gallon units, the higher net installed costs of an 80 gallon unit lead to the 50 gallon HPWHs being more likely to be cost effective.« less

Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic? : [participant presentation].

DOT National Transportation Integrated Search

2012-08-01

This webinar is for TxDOT project 0-6677: Costs Associated with Conversion of Surfaced to Un-surfaced Roads. The topic is Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic?.

Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic? : [instructor presentation].

DOT National Transportation Integrated Search

2012-08-01

This webinar is for TxDOT project 0-6677: Costs Associated with Conversion of Surfaced to Un-surfaced Roads. The topic is Is conversion of a roadway from surfaced to un-surfaced for agency cost savings realistic?.

Time- and cost-saving apparatus for analytical sample filtration

Treesearch

William R. Kenealy; Joseph C. Destree

2005-01-01

Simple and cost-effective protocols were developed for removing particulates from samples prior to analysis by high performance liquid chromatography and gas chromatography. A filter and vial holder were developed for use with a 96-well filtration plate. The device saves preparation time and costs.

Backup, Archive, Recovery

ERIC Educational Resources Information Center

Pearring, John

2012-01-01

The education sector remains abuzz with cost-cutting expectations despite pressures to increase services. Automation of costly manual tasks could save funds for many of these institutions, specifically in data protection. The IT departments of schools and universities can take advantage of a proven cost-savings opportunity in data protection that…

Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.

PubMed

Horwitz, Jill R; Kelly, Brenna D; DiNardo, John E

2013-03-01

The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.

State deregulation and Medicare costs for acute cardiac care.

PubMed

Ho, Vivian; Ku-Goto, Meei-Hsiang

2013-04-01

Past literature suggests that Certificate of Need (CON) regulations for cardiac care were ineffective in improving quality, but less is known about the effect of CON on patient costs. We analyzed Medicare data for 1991-2002 to test whether states that dropped CON experienced changes in costs or reimbursements for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. We found that states that dropped CON experienced lower costs per patient for CABG but not for percutaneous coronary intervention. Average Medicare reimbursement was lower for both procedures in states that dropped CON. The cost savings from removing CON regulations slightly exceed the total fixed costs of new CABG facilities that entered after deregulation. Assuming continued cost savings past 2002, the savings from deregulating CABG surgery outweigh the fixed costs of new entry. Thus, CON regulations for CABG may not be justified in terms of either improving quality or controlling cost growth.

Economics of an adolescent meningococcal conjugate vaccination catch-up campaign in the United States.

PubMed

Ortega-Sanchez, Ismael R; Meltzer, Martin I; Shepard, Colin; Zell, Elizabeth; Messonnier, Mark L; Bilukha, Oleg; Zhang, Xinzhi; Stephens, David S; Messonnier, Nancy E

2008-01-01

In June 2005, the Advisory Committee on Immunization Practices recommended the newly licensed quadrivalent meningococcal conjugate vaccine for routine use among all US children aged 11 years. A 1-time catch-up vaccination campaign for children and adolescents aged 11-17 years, followed by routine annual immunization of each child aged 11 years, could generate immediate herd immunity benefits. The objective of our study was to analyze the cost-effectiveness of a catch-up vaccination campaign with quadrivalent meningococcal conjugate vaccine for children and adolescents aged 11-17 years. We built a probabilistic model of disease burden and economic impacts for a 10-year period with and without a program of adolescent catch-up meningococcal vaccination, followed by 9 years of routine immunization of children aged 11 years. We used US age- and serogroup-specific surveillance data on incidence and mortality. Assumptions related to the impact of herd immunity were drawn from experience with routine meningococcal vaccination in the United Kingdom. We estimated costs per case, deaths prevented, life-years saved, and quality-adjusted life-years saved. With herd immunity, the catch-up and routine vaccination program for adolescents would prevent 8251 cases of meningococcal disease in a 10-year period (a 48% decrease). Excluding program costs, this catch-up and routine vaccination program would save US$551 million in direct costs and $920 million in indirect costs, including costs associated with permanent disability and premature death. At $83 per vaccinee, the catch-up vaccination would cost society approximately $223,000 per case averted, approximately $2.6 million per death prevented, approximately $127,000 per life-year saved, and approximately $88,000 per quality-adjusted life-year saved. Targeting counties with a high incidence of disease decreased the cost per life-year saved by two-thirds. Although costly, catch-up and routine vaccination of adolescents can have a substantial impact on meningococcal disease burden. Because of herd immunity, catch-up and routine vaccination cost per life-year saved could be up to one-third less than that previously assessed for routine vaccination of children aged 11 years.

Cost-Savings Analysis of Renal Scintigraphy, Stratified by Renal Function Thresholds: Mercaptoacetyltriglycine Versus Diethylene Triamine Penta-Acetic Acid.

PubMed

Parikh, Kushal R; Davenport, Matthew S; Viglianti, Benjamin L; Hubers, David; Brown, Richard K J

2016-07-01

To determine the financial implications of switching technetium (Tc)-99m mercaptoacetyltriglycine (MAG-3) to Tc-99m diethylene triamine penta-acetic acid (DTPA) at certain renal function thresholds before renal scintigraphy. Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant, retrospective, cohort study. Consecutive adult subjects (27 inpatients; 124 outpatients) who underwent MAG-3 renal scintigraphy, in the period from July 1, 2012 to June 30, 2013, were stratified retrospectively by hypothetical serum creatinine and estimated glomerular filtration rate (eGFR) thresholds, based on pre-procedure renal function. Thresholds were used to estimate the financial effects of using MAG-3 when renal function was at or worse than a given cutoff value, and DTPA otherwise. Cost analysis was performed with consideration of raw material and preparation costs, with radiotracer costs estimated by both vendor list pricing and proprietary institutional pricing. The primary outcome was a comparison of each hypothetical threshold to the clinical reality in which all subjects received MAG-3, and the results were supported by univariate sensitivity analysis. Annual cost savings by serum creatinine threshold were as follows (threshold given in mg/dL): $17,319 if ≥1.0; $33,015 if ≥1.5; and $35,180 if ≥2.0. Annual cost savings by eGFR threshold were as follows (threshold given in mL/min/1.73 m(2)): $21,649 if ≤60; $28,414 if ≤45; and $32,744 if ≤30. Cost-savings inflection points were approximately 1.25 mg/dL (serum creatinine) and 60 mL/min/1.73m(2) (eGFR). Secondary analysis by proprietary institutional pricing revealed similar trends, and cost savings of similar magnitude. Sensitivity analysis confirmed cost savings at all tested thresholds. Reserving MAG-3 utilization for patients who have impaired renal function can impart substantial annual cost savings to a radiology department. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Geostationary platform systems concepts definition study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1980-01-01

The results of a geostationary platform concept analysis are summarized. Mission and payloads definition, concept selection, the requirements of an experimental platform, supporting research and technology, and the Space Transportation System interface requirements are addressed. It is concluded that platforms represent a logical extension of current trends toward larger, more complex, multifrequency satellites. Geostationary platforms offer significant cost savings compared to individual satellites, with the majority of these economies being realized with single Shuttle launched platforms. Further cost savings can be realized, however, by having larger platforms. Platforms accommodating communications equipment that operates at multiple frequencies and which provide larger scale frequency reuse through the use of large aperture multibeam antennas and onboard switching maximize the useful capacity of the orbital arc and frequency spectrum. Projections of market demand indicate that such conservation measures are clearly essential if orderly growth is to be provided for. In addition, it is pointed out that a NASA experimental platform is required to demonstrate the technologies necessary for operational geostationary platforms of the 1990's.

Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.

PubMed

Tuttle, C R; Dewey, K G

1996-09-01

To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California. Cost-savings analysis. Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal. Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%. Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from $3,442 to $4,944 (4% discount) to $4,475 to $6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between $459 and $659 (4% discount) and $597 and $808 (0% discount) per family. Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.

Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda.

PubMed

Mayora, Chrispus; Ekirapa-Kiracho, Elizabeth; Bishai, David; Peters, David H; Okui, Olico; Baine, Sebastian Olikira

2014-01-01

High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services. This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider's perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated. The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively. Subsidizing maternal health care costs through demand and supply - side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda's Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be affordable, yet reliance on donor funding is often not sustainable. Alternative ways of raising additional resources for health must be explored. These include; encouraging private investments in critical sectors such as rural transport, health service provision; mobilizing households to save financial resources for preparedness, and financial targeting for the most vulnerable.

Electricity savings potentials in the residential sector of Bahrain

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

Akbari, H.; Morsy, M.G.; Al-Baharna, N.S.

1996-08-01

Electricity is the major fuel (over 99%) used in the residential, commercial, and industrial sectors in Bahrain. In 1992, the total annual electricity consumption in Bahrain was 3.45 terawatt-hours (TWh), of which 1.95 TWh (56%) was used in the residential sector, 0.89 TWh (26%) in the commercial sector, and 0.59 TWh (17%) in the industrial sector. Agricultural energy consumption was 0.02 TWh (less than 1%) of the total energy use. In Bahrain, most residences are air conditioned with window units. The air-conditioning electricity use is at least 50% of total annual residential use. The contribution of residential AC to themore » peak power consumption is even more significant, approaching 80% of residential peak power demand. Air-conditioning electricity use in the commercial sector is also significant, about 45% of the annual use and over 60% of peak power demand. This paper presents a cost/benefit analysis of energy-efficient technologies in the residential sector. Technologies studied include: energy-efficient air conditioners, insulating houses, improved infiltration, increasing thermostat settings, efficient refrigerators and freezers, efficient water heaters, efficient clothes washers, and compact fluorescent lights. We conservatively estimate a 32% savings in residential electricity use at an average cost of about 4 fils per kWh. (The subsidized cost of residential electricity is about 12 fils per kWh. 1000 fils = 1 Bahrain Dinar = US$ 2.67). We also discuss major policy options needed for implementation of energy-efficiency technologies.« less

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

PubMed

Leahy, Michael F; Hofmann, Axel; Towler, Simon; Trentino, Kevin M; Burrows, Sally A; Swain, Stuart G; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C; Farmer, Shannon L

2017-06-01

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001). Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

The cost of preoperative urodynamics: A secondary analysis of the ValUE trial.

PubMed

Norton, Peggy A; Nager, Charles W; Brubaker, Linda; Lemack, Gary E; Sirls, Larry T; Holley, Robert; Chai, Toby C; Kraus, Stephen R; Zyczynski, Halina; Smith, Bridget; Stoddard, Anne

2016-01-01

Urodynamic studies (UDS) are generally recommended prior to surgical treatment for stress urinary incontinence (SUI), despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI. This analysis aimed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis. This is a secondary analysis from the Value of Urodynamic Evaluation (ValUE) trial, a multicenter non-inferiority randomized trial to determine whether a basic office evaluation (OE) is non-inferior in terms of SUI surgery outcomes to office evaluation with addition of urodynamic studies (UDS). All participants underwent an OE; those patients who randomized to supplementary UDS underwent non-instrumented uroflowmetry, filling cystometry, and a pressure flow study. Costs associated with UDS were calculated using 2014 U.S. Medicare allowable fees. Models using various patient populations and payor mixes were created to obtain a range of potential costs of performing UDS in patients undergoing SUI surgery annually in the United States. Six hundred thirty women were randomized to OE or OE plus UDS. There was no difference in surgical outcomes between the two groups. The per patient cost of UDS varied from site to site, and included complex cystometrogram $314-$343 (CPT codes 51728-51729) plus complex uroflowmetry $16 (CPT code 51741). Extrapolating these costs for US women similar to our study population, 13-33 million US dollars could be saved annually by not performing preoperative urodynamics. For women with uncomplicated SUI and a confirmatory preoperative basic office evaluation, tens of millions of dollars US could be saved annually by not performing urodynamic testing. In the management of such women, eliminating this preoperative test has a major economic benefit. © 2014 Wiley Periodicals, Inc.

