Comparing methodologies for the allocation of overhead and capital costs to hospital services.

PubMed

Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

2009-06-01

Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

A Decomposition of Hospital Profitability: An