Potential Savings From Increasing Adherence to Inhaled Corticosteroid Therapy in Medicaid-Enrolled Children

PubMed Central

Rust, George; Zhang, Shun; McRoy, Luceta; Pisu, Maria

2016-01-01

Background Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx). Objectives We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children. Study Design We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007. Methods Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%. Results Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence. Conclusions If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma. PMID:25880622

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.

PubMed

Seidman, Gabriel; Atun, Rifat

2017-04-13

Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

Pre-emptive Therapy for Cytomegalovirus in Post-transplantation Liver Patients With Donor-Positive/Recipient-Negative Serostatus.

PubMed

Brasil, I R C; Custodio-Lima, J; Sampaio, R L; Pierre, A M M; Esmeraldo, T M; Lima, R V C; Lima, L F A; Esmeraldo, R M

2017-05-01

Infection by cytomegalovirus (CMV) is a major cause of morbidity among immunosuppressed patients, especially after solid organ transplantation. The risk of CMV after organ transplantation is strongly related to the serology of the donor and the recipient. The objective of this study was to analyze the outcomes and costs of pre-emptive therapy in patients after liver transplantation with donor-positive/recipient-negative (D+/R-) serostatus. This retrospective study analyzed all patients who underwent liver transplantation with CMV serostatus D+/R- between January 2012 and December 2015. The service protocol adopts pre-emptive therapy. The outcomes and costs of this therapy are described. Of the 119 patients undergoing liver transplantation, 19 were D+/R- and entered the main analysis. Of these, 7 had positive polymerase chain reaction (PCR) results, and 1 developed CMV disease. Of the 6 patients who received no treatment, none developed CMV disease. Analyzing costs, pre-emptive therapy for these patients generated service savings of R$32,346.00. Although outcomes of universal prophylaxis and pre-emptive therapy are similar, pre-emptive therapy save on costs and have to be considered in patients with high-risk CMV disease after liver transplantation. Copyright © 2017. Published by Elsevier Inc.

A break-even price calculation for the use of sirolimus-eluting stents in angioplasty.

PubMed

Galanaud, Jean-Philippe; Delavennat, Juliette; Durand-Zaleski, Isabelle

2003-03-01

One of the major complications of angioplasty is the early occurrence of restenosis requiring a repeat procedure. When bare-metal stents are used, clinical restenosis results in a repeat procedure in 10% to 15% of cases. Based on the results of an international, randomized clinical trial, the use of sirolimus-eluting stents reduces this risk. The aims of this study were to calculate the theoretical break-even price for sirolimus-eluting stents in France, the Netherlands, and the United States, and to determine the additional health care cost per patient. The break-even price was calculated by adding the savings resulting from a 15% decrease in the rate of clinical restenosis to the price of bare-metal stents. Costs were computed from the viewpoint of the health care system, exclusive of other societal costs. The break-even prices were 1291 Euro to 1489 Euro in France, 2028 Euro in the Netherlands, and 2708 Euroin the United States (1.00 Euro = 1.00 US dollar in purchasing power parity). These results indicate that the commercial price of sirolimuseluting stents will increase hospital spending for patients undergoing angioplasty by 17% to 55% per patient. This additional cost to the health care system should be discussed in view of possible productivity savings and improved quality of life for patients.

Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

PubMed

Oner, Julide; Sengoz, Burak

2015-01-01

The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing) at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

Utilization of Recycled Asphalt Concrete with Warm Mix Asphalt and Cost-Benefit Analysis

PubMed Central

Oner, Julide; Sengoz, Burak

2015-01-01

The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing) at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures. PMID:25574851

Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement.

PubMed

Egede, Leonard E; Gebregziabher, Mulugeta; Dismuke, Clara E; Lynch, Cheryl P; Axon, R Neal; Zhao, Yumin; Mauldin, Patrick D

2012-12-01

To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories. Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value. Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼$661 million (MPR <0.6 vs. ≥0.6) to ∼$1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 ($204,530,778) among MNA subjects. Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called "triple aim" of achieving better health, better quality care, and lower cost.

Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany.

PubMed

Mertens, Janina; Stock, Stephanie; Lüngen, Markus; von Berg, Andrea; Krämer, Ursula; Filipiak-Pittroff, Birgit; Heinrich, Joachim; Koletzko, Sibylle; Grübl, Armin; Wichmann, H-Erich; Bauer, Carl-P; Reinhardt, Dietrich; Berdel, Dietrich; Gerber, Andreas

2012-09-01

The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula. © 2012 John Wiley & Sons A/S.

[The cost-effectiveness of Haemophilus influenzae type b vaccine for children under 2 years of age in Colombia].

PubMed

Alvis Guzmán, Nelson; De La Hoz Restrepo, Fernando; Vivas Consuelo, David

2006-10-01

Conjugate vaccines are the best public health tools available for preventing most invasive diseases caused by Haemophilus influenzae type b (Hib), but the high cost of the vaccines has so far kept them from being introduced worldwide. The objective of this study was to estimate the cost-effectiveness of introducing Hib conjugate vaccines for the prevention of meningitis and pneumonia among children under 2 years of age in Colombia. We estimated the direct and indirect costs of managing in-hospital pneumonia and meningitis cases. In addition, following the recommendations of the World Health Organization, we assessed the cost-effectiveness of Hib vaccination programs. We also estimated the costs for preventing Hib cases, and the cost per year of life saved in two hypothetical situations: (1) with vaccination against Hib (with 90% coverage) and (2) without vaccination. The average in-hospital treatment costs were 611.50 US$ (95% confidence interval (95% CI) = 532.2 to 690.8 US$) per case of pneumonia and 848.9 US$ (95% CI = 716.8 to 981.0 US$) per case of meningitis. The average cost per Hib case prevented was 316.7 US$ (95% CI = 294.2 to 339.2 US$). In terms of cost-effectiveness, the cost would be 2.38 US$ per year of life saved for vaccination, versus 3.81 US$ per year of life saved without vaccination. Having an adequate Hib vaccination program in Colombia could prevent around 25,000 cases of invasive disease per year, representing a cost savings of at least 15 million US$ annually. Furthermore, the program could prevent some 700 deaths per year and save 44,054 years of life per year.

Cost profiles and budget impact of rechargeable versus non-rechargeable sacral neuromodulation devices in the treatment of overactive bladder syndrome.

PubMed

Noblett, Karen L; Dmochowski, Roger R; Vasavada, Sandip P; Garner, Abigail M; Liu, Shan; Pietzsch, Jan B

2017-03-01

Sacral neuromodulation (SNM) is a guideline-recommended third-line treatment option for managing overactive bladder. Current SNM devices are not rechargeable, and require neurostimulator replacement every 3-6 years. Our study objective was to assess potential cost effects to payers of adopting a rechargeable SNM neurostimulator device. We constructed a cost-consequence model to estimate the costs of long-term SNM-treatment with a rechargeable versus non-rechargeable device. Costs were considered from the payer perspective at 2015 reimbursement levels. Adverse events, therapy discontinuation, and programming rates were based on the latest published data. Neurostimulator longevity was assumed to be 4.4 and 10.0 years for non-rechargeable and rechargeable devices, respectively. A 15-year horizon was modeled, with costs discounted at 3% per year. Total budget impact to the United States healthcare system was estimated based on the computed per-patient cost findings. Over the 15-year horizon, per-patient cost of treatment with a non-rechargeable device was $64,111 versus $36,990 with a rechargeable device, resulting in estimated payer cost savings of $27,121. These cost savings were found to be robust across a wide range of scenarios. Longer analysis horizon, younger patient age, and longer rechargeable neurostimulator lifetime were associated with increased cost savings. Over a 15-year horizon, adoption of a rechargeable device strategy was projected to save the United States healthcare system up to $12 billion. At current reimbursement rates, our analysis suggests that rechargeable neurostimulator SNM technology for managing overactive bladder syndrome may deliver significant cost savings to payers over the course of treatment. Neurourol. Urodynam. 36:727-733, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The cost-effectiveness of three interventions for providing preventive services to low-income children.

PubMed

Johnson, Ben; Serban, Nicoleta; Griffin, Paul M; Tomar, Scott L

2017-12-01

We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia. We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes. Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by <1% and cost over $38 million. Given one parameter set, SBSPs could serve over 27 000 children with an intervention cost between $500 000 and $1.3 million with a potential cost saving of $1.1 million. Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000. The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Winglets Save Billions of Dollars in Fuel Costs

NASA Technical Reports Server (NTRS)

2010-01-01

The upturned ends now featured on many airplane wings are saving airlines billions of dollars in fuel costs. Called winglets, the drag-reducing technology was advanced through the research of Langley Research Center engineer Richard Whitcomb and through flight tests conducted at Dryden Flight Research Center. Seattle-based Aviation Partners Boeing -- a partnership between Aviation Partners Inc., of Seattle, and The Boeing Company, of Chicago -- manufactures Blended Winglets, a unique design featured on Boeing aircraft around the world. These winglets have saved more than 2 billion gallons of jet fuel to date, representing a cost savings of more than $4 billion and a reduction of almost 21.5 million tons in carbon dioxide emissions.

ESCOs: Helping Schools Save Money and Energy.

ERIC Educational Resources Information Center

School Planning & Management, 2000

2000-01-01

Discusses the use of energy savings performance contracts to help reduce costs and improve school infrastructure and the educational environment. Further discussed are how indoor air quality reduces health, productivity, and costs; and examples are provided of how other schools have achieved better school environments and reduced energy costs. (GR)

Cardiovascular Magnetic Resonance Imaging-Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study.

PubMed

Hegde, Vinayak A; Biederman, Robert Ww; Mikolich, J Ronald

2017-01-01

This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. Cardiovascular magnetic resonance imaging provides diagnostic image quality in >98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner.

Cardiovascular Magnetic Resonance Imaging—Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study

PubMed Central

Hegde, Vinayak A; Biederman, Robert WW; Mikolich, J Ronald

2017-01-01

BACKGROUND This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. CONCLUSIONS Cardiovascular magnetic resonance imaging provides diagnostic image quality in >98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner. PMID:28579858

Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

PubMed

Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

2017-11-01

A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand.

PubMed

Permsuwan, Unchalee; Chaiyakunapruk, Nathorn; Nathisuwan, Surakit; Sukonthasarn, Apichard

2015-09-01

Non-ST elevation acute coronary syndrome (NSTE-ACS) imposes a significant health and economic burden on a society. Anticoagulants are recommended as standard therapy by various clinical practice guidelines. Fondaparinux was introduced and evaluated in a number of large randomised, controlled trials. This study therefore aimed to determine the cost-effectiveness of fondaparinux versus enoxaparin in the treatment of NSTE-ACS in Thailand. A two-part construct model comprising a one-year decision tree and a Markov model was developed to capture short and long-term costs and outcomes from the perspective of provider and society. Effectiveness data were derived from OASIS-5 trial while bleeding rates were derived from the Thai Acute Coronary Syndrome Registry (TACSR). Costs data were based on a Thai database and presented in the year of 2013. Both costs and outcomes were discounted by 3% annually. A series of sensitivity analyses were performed. The results showed that compared with enoxaparin, fondaparinux was a cost-saving strategy (lower cost with slightly higher effectiveness). Cost of revascularisation with major bleeding had a greater impact on the amount of cost saved both from societal and provider perspectives. With a threshold of 160,000 THB ((4,857.3 USD) per QALY in Thailand, fondaparinux was about 99% more cost-effective compared with enoxaparin. Fondaparinux should be considered as a cost-effective alternative when compared to enoxaparin for NSTE-ACS based on Thailand's context, especially in the era of limited healthcare resources. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

The cost of illness attributable to diabetic foot and cost-effectiveness of secondary prevention in Peru.

PubMed

Cárdenas, María Kathia; Mirelman, Andrew J; Galvin, Cooper J; Lazo-Porras, María; Pinto, Miguel; Miranda, J Jaime; Gilman, Robert H

2015-10-26

Diabetes mellitus is a public health challenge worldwide, and roughly 25% of patients with diabetes in developing countries will develop at least one foot ulcer during their lifetime. The gravest outcome of an ulcerated foot is amputation, leading to premature death and larger economic costs. This study aimed to estimate the economic costs of diabetic foot in high-risk patients in Peru in 2012 and to model the cost-effectiveness of a year-long preventive strategy for foot ulceration including: sub-optimal care (baseline), standard care as recommended by the International Diabetes Federation, and standard care plus daily self-monitoring of foot temperature. A decision tree model using a population prevalence-based approach was used to calculate the costs and the incremental cost-effectiveness ratio (ICER). Outcome measures were deaths and major amputations, uncertainty was tested with a one-way sensitivity analysis. The direct costs for prevention and management with sub-optimal care for high-risk diabetics is around US$74.5 million dollars in a single year, which decreases to US$71.8 million for standard care and increases to US$96.8 million for standard care plus temperature monitoring. The implementation of a standard care strategy would avert 791 deaths and is cost-saving in comparison to sub-optimal care. For standard care plus temperature monitoring compared to sub-optimal care the ICER rises to US$16,124 per death averted and averts 1,385 deaths. Diabetic foot complications are highly costly and largely preventable in Peru. The implementation of a standard care strategy would lead to net savings and avert deaths over a one-year period. More intensive prevention strategies such as incorporating temperature monitoring may also be cost-effective.

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

Baxter, Van D.; Munk, Jeffrey D.; Gehl, Anthony C.

The field study is planned to continue through the 2016 cooling season with the draft final project report due by September 30, 2016. This report provides a description of both installations and preliminary 2015 cooling and fall season performance results for the Knoxville site. For the August 18 through December 14 period, the Knoxville site GS-IHP provided 53.6% total source energy savings compared to a baseline electric RTU/heat pump and electric WH. Peak demand savings ranged from 33% to 59% per month. Energy cost savings of 53.1% have been achieved to date with more than half of that coming frommore » reduced demand charges. Data on installation and maintenance costs are being collected and will be combined with total test period energy savings data for a payback analysis to be included in the project final report. The GS-IHP also saved a significant amount of carbon emissions. The total emission savings for the Knoxville site for the August-December 2015 period were ~0.8 metric tons. If trading for carbon credits ever becomes a reality, additional cost savings would be realized.« less

Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.

PubMed

van Nieuwenhoven, Christianne A; Buskens, Erik; Bergmans, Dennis C; van Tiel, Frank H; Ramsay, Graham; Bonten, Marc J M

2004-01-01

Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were 351 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients. Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is <0.923, the costs of the intervention are less than 2,500 dollars, and the prevalence of VAP without intervention is >4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.

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

DTIC Science & Technology

2014-04-30

bäÉîÉåíÜ=^ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = Potential Cost Savings for Use of 3D Printing Combined With 3D...TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Potential Cost Savings for Use of 3D Printing Combined With 3D Imaging and...Chair: RADM David Lewis, USN Program Executive Officer, SHIPS Potential Cost Savings for Use of 3D Printing Combined With 3D Imaging and CPLM for

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

PubMed

Claxton, L; Taylor, M; Kay, E

2016-02-12

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

Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

PubMed

Cedillo, Sergio; Sicras-Mainar, Antoni; Jiménez-Ruiz, Carlos A; Fernández de Bobadilla, Jaime; Rejas-Gutiérrez, Javier

2017-01-01

The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation. © 2016 S. Karger AG, Basel.

[Cost- effectiveness analysis of pneumococcal vaccination in Iceland].

PubMed

Björnsdóttir, Margrét

2010-09-01

Pneumococcus is a common cause of disease among children and the elderly. With the emergence of resistant serotypes, antibiotic treatment is getting limited. Many countries have therefore introduced a vaccination program among children against the most common serotypes. The aim of this study was to analyse cost-effectiveness of adding a vaccination program against pneumococcus in Iceland. A cost-effectiveness analysis was carried out from a societal perspective where the cost-effectiveness ratio ICER was estimated from the cost of each additional life and life year saved. The analyse was based on the year 2008 and all cost were calculated accordingly. The rate of 3% was used for net present-value calculation. Annual societal cost due to pneumococcus in Iceland was estimated to be 718.146.252 ISK if children would be vaccinated but 565.026.552 ISK if they would not be vaccinated. The additional cost due to the vaccination program was therefore 153.119.700 ISK . The vaccination program could save 0,669 lives among children aged 0-4 years old and 21.11 life years. The cost was 228.878.476 ISK for each additional life saved and 7.253.420 ISK for each additional life year saved. Given initial assumptions the results indicate that a vaccination programme against pneumococcal disease in Iceland would be cost effective.

E-procurement and automatic identification: enhancing supply chain management in the healthcare industry.

PubMed

Smith, Alan D; Flanegin, Frank R

2004-01-01

The concepts of automated e-procurement, or electronic B2B (business-to-business) trade, are grounded in the strategic leveraging of both tangible/intangible assets for successful implementation and execution of electronic trade, resulting in significant financial benefits for firms. Some of the major reasons for this growth include significant process savings from automation, compliance, and purchasing advantage; and reduced costs that organisations can experience by conducting transactions electronically. Although these are the basic benefits associated with generic e-commerce strategies, a majority of these B2B transactions have focused on the purchase of indirect materials (especially office products and travel services). In fact, more than 93% of medical supplies on hospital shelves appear to have universal product numbers on them--at least while still in their boxes and there is a great potential for huge savings in e-procurement in the healthcare field. However, other types of supply chain-related purchases, including maintenance, repair, and operating and replacement parts, and direct material purchases, are becoming more important operational management considerations. In addition, several other key considerations are: existing procurement strategy, the vendor, technology, suppliers, and total costs of ownership. Companies need to analyse their current procurement strategy before developing an e-procurement plan.

An Analysis of the Cost and Performance of Photovoltaic Systems as a Function of Module Area

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

Horowitz, Kelsey A.W.; Fu, Ran; Silverman, Tim

We investigate the potential effects of module area on the cost and performance of photovoltaic systems. Applying a bottom-up methodology, we analyzed the costs associated with mc-Si and thin-film modules and systems as a function of module area. We calculate a potential for savings of up to $0.04/W, $0.10/W, and $0.13/W in module manufacturing costs for mc-Si, CdTe, and CIGS respectively, with large area modules. We also find that an additional $0.05/W savings in balance-of-systems costs may be achieved. However, these savings are dependent on the ability to maintain efficiency and manufacturing yield as area scales. Lifetime energy yield mustmore » also be maintained to realize reductions in the levelized cost of energy. We explore the possible effects of module size on efficiency and energy production, and find that more research is required to understand these issues for each technology. Sensitivity of the $/W cost savings to module efficiency and manufacturing yield is presented. We also discuss non-cost barriers to adoption of large area modules.« less

Cost-effectiveness of the Health X Project for tuberculosis control in China.

PubMed

Wang, W-B; Zhang, H; Petzold, M; Zhao, Q; Xu, B; Zhao, G-M

2014-08-01

Between 2002 and 2008, China's National Tuberculosis Control Programme created the Health X Project, financed in part by a World Bank loan, with additional funding from the UK Department for International Development. To assess the cost-effectiveness of the Project and its impact from a financial point of view on tuberculosis (TB) control in China. A decision-analytic model was used to evaluate the cost-effectiveness of the Project. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results. The primary outcome of the study was cost per disability-adjusted life-year (DALY) saved and incremental DALYs saved. In comparison with alternative scenario 1, the Project detected 1.6 million additional cases, 44 000 deaths were prevented and a total of 18.4 million DALYs saved. The Project strategies cost approximately Chinese yuan (CNY) 953 per DALY saved (vs. CNY1140 in the control areas), and saved an estimated CNY17.5 billion in comparison with the unchanged alternative scenario (scenario 1) or CNY10.8 billion with the control scenario (scenario 2). The Project strategies were affordable and of comparable cost-effectiveness to those of other developing countries. The results also provide strong support for the existing policy of scaling up DOTS in China.

Societal economic costs and benefits from death: another look.

PubMed

Stack, Steven

2007-04-01

B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide.

Productivity Savings from Colorectal Cancer Prevention and Control Strategies

PubMed Central

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

2011-01-01

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

Productivity savings from colorectal cancer prevention and control strategies.

PubMed

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

2011-08-01

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

Agricultural costs of the Chesapeake Bay total maximum daily load.

PubMed

Kaufman, Zach; Abler, David; Shortle, James; Harper, Jayson; Hamlett, James; Feather, Peter

2014-12-16

This study estimates costs to agricultural producers of the Watershed Implementation Plans (WIPs) developed by states in the Chesapeake Bay Watershed to comply with the Chesapeake Bay total maximum daily load (TMDL) and potential cost savings that could be realized by a more efficient selection of agricultural Best Management Practices (BMPs) and spatial targeting of BMP implementation. The cost of implementing the WIPs between 2011 and 2025 is estimated to be about $3.6 billion (in 2010 dollars). The annual cost associated with full implementation of all WIP BMPs from 2025 onward is about $900 million. Significant cost savings can be realized through careful and efficient BMP selection and spatial targeting. If retiring up to 25% of current agricultural land is included as an option, Bay-wide cost savings of about 60% could be realized compared to the WIPs.

Is fenofibrate a cost-saving treatment for middle-aged individuals with type 2 diabetes? A South African private-sector perspective.

PubMed

Wessels, Francois

2010-01-01

This project was based on the FIELD trial. It is a localisation of the study by Carrington and Stewart. The aim of the original study was to determine the impact of fenofibrate therapy on healthcare costs of middle-aged patients with type 2 diabetes at high risk of future cardiovascular events. The methodology used in the Carrington article was adopted for this study. The clinical foundation for the analysis was derived from the findings of the FIELD study. All costs were sourced from electronic databases obtained from private-sector South African funders of healthcare. Event costs for the cardiovascular events were determined and added to the treatment costs for the individual treatment arms. The cost saving was determined as the difference between the event costs saved and the additional treatment costs associated with fenofibrate treatment. All costs were reported as 2008 ZAR and a discount rate of 10% was used. The study adopted a South African private-sector funder perspective. If the same approach is followed as in the Carrington and Stewart study, a cost saving of 18% results. This is the difference between the total costs associated with the placebo and fenofibrate arms, respectively (R3 480 471 compared to R2 858 598 per 1 000 patient years for the placebo and fenofibrate arms, respectively). The total costs were determined as the sum of associated event costs and treatment costs for each of the comparators. Based on this exploratory analysis, it seems that Lipanthyl treatment in middle-aged patients resulted in a cost saving due to the prevention of cardiovascular events when it was used in the treatment of type 2 diabetics, as in the FIELD study. It should therefore be considered to be cost effective, even when just the cardiovascular risk reduction effect is considered.

Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study

PubMed Central

Cobiac, Linda J.; Vos, Theo; Barendregt, Jan J.

2009-01-01

Background Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity. Methods and Findings From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered. Conclusions Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector. Please see later in the article for Editors' Summary PMID:19597537

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

PubMed

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

2017-09-01

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

Cost-benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals.

PubMed

Diel, Roland; Nienhaus, Albert; Hillemann, Doris; Richter, Elvira

2016-02-01

Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects. Copyright ©ERS 2016.

Nuclear power technology requirements for NASA exploration missions

NASA Technical Reports Server (NTRS)

Bloomfield, Harvey S.

1990-01-01

It is pointed out that future exploration of the moon and Mars will mandate developments in many areas of technology. In particular, major advances will be required in planet surface power systems. Critical nuclear technology challenges that can enable strategic self-sufficiency, acceptable operational costs, and cost-effective space transportation goals for NASA exploration missions have been identified. Critical technologies for surface power systems include stationary and mobile nuclear reactor and radioisotope heat sources coupled to static and dynamic power conversion devices. These technologies can provide dramatic reductions in mass, leading to operational and transportation cost savings. Critical technologies for space transportation systems include nuclear thermal rocket and nuclear electric propulsion options, which present compelling concepts for significantly reducing mass, cost, or travel time required for Earth-Mars transport.

The costs of HIV antiretroviral therapy adherence programs and impact on health care utilization.

PubMed

Sansom, Stephanie L; Anthony, Monique N; Garland, Wendy H; Squires, Kathleen E; Witt, Mallory D; Kovacs Andrea, A; Larsen, Robert A; Valencia, Rosa; Pals, Sherri L; Hader, Shannon; Weidle, Paul J; Wohl, Amy R

2008-02-01

From a trial comparing interventions to improve adherence to antiretroviral therapy-directly administered antiretroviral therapy (DAART) or an intensive adherence case management (IACM)-to standard of care (SOC), for HIV-infected participants at public HIV clinics in Los Angeles County, California, we examined the cost of adherence programs and associated health care utilization. We assessed differences between DAART, IACM, and SOC in the rate of hospitalizations, hospital days, and outpatient and emergency department visits during an average of 1.7 years from study enrollment, beginning November 2001. We assigned costs to health care utilization and program delivery. We calculated incremental costs of DAART or IACM v SOC, and compared those costs with savings in health care utilization among participants in the adherence programs. IACM participants experienced fewer hospital days compared with SOC (2.3 versus 6.7 days/1000 person-days, incidence rate ratio [IRR]: 0.34, 97.5% confidence interval [CI]: 0.13-0.87). DAART participants had more outpatient visits than SOC (44.2 versus 31.5/1000 person-days, IRR: 1.4; 97.5% CI: 1.01-1.95). Average per-participant health care utilization costs were $13,127, $8,988, and $14,416 for DAART, IACM, and SOC, respectively. Incremental 6-month program costs were $2,120 and $1,653 for DAART and IACM participants, respectively. Subtracting savings in health care utilization from program costs resulted in an average net program cost of $831 per DAART participant; and savings of $3,775 per IACM participant. IACM was associated with a significant decrease in hospital days compared to SOC and was cost saving when program costs were compared to savings in health care utilization.

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

PubMed

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

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

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

PubMed

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

2015-09-01

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

Integrated orbital servicing study for low-cost payload programs. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Derocher, W. L., Jr.

1975-01-01

Various operating methodologies to achieve low-cost space operations were investigated as part of the Space Transportation System (STS) planning. The emphasis was to show that the development investment, initial fleet costs, and supporting facilities for the STS could be effectively offset by exploiting the capabilities of the STS to satisfy mission requirements and reduce the cost of payload programs. The following major conclusions were reached: (1) the development of an on-orbit servicer maintenance system is compatible with many spacecraft programs and is recommended as the most cost-effective system, (2) spacecraft can be designed to be serviceable with acceptable design, weight, volume, and cost effects, (3) use of on-orbit servicing over a 12 year period results in savings ranging between four and nine billion dollars, (4) the pivoting arm on-orbit servicer was selected and a preliminary design was prepared, (5) orbital maintenance has no significant impact on the STS.

Aircraft ground damage and the use of predictive models to estimate costs

NASA Astrophysics Data System (ADS)

Kromphardt, Benjamin D.

Aircraft are frequently involved in ground damage incidents, and repair costs are often accepted as part of doing business. The Flight Safety Foundation (FSF) estimates ground damage to cost operators $5-10 billion annually. Incident reports, documents from manufacturers or regulatory agencies, and other resources were examined to better understand the problem of ground damage in aviation. Major contributing factors were explained, and two versions of a computer-based model were developed to project costs and show what is possible. One objective was to determine if the models could match the FSF's estimate. Another objective was to better understand cost savings that could be realized by efforts to further mitigate the occurrence of ground incidents. Model effectiveness was limited by access to official data, and assumptions were used if data was not available. However, the models were determined to sufficiently estimate the costs of ground incidents.

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications.

PubMed

Pilz, Guenter; Patel, Pankaj A; Fell, Ulrich; Ladapo, Joseph A; Rizzo, John A; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2011-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option.

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications

PubMed Central

Patel, Pankaj A.; Fell, Ulrich; Ladapo, Joseph A.; Rizzo, John A.; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2010-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option. PMID:20524070

Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race.

PubMed

Sisk, Jane E; Whang, William; Butler, Jay C; Sneller, Vishnu-Priya; Whitney, Cynthia G

2003-06-17

Guidelines are increasingly recommending preventive services starting at 50 years of age, and policymakers are considering such a recommendation for pneumococcal polysaccharide vaccination. The finding that pneumococcal vaccination is cost-saving for people 65 years of age or older raises the question of the vaccination's implications for other older adults, especially black people, whose disease incidence exceeds that of nonblack people, and those with high-risk conditions. To assess the implications of vaccinating black and nonblack people 50 through 64 years of age against invasive pneumococcal disease. Cost-effectiveness analysis. Published literature for vaccination effectiveness and cost estimates; data on disease incidence and case-fatality rates from the Centers for Disease Control and Prevention. Hypothetical cohort 50 through 64 years of age with the 1995 U.S. age distribution. Lifetime. Societal. Pneumococcal polysaccharide vaccination compared with no vaccination. Incremental medical costs and health effects, in quality-adjusted life-years per vaccinee. Vaccination saved medical costs and improved health among high-risk black people (27.55 dollars savings per vaccinee) and nonblack people (5.92 dollars savings per vaccinee), excluding survivors' future costs. For low-risk black and nonblack people and the overall general population, vaccination cost 2477 dollars, 8195 dollars, and 3434 dollars, respectively, to gain 1 year of healthy life. Excluding survivors' future costs, in the general immunocompetent population, cost per quality-adjusted life-year in global worst-case results ranged from 21 513 dollars for black people to 68 871 dollars for nonblack people; in the high-risk population, cost ranged from 11 548 dollars for black people to 39 000 dollars for nonblack people. In the global best case, vaccination was cost-saving for black and nonblack people in the general immunocompetent and high-risk populations, excluding survivors' future costs. The cost-effectiveness range was narrower in probabilistic sensitivity analyses, with 95% probabilistic intervals ranging from cost-saving to 1594 dollars for black people and from cost-saving to 12 273 dollars for nonblack people in the general immunocompetent population. Costs per quality-adjusted life-year for low-risk people with case-fatality rates from 1998 were 2477 dollars for black people and 8195 dollars for nonblack people, excluding survivors' medical costs. These results support the current recommendation to vaccinate high-risk people and provide useful information for considering extending the recommendation to the general population 50 through 64 years of age. Lack of evidence about the effectiveness of revaccination for people 65 years of age or older, when disease risks are higher, argues for further research to guide vaccination policy.

Building Specifications

NASA Technical Reports Server (NTRS)

1978-01-01

The building in the top photo is the new home of the National Permanent Savings Bank in Washington, D.C., designed by Hartman-Cox Architects. Its construction was based on a money-saving method of preparing building specifications which derived from NASA technology developed to obtain quality construction while holding down cost of launch facilities, test centers and other structures. Written technical specifications spell out materials and components to be used on construction projects and identify the quality tests each item must pass. Specifications can have major impact on construction costs. Poorly formulated specifications can lead to unacceptable construction which must be replaced, unnecessarily high materials costs, safety hazards, disputes and often additional costs due to delays and litigation. NASA's Langley Research Center developed a novel approach to providing accurate, uniform, cost-effective specifications which can be readily updated to incorporate new building technologies. Called SPECSINTACT, it is a computerized - system accessible to all NASA centers involved in construction programs. The system contains a comprehensive catalog of master specifications applicable to many types of construction. It enables designers of any structure to call out relevant sections from computer storage and modify them to fit the needs of the project at hand. Architects and engineers can save time by concentrating their efforts on needed modifications rather than developing all specifications from scratch. Successful use of SPECSINTACT has led to a number of spinoff systems. One of the first was MASTERSPEC, developed from NASA's experience by Production Systems for Architects and Engineers, Inc., an organization established by the American Institute of Architects. MASTERSPEC, used in construction of the bank building pictured, follows the same basic format as SPECSINTACT and can be used in either automated or manual modes. The striking appearance of the bank building shows that, while MASTERSPEC saves time and money, its use involves no sacrfice in architectural design freedom. The Naval Engineering Facilities Command employs an automated specifications system based on SPECSINTACT. The Public Buildings Service of the General Services Administration used SPECSINTACT as a starting point in a plan to make its guideline specifications available to architects and engineers on a nationwide computer network. Public Technology, Inc., a NASA Technology Application Team, is working with Production Systems for Architects and Engineers, Inc., to promote widespread use of the system by state and local governments for cost benefits to taxpayers.

Alumina Calcination in the Fluid-Flash Calciner

NASA Astrophysics Data System (ADS)

Fish, William M.

In the mid 40's, Alcoa turned to fluidized solids techniques as a means of improving the efficiency of the alumina calcining process. This paper traces calciner development from the first pilot operation in 1946 through the first plant fluid-bed unit in 1952, the early "fluid-flash" calciner designs in 1960, the first 300 ton/day fluid-flash calciner at Alcoa's Bauxite, Arkansas plant in 1963, the 600 ton/day calciners installed in Suriname and Australia in 1965 and 1966, up to the 1500 ton/day Mark III calciners now operating in Jamaica, Australia and the United States. These Mark III fluid-flash calciners have provided a 30 to 40 percent fuel saving in addition to major savings in capital investment and maintenance costs.

How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

PubMed

Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

2015-09-21

Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.

Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases.

PubMed

Nielsen, Karen C; Greengrass, Roy A; Pietrobon, Ricardo; Klein, Stephen M; Steele, Susan M

2003-01-01

Continuous interscalene brachial plexus blockade (CIBPB) in a hospital setting can provide excellent surgical conditions and postoperative analgesia for major shoulder surgery. This is a case report of four patients on the efficacy and advantages of CIBPB for postoperative analgesia at home. Four patients scheduled for rotator cuff repair under CIBPB were discharged home the day of surgery with an interscalene catheter connected to an automated infusion pump administering 0.2% ropivacaine at 10 mL x hr(-1) for 72 hr. Prior to discharge, patients and their attendant were given verbal and written instructions concerning local anesthetic toxicity and explicit contact information for an anesthesiologist or nurse. Outcomes were measured pre- and postoperatively, including verbal analogue pain scores (pain VAS), verbal analogue nausea scores (nausea VAS), side effects, cognitive function (mini-mental state questionnaire), sleep (hours/night), and patient satisfaction (Likert scale). Postoperative VAS scores over three days were very low. Two patients reported only one episode of nausea. There were no complications associated with local anesthetic toxicity or catheter use. Cognitive function improved over three days. Sleep increased from a mean of five hours before surgery to seven hours over the next three nights. Patient satisfaction with care was high. Significant cost savings were documented. The use of CIBPB for 72 hr in patients undergoing major ambulatory shoulder surgery can result in good analgesia with minimal opioid requirement, cost savings and possibly improvement in outcome measures.

Hospital consolidation and costs: another look at the evidence.

PubMed

Dranove, David; Lindrooth, Richard

2003-11-01

We investigate whether pairwise hospital consolidation leads to cost savings. We use a unified empirical methodology to assess both systems and mergers. Our comparison group for each consolidation consists of 10 'pseudo-mergers' chosen based on propensity scores. Cost function estimates reveal that consolidation into systems does not generate savings, even after 4 years. Mergers in which hospitals consolidate financial reporting and licenses generate savings of approximately 14%: 2, 3, and 4 years after merger. The system consolidation and merger results are very robust to changes in the specification and the sample.

Energy and Cost Savings of Retro-Commissioning and Retrofit Measures for Large Office Buildings

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

Wang, Weimin; Zhang, Jian; Moser, Dave

2012-08-03

This paper evaluates the energy and cost savings of seven retro-commissioning measures and 29 retrofit measures applicable to most large office buildings. The baseline model is for a hypothetical building with characteristics of large office buildings constructed before 1980. Each retro-commissioning measure is evaluated against the original baseline in terms of its potential of energy and cost savings while each retrofit measure is evaluated against the commissioned building. All measures are evaluated in five locations (Miami, Las Vegas, Seattle, Chicago and Duluth) to understand the impact of weather conditions on energy and cost savings. The results show that implementation ofmore » the seven operation and maintenance measures as part of a retro-commissioning process can yield an average of about 22% of energy use reduction and 14% of energy cost reduction. Widening zone temperature deadband, lowering VAV terminal minimum air flow set points and lighting upgrades are effective retrofit measures to be considered.« less

The cost savings of expanding Medicaid eligibility to include currently uninsured homeless adults with substance use disorders.

PubMed

Zur, Julia; Mojtabai, Ramin; Li, Suhui

2014-04-01

Following the June 2012 Supreme Court ruling that states are no longer mandated to expand their Medicaid programs in 2014 as part of the Affordable Care Act, many states plan to opt out of the expansion, citing affordability as their primary concern. In response to this controversy, the present study evaluated the cost savings of expanding Medicaid coverage to include currently ineligible homeless adults with substance use disorders, a subset of the population that incurs some of the greatest societal costs and is disproportionately impacted by uninsurance. Using a time horizon of 7 years, separate analyses were conducted for state and federal governments, and then a final analysis evaluated the combined costs for the other two models. Results of the study demonstrate that, although the expansion will be associated with a net cost when combining state and federal expenses and savings, states will experience tremendous savings if they choose to participate.

What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?

PubMed

Galasko, Gavin I W; Barnes, Sophie C; Collinson, Paul; Lahiri, Avijit; Senior, Roxy

2006-01-01

To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects. A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD <45% on TE) were compared. A total of 1205 subjects attended. Ninety six per cent of subjects with LVSD in the general population had identifiable risk factors. All screening strategies gave excellent negative predictive value. Screening high-risk subjects was most cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing approximately 650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE). Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.

The economic value of contraception: a comparison of 15 methods.

PubMed Central

Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S

1995-01-01

OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2 PMID:7702112

A Cost Analysis of the Iowa Medicaid Primary Care Case Management Program

PubMed Central

Momany, Elizabeth T; Flach, Stephen D; Nelson, Forrest D; Damiano, Peter C

2006-01-01

Objective To determine the cost savings attributable to the implementation and expansion of a primary care case management (PCCM) program on Medicaid costs per member in Iowa from 1989 to 1997. Data Sources Medicaid administrative data from Iowa aggregated at the county level. Study Design Longitudinal analysis of costs per member per month, analyzed by category of medical expense using weighted least squares. We compared the actual costs with the expected costs (in the absence of the PCCM program) to estimate cost savings attributable to the PCCM program. Principal Findings We estimated that the PCCM program was associated with a savings of $66 million to the state of Iowa over the study period. Medicaid expenses were 3.8 percent less than what they would have been in the absence of the PCCM program. Effects of the PCCM program appeared to grow stronger over time. Use of the PCCM program was associated with increases in outpatient care and pharmaceutical expenses, but a decrease in hospital and physician expenses. Conclusions Use of a Medicaid PCCM program was associated with substantial aggregate cost savings over an 8-year period, and this effect became stronger over time. Cost reductions appear to have been mediated by substituting outpatient care for inpatient care. PMID:16899012

Prospects for reducing the processing cost of lithium ion batteries

DOE PAGES

Wood III, David L.; Li, Jianlin; Daniel, Claus

2014-11-06

A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; doubling the thicknesses of the anode and cathode to raise energy density; and, reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and amore » standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from $502.8 kWh-1-usable to $370.3 kWh-1-usable, a savings of $132.5/kWh (or 26.4%).« less

Cost-utility of enoxaparin compared with unfractionated heparin in unstable coronary artery disease

PubMed Central

Nicholson, Tricia; McGuire, Alistair; Milne, Ruairidh

2001-01-01

Background Low molecular weight heparins hold several advantages over unfractionated heparin including convenience of administration. Enoxaparin is one such heparin licensed in the UK for use in unstable coronary artery disease (unstable stable angina and non-Q wave myocardial infarction). In these patients, two large randomised controlled trials and their meta-analysis showed small benefits for enoxaparin over unfractionated heparin at 30–43 days and potentially at one year. We found no relevant published full economic evaluations, only cost studies, one of which was conducted in the UK. The other studies, from the US, Canada and France, are difficult to interpret since their resource use and costs may not reflect UK practice. Methods We aimed to compare the benefits and costs of short-term treatment (two to eight days) with enoxaparin and unfractionated heparin in unstable coronary artery disease. We used published data sources to estimate the incremental cost per quality adjusted life year (QALY), adopting a NHS perspective and using 1998 prices. Results The base case was a 0.013 QALY gain and net cost saving of £317 per person treated with enoxaparin instead of unfractionated heparin. All but one sensitivity analysis showed net savings and QALY gains, the exception (the worst case) being a cost per QALY of £3,305. Best cases were a £495 saving and 0.013 QALY gain, or a £317 saving and 0.014 QALY gain per person. Conclusions Enoxaparin appears cost saving compared with unfractionated heparin in patients with unstable coronary artery disease. However, cost implications depend on local revascularisation practice. PMID:11701090

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

PubMed

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

2016-08-01

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

Cost-effectiveness of point-of-care testing for dehydration in the pediatric ED.

PubMed

Whitney, Rachel E; Santucci, Karen; Hsiao, Allen; Chen, Lei

2016-08-01

Acute gastroenteritis (AGE) and subsequent dehydration account for a large proportion of pediatric emergency department (PED) visits. Point-of-care (POC) testing has been used in conjunction with clinical assessment to determine the degree of dehydration. Despite the wide acceptance of POC testing, little formal cost-effective analysis of POC testing in the PED exists. We aim to examine the cost-effectiveness of using POC electrolyte testing vs traditional serum chemistry testing in the PED for children with AGE. This was a cost-effective analysis using data from a randomized control trial of children with AGE. A decision analysis model was constructed to calculate cost-savings from the point of view of the payer and the provider. We used parameters obtained from the trial, including cost of testing, admission rates, cost of admission, and length of stay. Sensitivity analyses were performed to evaluate the stability of our model. Using the data set of 225 subjects, POC testing results in a cost savings of $303.30 per patient compared with traditional serum testing from the point of the view of the payer. From the point-of-view of the provider, POC testing results in consistent mean savings of $36.32 ($8.29-$64.35) per patient. Sensitivity analyses demonstrated the stability of the model and consistent savings. This decision analysis provides evidence that POC testing in children with gastroenteritis-related moderate dehydration results in significant cost savings from the points of view of payers and providers compared to traditional serum chemistry testing. Copyright © 2016 Elsevier Inc. All rights reserved.

Regional Variation in Residential Heat Pump Water Heater Performance in the U.S.: Preprint

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

Maguire, J.; Burch, J.; Merrigan, T.

2014-01-01

Residential heat pump water heaters (HPWHs) have recently reemerged on the U.S. market. These units have the potential to provide homeowners significant cost and energy savings. However, actual in use performance of a HPWH will vary significantly with climate, installation location, HVAC equipment, and hot water use. To determine what actual in use energy consumption of a HPWH may be in different regions of the U.S., annual simulations of both 50 and 80 gallon HPWHs as well as a standard electric water heater were performed for over 900 locations across the U.S. The simulations included a benchmark home to takemore » into account interactions between the space conditioning equipment and the HPWH and a realistic hot water draw profile. It was found that the HPWH will always save some source energy when compared to a standard electric resistance water heater, although savings varies widely with location. In addition to looking at source energy savings, the breakeven cost (the net installed cost a HPWH would have to have to be a cost neutral replacement for a standard water heater) was also examined. The highest breakeven costs were seen in cases with high energy savings, such as the southeastern U.S., or high energy costs, such as New England and California. While the breakeven cost is higher for 80 gallon units than 50 gallon units, the higher net installed costs of an 80 gallon unit lead to the 50 gallon HPWHs being more likely to be cost effective.« less

Valuation of travel time savings in viewpoint of WTA.

PubMed

Shao, Chang-Qiao; Liu, Yang; Liu, Xiao-Ming

2014-01-01

In order to investigate the issues in measurement of value of travel time savings (VTTS), the willingness-to-accept (WTA) for the private car owner is studied by using surveyed data. It is convincing that trip purpose, trip length, time savings, cost savings, income, and allowance from employee have effects on the WTA. Moreover, influences of these variables are not the same for different trip purposes. For commuting trips, effects of income and allowance from employee are significant while time savings and cost savings are dominated for leisure and shopping trips. It is also found that WTA is much higher than expected which implies that there are a group of drivers who are not prone to switching to other trip modes other than passenger car.

10 CFR 455.64 - Life-cycle cost methodology.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-investment ratio is the ratio of the present value of net cost savings attributable to an energy conservation measure to the present value of the net increase in investment, maintenance and operating, and replacement... present value. The format for displaying life-cycle costs shall be a savings-to-investment ratio. (b) An...

10 CFR 455.64 - Life-cycle cost methodology.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-investment ratio is the ratio of the present value of net cost savings attributable to an energy conservation measure to the present value of the net increase in investment, maintenance and operating, and replacement... present value. The format for displaying life-cycle costs shall be a savings-to-investment ratio. (b) An...

10 CFR 455.64 - Life-cycle cost methodology.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-investment ratio is the ratio of the present value of net cost savings attributable to an energy conservation measure to the present value of the net increase in investment, maintenance and operating, and replacement... present value. The format for displaying life-cycle costs shall be a savings-to-investment ratio. (b) An...

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…

Analysis of extreme values of the economic efficiency indicators of transport infrastructure projects

NASA Astrophysics Data System (ADS)

Korytárová, J.; Vaňková, L.

2017-10-01

Paper builds on previous research of the authors into the evaluation of economic efficiency of transport infrastructure projects evaluated by the economic efficiency ratio - NPV, IRR and BCR. Values of indicators and subsequent outputs of the sensitivity analysis show extremely favourable values in some cases. The authors dealt with the analysis of these indicators down to the level of the input variables and examined which inputs have a larger share of these extreme values. NCF for the calculation of above mentioned ratios is created by benefits that arise as the difference between zero and investment options of the project (savings in travel and operating costs, savings in travel time costs, reduction in accident costs and savings in exogenous costs) as well as total agency costs. Savings in travel time costs which contribute to the overall utility of projects by more than 70% appear to be the most important benefits in the long term horizon. This is the reason why this benefit emphasized. The outcome of the article has resulted how the particular basic variables contributed to the total robustness of economic efficiency of these project.

A cost-benefit analysis of a deposit-refund program for beverage containers in Israel

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

Lavee, Doron, E-mail: doron@pareto.co.i

2010-02-15

The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program - storage, collection, and treatment costs of empty containers, and all potential benefits - savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearlymore » economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.« less

Advocates of College-Savings Plans Hope to Cash In on Credit Crunch

ERIC Educational Resources Information Center

Kelderman, Eric

2008-01-01

This article reports that advocates of state-sponsored college-savings plans seek to use the current credit crunch as a wake-up call for parents and policy makers to shift away from the growing use of loans by families to cover college costs. In the long run, savings are the best way for most families to avoid the burdensome costs of private…

Economic evaluation of major knee surgery with recombinant activated factor VII in hemophilia patients with high titer inhibitors and advanced knee arthropathy: exploratory results via literature-based modeling.

PubMed

Ballal, Rahul D; Botteman, Marc F; Foley, Isaac; Stephens, Jennifer M; Wilke, Caitlyn T; Joshi, Ashish V

2008-03-01

People with severe hemophilia suffer from frequent intra-articular hemorrhages, leading to pain, swelling, reduced flexion, and arthropathy. Elective orthopedic surgery using factor VIII (FVIII) replacement to prevent uncontrolled bleeding has been endorsed as an effective treatment option for patients with severe or advanced hemophilic arthropathy. These surgeries reduce pain, restore mobility and function, and reduce the frequency of recurrent joint bleeds. Unfortunately, some patients with hemophilia develop inhibitors to FVIII, which neutralize FVIII activity and render the use of even massive amounts of FVIII replacement ineffective and surgery very risky. For this reason, elective surgical procedures in high-titer inhibitor patients had largely been abandoned until the introduction of new agents, such as recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Denmark). rFVIIa has been shown effective for prophylaxis during elective surgery and has therefore improved the feasibility of orthopedic surgery in hemophilia patients with high-titer inhibitors. The present research explored, from a modified US payer perspective, the direct economic and quality of life benefits of four different elective knee surgeries (total knee replacement [TKR], knee arthrodesis [KA], proximal tibial osteotomy, and distal femoral osteotomy) with rFVIIa coverage in hemophilia patients with high-titer inhibitors. An exploratory literature-based life-table model was developed to compare the direct medical costs and quality of life of two hypothetical cohorts of high-titer inhibitor patients with frequent bleeding episodes: one undergoing and the other not undergoing elective knee surgery. Knee surgery costs included perioperative rFVIIa costs, inpatient and rehabilitation care, and repeat procedures due to surgery failure, prosthesis loosening or deep infection. Based on efficacy studies, knee surgery was assumed to reduce mean annual bleeding episodes at the affected joint from 9.13 to 1.64. The cost of managing each bleeding episode was estimated at $15 298. Thus, by reducing bleeding episodes, surgery was expected to result in related cost offsets. All costs were expressed in 2006 US dollars. Surgery was also assumed to result in gains in quality of life by reducing pain and reducing bleeding episodes. The impact of pain reduction on quality of life and utility was estimated by simulating EQ-5D scores for a typical patient with and without knee surgery. Based on the model, average knee surgery costs are predicted to range from a low of $694 000 (for KA) to a high of $855 000 (for TKR). However, knee surgery is also expected to reduce the subsequent number of bleeding episodes and resultant costs, leading to long-term costs savings. Due to improvement in pain levels, surgical patients are expected to experience improvements in quality-adjusted life-years (QALYs). Thus, surgery appears to be the preferred strategy (i.e., saves costs and increases QALYs). Based on the assumptions used in the model, the initial cost of knee surgery was offset during the 8th and 10th years for KA and TKR, respectively, with intermediate break-even time for the other surgeries. As expected, cost savings and gains in QALYs increased over time, as well as the cost effective ness of knee surgery. Specifically, the cost per QALY with KA and TKR fell under $50 000/QALY during the 6th and 8th years, respectively, with intermediate time for the other surgeries. The present exploratory analysis is based on the long-term extrapolation of data from a small number of patients without inhibitors and short-term studies. It suggests that major knee surgery utilizing rFVIIa in hemophilia patients with inhibitors may be cost-effective on average, with expected cost savings apparent within a decade of knee surgery. The present exploratory results should be validated with real-world, longitudinal patient data.

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies

PubMed Central

Prada, Sergio I.

2017-01-01

Background The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug–drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. Objectives To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. Method For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. Discussion In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. Conclusion There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of methodology transparency, which is important, because lack of transparency hinders states from learning from each other. Ultimately, the federal government needs to evaluate and improve its DUR program. PMID:29403573

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

PubMed

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

2015-01-01

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

National Weatherization Assistance Program Impact Evaluation: Energy Impacts for Large Multifamily Buildings

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

Blasnik, Michael; Dalhoff, Greg; Carroll, David

This report estimates energy savings, energy cost savings, and cost effectiveness attributable to weatherizing large multifamily buildings under the auspices of the Department of Energy's Weatherization Assistance Program during Program Year 2008.

Verify by Genability - Providing Solar Customers with Accurate Reports of Utility Bill Cost Savings

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

The National Renewable Energy Laboratory (NREL), partnering with Genability and supported by the U.S. Department of Energy's SunShot Incubator program, independently verified the accuracy of Genability's monthly cost savings.

National Weatherization Assistance Program Impact Evaluation: Energy Impacts for Small Multifamily Buildings

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

Blasnik, Michael; Dalhoff, Greg; Carroll, David

2014-09-01

This report estimates energy savings, energy cost savings, and cost effectiveness attributable to weatherizing small multifamily buildings under the auspices of the Department of Energy's Weatherization Assistance Program during Program Year 2008.

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

PubMed

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

2012-08-01

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

Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

PubMed

Rhee, Peter C; Fischer, Michelle M; Rhee, Laura S; McMillan, Ha; Johnson, Anthony E

2017-03-01

Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. Economic/Decision Analysis IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Influenza vaccination health impact and cost effectiveness among adults aged 50 to 64 and 65 and older.

PubMed

Maciosek, Michael V; Solberg, Leif I; Coffield, Ashley B; Edwards, Nichol M; Goodman, Michael J

2006-07-01

Influenza causes approximately 36,000 deaths per year in the United States despite the presence of an effective vaccine. This assessment of the value of influenza vaccination to the U.S. population is part of an update to the 2001 ranking of clinical preventive services recommended by the U.S. Preventive Services Task Force. The forthcoming ranking will include the new recommendation of the Advisory Committee on Immunization Practices to extend influenza vaccination to adults aged 50 to 64 years. This service is evaluated on the two most important dimensions: burden of disease prevented and cost effectiveness. Study methods, described in a companion article, are designed to ensure consistency across many services. Over the lifetime of a birth cohort of 4 million, it is estimated that about 275,000 quality-adjusted life years (QALYs) would be saved if influenza vaccination were offered annually to all people after age 50. Eighty percent of the QALYs saved (220,000) would be achieved by offering the vaccine only to persons aged 65 and older. In year 2000 dollars, the cost effectiveness of influenza vaccination is $980 per QALY saved in persons aged 65 and older, and $28,000 per QALY saved in persons aged 50 to 64. When the costs of patient time and travel are excluded, the cost effectiveness ratio of vaccinating 50- to 64-year-olds decreases to $7200 per QALY saved, and vaccinating those aged 65 and older saves $17 per person vaccinated. Influenza vaccination is a high-impact, cost-effective service for persons aged 65 and older. Vaccinations are also cost effective for persons aged 50 to 64.

Ahorre Energia: Consejos sobre el ahorro de dinero y energia en el hogar (Book)

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

Not Available

Learn how to save money with Energy Saver: Tips on Saving Money & Energy at Home, from the U.S. Department of Energy. The Energy Saver guide will help you reduce your monthly energy costs and live more efficiently. This guide takes you through the systems and appliances that consume the most energy in your home, and provides solutions to cut costs for you while saving the environment. The Energy Saver guide also includes transportation tips to help you save money at the pump.

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.

A method to assess the potential effects of air pollution mitigation on healthcare costs.

PubMed

Sætterstrøm, Bjørn; Kruse, Marie; Brønnum-Hansen, Henrik; Bønløkke, Jakob Hjort; Flachs, Esben Meulengracht; Sørensen, Jan

2012-01-01

The aim of this study was to develop a method to assess the potential effects of air pollution mitigation on healthcare costs and to apply this method to assess the potential savings related to a reduction in fine particle matter in Denmark. The effects of air pollution on health were used to identify "exposed" individuals (i.e., cases). Coronary heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer were considered to be associated with air pollution. We used propensity score matching, two-part estimation, and Lin's method to estimate healthcare costs. Subsequently, we multiplied the number of saved cases due to mitigation with the healthcare costs to arrive to an expression for healthcare cost savings. The potential cost saving in the healthcare system arising from a modelled reduction in air pollution was estimated at €0.1-2.6 million per 100,000 inhabitants for the four diseases. We have illustrated an application of a method to assess the potential changes in healthcare costs due to a reduction in air pollution. The method relies on a large volume of administrative data and combines a number of established methods for epidemiological analysis.

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

PubMed

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

2014-01-01

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

Cost Analysis of a Novel Enzymatic Debriding Agent for Management of Burn Wounds.

PubMed

Giudice, Giuseppe; Filoni, Angela; Maggio, Giulio; Bonamonte, Domenico; Vestita, Michelangelo

2017-01-01

Introduction . Given its efficacy and safety, NexoBrid™ (NXB) has become part of our therapeutic options in burns treatment with satisfactory results. However, no cost analysis comparing NXB to the standard of care (SOC) has been carried out as of today. Aim . To assess the cost of treatment with NXB and compare it to the SOC cost. Methods . 20 patients with 14-22% of TBSA with an intermediate-deep thermal burn related injury were retrospectively and consecutively included. 10 of these patients were treated with the SOC, while the other 10 with NXB. The cost analysis was performed in accordance with the weighted average Italian Health Ministry DRGs and with Conferenza Stato/Regioni 2003 and the study by Tan et al. For each cost, 95% confidence intervals have been evaluated. Results . Considering the 10 patients treated with NXB, the overall savings (total net saving) amounted to 53300 euros. The confidence interval analysis confirmed the savings. Discussion . As shown by our preliminary results, significant savings are obtained with the use of NXB. The limit of our study is that it is based on Italian health care costs and assesses a relative small cohort of patients. Further studies on larger multinational cohorts are warranted.

Paternity leave in Sweden: costs, savings and health gains.

PubMed

Månsdotter, Anna; Lindholm, Lars; Winkvist, Anna

2007-06-01

The initial objective is to examine the relationship between paternity leave in 1978-1979 and male mortality during 1981-2001, and the second objective is to calculate the cost-effectiveness of the 1974 parental insurance reform in Sweden. Based on a population of all Swedish couples who had their first child together in 1978 (45,801 males), the risk of death for men who took paternity leave, compared with men who did not, was estimated by odds ratios. The cost-effectiveness analysis considered costs for information, administration and production losses, minus savings due to decreased sickness leave and inpatient care, compared to health gains in life-years and quality-adjusted life-years (QALYs). It is demonstrated that fathers who took paternity leave have a statistically significant decreased death risk of 16%. Costs minus savings (discounted values) stretch from a net cost of EUR 19 million to a net saving of EUR 11 million, and the base case cost-effectiveness is EUR 8000 per QALY. The study indicates that that the right to paternity leave is a desirable reform based on commonly stated public health, economic, and feminist goals. The critical issue in future research should be to examine impact from health-related selection.

Policy interactions and underperforming emission trading markets in China.

PubMed

Zhang, Bing; Zhang, Hui; Liu, Beibei; Bi, Jun

2013-07-02

Emission trading is considered to be cost-effective environmental economic instrument for pollution control. However, the ex post analysis of emission trading program found that cost savings have been smaller and the trades fewer than might have been expected at the outset of the program. Besides policy design issues, pre-existing environmental regulations were considered to have a significant impact on the performance of the emission trading market in China. Taking the Jiangsu sulfur dioxide (SO2) market as a case study, this research examined the impact of policy interactions on the performance of the emission trading market. The results showed that cost savings associated with the Jiangsu SO2 emission trading market in the absence of any policy interactions were CNY 549 million or 12.5% of total pollution control costs. However, policy interactions generally had significant impacts on the emission trading system; the lone exception was current pollution levy system. When the model accounted for all four kinds of policy interactions, the total pollution control cost savings from the emission trading market fell to CNY 39.7 million or 1.36% of total pollution control costs. The impact of policy interactions would reduce 92.8% of cost savings brought by emission trading program.

Economic aspects of drug substitution

PubMed Central

Salehi, Hossein; Schweitzer, Stuart O.

1985-01-01

One of the major directions of health policy is the attempt to contain expenditures on pharmaceuticals by encouraging substitution of generic for brand name drug products. Yet, a major marketing survey of prescribing and dispensing patterns in California in 1977 found relatively little drug substitution occurring, and in fact substitution of more expensive products occurred more frequently than did substitution of less expensive products. This article tests alternative models of pharmacy dispensing behavior to better explain substitution patterns and it estimates price functions to measure the extent to which cost savings on generic products are passed on to consumers. PMID:10311162

The Program Administrator Cost of Saved Energy for Utility Customer-Funded Energy Efficiency Programs

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

Billingsley, Megan A.; Hoffman, Ian M.; Stuart, Elizabeth

End-use energy efficiency is increasingly being relied upon as a resource for meeting electricity and natural gas utility system needs within the United States. There is a direct connection between the maturation of energy efficiency as a resource and the need for consistent, high-quality data and reporting of efficiency program costs and impacts. To support this effort, LBNL initiated the Cost of Saved Energy Project (CSE Project) and created a Demand-Side Management (DSM) Program Impacts Database to provide a resource for policy makers, regulators, and the efficiency industry as a whole. This study is the first technical report of themore » LBNL CSE Project and provides an overview of the project scope, approach, and initial findings, including: • Providing a proof of concept that the program-level cost and savings data can be collected, organized, and analyzed in a systematic fashion; • Presenting initial program, sector, and portfolio level results for the program administrator CSE for a recent time period (2009-2011); and • Encouraging state and regional entities to establish common reporting definitions and formats that would make the collection and comparison of CSE data more reliable. The LBNL DSM Program Impacts Database includes the program results reported to state regulators by more than 100 program administrators in 31 states, primarily for the years 2009–2011. In total, we have compiled cost and energy savings data on more than 1,700 programs over one or more program-years for a total of more than 4,000 program-years’ worth of data, providing a rich dataset for analyses. We use the information to report costs-per-unit of electricity and natural gas savings for utility customer-funded, end-use energy efficiency programs. The program administrator CSE values are presented at national, state, and regional levels by market sector (e.g., commercial, industrial, residential) and by program type (e.g., residential whole home programs, commercial new construction, commercial/industrial custom rebate programs). In this report, the focus is on gross energy savings and the costs borne by the program administrator—including administration, payments to implementation contractors, marketing, incentives to program participants (end users) and both midstream and upstream trade allies, and evaluation costs. We collected data on net savings and costs incurred by program participants. However, there were insufficient data on participant cost contributions, and uncertainty and variability in the ways in which net savings were reported and defined across states (and program administrators).« less

Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation.

PubMed

Treacy, Daniel; Howard, Kirsten; Hayes, Alison; Hassett, Leanne; Schurr, Karl; Sherrington, Catherine

2018-01-01

Among people admitted for inpatient rehabilitation, is usual care plus standing balance circuit classes more cost-effective than usual care alone? Cost-effectiveness study embedded within a randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. 162 rehabilitation inpatients from a metropolitan hospital in Sydney, Australia. The experimental group received a 1-hour standing balance circuit class, delivered three times a week for 2 weeks, in addition to usual therapy. The circuit classes were supervised by one physiotherapist and one physiotherapy assistant for up to eight patients. The control group received usual therapy alone. Costs were estimated from routinely collected hospital use data in the 3 months after randomisation. The functional outcome measure was mobility measured at 3 months using the Short Physical Performance Battery administered by a blinded assessor. An incremental analysis was conducted and the joint probability distribution of costs and outcomes was examined using bootstrapping. The median cost savings for the intervention group was AUD4,741 (95% CI 137 to 9,372) per participant; 94% of bootstraps showed that the intervention was both effective and cost saving. Two weeks of additional standing balance circuit classes delivered in addition to usual therapy resulted in decreased healthcare costs at 3 months in hospital inpatients admitted for rehabilitation. There is a high probability that this intervention is both cost saving and effective. ACTRN12611000412932. [Treacy D, Howard K, Hayes A, Hassett L, Schurr K, Sherrington C (2018) Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation. Journal of Physiotherapy 64: 41-47]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

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

PubMed

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

2017-08-01

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

Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs.

PubMed

Nordin, Andrew B; Sales, Stephen; Nielsen, Jason W; Adler, Brent; Bates, David Gregory; Kenney, Brian

2018-01-01

Ultrasound is preferred over computed tomography (CT) for diagnosing appendicitis in children to avoid undue radiation exposure. We previously reported our experience in instituting a standardized appendicitis ultrasound template, which decreased CT rates by 67.3%. In this analysis, we demonstrate the ongoing cost savings associated with using this template. Retrospective chart review for the time period preceding template implementation (June 2012-September 2012) was combined with prospective review through December 2015 for all patients in the emergency department receiving diagnostic imaging for appendicitis. The type of imaging was recorded, and imaging rates and ultrasound test statistics were calculated. Estimated annual imaging costs based on pretemplate ultrasound and CT utilization rates were compared with post-template annual costs to calculate annual and cumulative savings. In the pretemplate period, ultrasound and CT rates were 80.2% and 44.3%, respectively, resulting in a combined annual cost of $300,527.70. Similar calculations were performed for each succeeding year, accounting for changes in patient volume. Using pretemplate rates, our projected 2015 imaging cost was $371,402.86; however, our ultrasound rate had increased to 98.3%, whereas the CT rate declined to 9.6%, yielding an annual estimated cost of $224,853.00 and a savings of $146,549.86. Since implementation, annual savings have steadily increased for a cumulative cost savings of $336,683.83. Standardizing ultrasound reports for appendicitis not only reduces the use of CT scans and the associated radiation exposure but also decreases annual imaging costs despite increased numbers of imaging studies. Continued cost reduction may be possible by using diagnostic algorithms. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-World Cost Savings Demonstrated by Switching Patients with Refractory Diabetic Macular Edema to Intravitreal Fluocinolone Acetonide (Iluvien): A Retrospective Cost Analysis Study.

PubMed

Ch'ng, Soon W; Brent, Alexander J; Empeslidis, Theodoros; Konidaris, Vasileios; Banerjee, Somnath

2018-06-01

It is hypothesized that using fluocinolone acetonide (FAc) implants such as Iluvien for the treatment of diabetic macular edema (DME) may reduce the total number of intravitreal injections and clinic visits, resulting in an overall treatment cost reduction. The primary aim of this study is to identify the real-world cost savings achievable in a tertiary National Health Service (NHS) hospital. A retrospective cost analysis study was conducted. The inclusion criteria were patients with refractory DME who were switched to Iluvien. The average yearly costs were calculated both before and after the switch to Iluvien. All costs including medicines, investigations, clinics, and management of raised intraocular pressure (IOP) were calculated. The cost differences over the 3 years' worth of Iluvien treatment were calculated and analyzed. To ensure non-inferiority of this treatment intervention, the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were also analyzed. Statistical analysis was conducted with a Student t test where appropriate and statistical significance is identified where p < 0.05. Fourteen eyes of 13 patients met the inclusion criteria. Switching patients to Iluvien achieved on average a saving of £2606.17 per patient (p = 0.33) over the 3 years. However, seven cases (50%) had a rise in IOP after Iluvien that warranted medical treatment and two cases (14.3%) required glaucoma surgery. Incorporating the costs of glaucoma management reduced the overall savings over 3 years to £1064.66 per patient. The BCVA and CRT analysis showed a non-inferiority relationship between Iluvien and any previous treatment. The use of Iluvien in refractory DME patients represents a cost- and time-saving procedure, while showing non-inferiority in terms of efficacy.

Use of Residential Smart Appliances for Peak-Load Shifting and Spinning Reserves Cost/Benefit Analysis

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

Sastry, Chellury; Pratt, Robert G.; Srivastava, Viraj

2010-12-01

In this report, we present the results of an analytical cost/benefit study of residential smart appliances from a utility/grid perspective in support of a joint stakeholder petition to the ENERGY STAR program within the Environmental Protection Agency (EPA) and Department of Energy (DOE). The goal of the petition is in part to provide appliance manufacturers incentives to hasten the production of smart appliances. The underlying hypothesis is that smart appliances can play a critical role in addressing some of the societal challenges, such as anthropogenic global warming, associated with increased electricity demand, and facilitate increased penetration of renewable sources ofmore » power. The appliances we consider include refrigerator/freezers, clothes washers, clothes dryers, room air-conditioners, and dishwashers. The petition requests the recognition that providing an appliance with smart grid capability, i.e., products that meet the definition of a smart appliance, is at least equivalent to a corresponding five percent in operational machine efficiencies. It is then expected that given sufficient incentives and value propositions, and suitable automation capabilities built into smart appliances, residential consumers will be adopting these smart appliances and will be willing participants in addressing the aforementioned societal challenges by more effectively managing their home electricity consumption. The analytical model we utilize in our cost/benefit analysis consists of a set of user-definable assumptions such as the definition of on-peak (hours of day, days of week, months of year), the expected percentage of normal consumer electricity consumption (also referred to as appliance loads) that can shifted from peak hours to off-peak hours, the average power rating of each appliance, etc. Based on these assumptions, we then formulate what the wholesale grid operating-cost savings, or benefits, would be if the smart capabilities of appliances were invoked, and some percentage of appliance loads were shifted away from peak hours to run during off-peak hours, and appliance loads served power-system balancing needs such as spinning reserves that would otherwise have to be provided by generators. The rationale is that appliance loads can be curtailed for about ten minutes or less in response to a grid contingency without any diminution in the quality of service to the consumer. We then estimate the wholesale grid operating-cost savings based on historical wholesale-market clearing prices (location marginal and spinning reserve) from major wholesale power markets in the United States. The savings derived from the smart grid capabilities of an appliance are then compared to the savings derived from a five percent increase in traditional operational machine efficiencies, referred to as cost in this report, to determine whether the savings in grid operating costs (benefits) are at least as high as or higher than the operational machine efficiency credit (cost).« less

Interpreting cost of ownership for mix-and-match lithography

NASA Astrophysics Data System (ADS)

Levine, Alan L.; Bergendahl, Albert S.

1994-05-01

Cost of ownership modeling is a critical and emerging tool that provides significant insight into the ways to optimize device manufacturing costs. The development of a model to deal with a particular application, mix-and-match lithography, was performed in order to determine the level of cost savings and the optimum ways to create these savings. The use of sensitivity analysis with cost of ownership allows the user to make accurate trade-offs between technology and cost. The use and interpretation of the model results are described in this paper. Parameters analyzed include several manufacturing considerations -- depreciation, maintenance, engineering and operator labor, floorspace, resist, consumables and reticles. Inherent in this study is the ability to customize this analysis for a particular operating environment. Results demonstrate the clear advantages of a mix-and-match approach for three different operating environments. These case studies also demonstrate various methods to efficiently optimize cost savings strategies.

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

PubMed

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

2010-05-01

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

Health benefits, risks, and cost-effectiveness of influenza vaccination of children.

PubMed

Prosser, Lisa A; Bridges, Carolyn Buxton; Uyeki, Timothy M; Hinrichsen, Virginia L; Meltzer, Martin I; Molinari, Noelle-Angelique M; Schwartz, Benjamin; Thompson, William W; Fukuda, Keiji; Lieu, Tracy A

2006-10-01

We estimated cost-effectiveness of annually vaccinating children not at high risk with inactivated influenza vaccine (IIV) to range from US $12,000 per quality-adjusted life year (QALY) saved for children ages 6-23 months to $119,000 per QALY saved for children ages 12-17 years. For children at high risk (preexisting medical conditions) ages 6-35 months, vaccination with IIV was cost saving. For children at high risk ages 3-17 years, vaccination cost $1,000-$10,000 per QALY. Among children notat high risk ages 5-17 years, live, attenuated influenza vaccine had a similar cost-effectiveness as IIV. Risk status was more important than age in determining the economic effects of annual vaccination, and vaccination was less cost-effective as the child's age increased. Thus, routine vaccination of all children is likely less cost-effective than vaccination of all children ages 6-23 months plus all other children at high risk.

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

PubMed

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

2012-06-01

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

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

PubMed Central

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

2016-01-01

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

Enoxaparin. A pharmacoeconomic appraisal of its use in thromboembolic prophylaxis after total hip arthroplasty.

PubMed

Dunn, C J; Goa, K L

1996-08-01

Total hip arthroplasty (THA) is a major orthopaedic procedure with a high risk of postoperative thromboembolism. Increasing demand for this type of surgery, together with its high cost, has led to examination of means by which the cost of THA may be minimised. Current clinical opinion favours the use of suitable pharmacological thromboprophylaxis in patients undergoing THA; such prophylaxis may be provided with subcutaneous standard unfractionated heparin (UFH), oral warfarin or subcutaneous low molecular weight heparin (LMWH). Traditionally, LMWHs have been perceived as being more expensive to use than UFH or warfarin because of their relatively high acquisition cost. However, recent pharmacoeconomic data have shown that cost savings are possible when LMWHs are used. This is attributed mainly to reduced frequency of administration, reductions in costs associated with diagnosis and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the lack of need for laboratory monitoring of blood coagulation parameters. LMWHs have proportionally less anti-factor IIa (antithrombin) activity relative to anti-factor Xa activity than UFH. Enoxaparin, a LMWH with a mean molecular weight of 4 to 5kD, is reported to have approximately 5 times less activity against thrombin than UFH, for equivalent anti-factor Xa activity. Randomised clinical trials in patients undergoing THA have shown enoxaparin to be at least as effective as UFH in the prevention of DVT and PE, with consistent trends towards a lower incidence of DVT with enoxaparin than with UFH. Similar rates of haemorrhagic complications were reported for enoxaparin and UFH in most trials, although a significantly higher total transfusion requirement was reported for UFH than for enoxaparin in a double-blind study. A significantly higher incidence of bleeding was observed with UFH than with enoxaparin in another study, with similar transfusion requirements for both treatment groups. Cost comparisons in which costs were assigned retrospectively to clinical data have shown cost advantages for LMWHs in general over UFH when costs of administration, hospital bed occupancy and laboratory/radiology procedures are calculated. Cost savings with LMWHs were attributed mainly to reductions in the cost of managing thromboembolic complications in patients receiving these drugs. One meta-analysis showed a saving of $US50 000 (1993 figures) for LMWH over UFH (both subcutaneously twice daily) for every 1000 patients. Subcutaneous enoxaparin at a dosage of 30mg twice daily was shown to be more cost effective than oral warfarin in the prophylaxis of DVT and PE in 2 North American studies in which costs were related to outcomes. One study comprised the application of a decision analysis to a hypothetical group of 10 000 patients; an incremental cost effectiveness of $US12 288 (1993 figures) per death averted was reported for enoxaparin. Enoxaparin was also associated with an overall incremental cost effectiveness of $Can29 140 (1992 figures) per year of life saved (YLS) in the other study, in which costs were applied to clinical data obtained retrospectively from 10 randomised trials. Although no cost-effectiveness analyses have been carried out to compare enoxaparin with UFH, a UK cost comparison reported an overall cost saving of pounds 20 per patient (figures from 1989 to 1990) with enoxaparin 40mg once daily subcutaneously over subcutaneous UFH 5000IU 3 times daily. It has also been suggested that the use of once- or twice-daily enoxaparin in preference to UFH may reduce the overall length of hospital stay; a significant difference emerged in 1 analysis (9.9 or 9.5 vs 11.3 days). Pharmacoeconomic data therefore support the use of enoxaparin as an effective thromboprophylactic treatment with potential cost advantages over warfarin and UFH. Cost-effecti

A regression-based approach to estimating retrofit savings using the Building Performance Database

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

Walter, Travis; Sohn, Michael D.

Retrofitting building systems is known to provide cost-effective energy savings. This article addresses how the Building Performance Database is used to help identify potential savings. Currently, prioritizing retrofits and computing their expected energy savings and cost/benefits can be a complicated, costly, and an uncertain effort. Prioritizing retrofits for a portfolio of buildings can be even more difficult if the owner must determine different investment strategies for each of the buildings. Meanwhile, we are seeing greater availability of data on building energy use, characteristics, and equipment. These data provide opportunities for the development of algorithms that link building characteristics and retrofitsmore » empirically. In this paper we explore the potential of using such data for predicting the expected energy savings from equipment retrofits for a large number of buildings. We show that building data with statistical algorithms can provide savings estimates when detailed energy audits and physics-based simulations are not cost- or time-feasible. We develop a multivariate linear regression model with numerical predictors (e.g., operating hours, occupant density) and categorical indicator variables (e.g., climate zone, heating system type) to predict energy use intensity. The model quantifies the contribution of building characteristics and systems to energy use, and we use it to infer the expected savings when modifying particular equipment. We verify the model using residual analysis and cross-validation. We demonstrate the retrofit analysis by providing a probabilistic estimate of energy savings for several hypothetical building retrofits. We discuss the ways understanding the risk associated with retrofit investments can inform decision making. The contributions of this work are the development of a statistical model for estimating energy savings, its application to a large empirical building dataset, and a discussion of its use in informing building retrofit decisions.« less

How Automation Can Help Alleviate the Budget Crunch in Public Health Research.

PubMed

Muennig, Peter A

2015-09-01

In an era of severe funding constraints for public health research, more efficient means of conducting research will be needed if scientific progress is to continue. At present major funders, such as the National Institutes of Health, do not provide specific instructions to grant authors or to reviewers regarding the cost efficiency of the research that they conduct. Doing so could potentially allow more research to be funded within current budgetary constraints and reduce waste. I describe how a blinded randomized trial was conducted for $ 275,000 by completely automating the consent and data collection processes. The study used the participants' own computer equipment, relied on big data for outcomes, and outsourced some costly tasks, potentially saving $1 million in research costs.

Magnetic fields of green.

PubMed

Branton, Scott; Lile, Lawrence

2011-01-01

By incorporating even the basic elements of a more environmentally friendly, "green"construction and design in an MRI setting can create a safer, more pleasant space for the patients and staff, better images, and operational cost savings. Using building systems that have reduced amounts of steel can decrease construction time, increase thermal insulation, and reduce the weight of the structure meaning less energy required to transport and install. HVAC systems and lighting design can also play a major role in creating a "green"MRI suite. LEED certification places a focus on quality of the built environment, life cycle cost, and a productive indoor environment, as well as impact on the exterior environment. An LEED certified building considers costs and benefits for the lifetime of the building.

Potential Cost Savings Ideas for FAA and Users

DOT National Transportation Integrated Search

1997-06-04

The intent of this paper is to catalogue potential cost-savings ideas which : impact both the FAA and the aviation community. These ideas have come from : various sources including MITRE, Coopers & Lybrand (C&L), FAA studies, General : Accounting Off...

Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases: A multicenter study

PubMed Central

Viola, Anna; Costantino, Giuseppe; Privitera, Antonino Carlo; Bossa, Fabrizio; Lauria, Angelo; Grossi, Laurino; Principi, Maria Beatrice; Della Valle, Nicola; Cappello, Maria

2017-01-01

AIM To assess the impact of short infliximab (IFX) infusion on hospital resource utilization and costs. METHODS All inflammatory bowel diseases (IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were evaluated. RESULTS One hundred and twenty-five patients were recruited (64 with ulcerative colitis and 61 with Crohn’s disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years (SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501 (30.5% short infusions). In the analyzed cohort, 1143 h were saved (762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving (-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled (infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase (observation) leading to a time saving of 10% on average among the analyzed centers. Finally, the short infusion protocol has been demonstrated to lead to indirect cost savings of €138/patient (average -€17.300 on the whole cohort). CONCLUSION A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital’s perspective, as it contributes to increase infusion units capacity, and the patients’ perspective, as it reduces indirect costs and the impact of treatment on everyday life and work productivity. PMID:28533923

Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection.

PubMed

Cummings, Keith L; Anderson, Deverick J; Kaye, Keith S

2010-04-01

Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown. To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care. Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events. Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina. Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040-$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91-$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098-$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73-$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital. Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.

The Oncology Care Model: A Critique.

PubMed

Thomas, Christian A; Ward, Jeffrey C

2016-01-01

Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost. Several models have been piloted, including a Center for Medicare & Medicaid Innovation (CMMI)-sponsored medical home model (COME HOME) for patients with solid tumors that was able to generate savings by integrating a phone triage system, pathways, and seamless patient care 7 days a week to reduce overall cost of care, mostly by decreasing patient admissions to hospitals and referrals to emergency departments. CMMI is now launching a new pilot model, the Oncology Care Model (OCM), which differs from COME HOME in several important ways. It does not abolish FFS but provides an additional payment in 6-month increments for each patient on active cancer treatment. It also allows practices to participate in savings if they can decrease the overall cost of care, to include all chemotherapy and supportive care drugs, and fulfill certain quality metrics. A critical discussion of the proposed model, which is scheduled to start in 2016, will be provided at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting with practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.

Do microfinance programs help families insure consumption against illness?

PubMed

Gertler, Paul; Levine, David I; Moretti, Enrico

2009-03-01

Families in developing countries face enormous financial risks from major illness both in terms of the cost of medical care and the loss in income associated with reduced labor supply and productivity. We test whether access to microfinancial savings and lending institutions helps Indonesian families smooth consumption after declines in adult health. In general, results support the importance of these institutions in helping families to self-insure consumption against health shocks.

A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost-utility.

PubMed

Nghiem, Nhung; Cleghorn, Christine L; Leung, William; Nair, Nisha; Deen, Frederieke S van der; Blakely, Tony; Wilson, Nick

2017-07-24

Mass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost-utility of the package of a national quitline service and its promotion in the mass media. We adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs. The 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60-115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings. The package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving. © 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.

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

PubMed

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

2012-03-01

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

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

PubMed

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

2012-01-01

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

A cost/benefit analysis of commercial fusion-fission hybrid reactor development

NASA Astrophysics Data System (ADS)

Kostoff, Ronald N.

1983-04-01

A simple algorithm was developed that allows rapid computation of the ratio, R, of present worth of benefits to present worth of hybrid R&D program costs as a function of potential hybrid unit electricity cost savings, discount rate, electricity demand growth rate, total hybrid R&D program cost, and time to complete a demonstration reactor. In the sensitivity study, these variables were assigned nominal values (unit electricity cost savings of 4 mills/kW-hr, discount rate of 4%/year, growth rate of 2.25%/year, total R&D program cost of 20 billion, and time to complete a demonstration reactor of 30 years), and the variable of interest was varied about its nominal value. Results show that R increases with decreasing discount rate and increasing unit electricity savings and ranges from 4 to 94 as discount rate ranges from 5 to 3%/year and unit electricity savings range from 2 to 6 mills/kW-hr. R increases with increasing growth rate and ranges from 3 to 187 as growth rate ranges from 1 to 3.5%/year and unit electricity cost savings range from 2 to 6 mills/kW-hr. R attains a maximum value when plotted against time to complete a demonstration reactor. The location of this maximum value occurs at shorter completion times as discount rate increases, and this optimal completion time ranges from 20 years for a discount rate of 4%/year to 45 years for a discount rate of 3%/year.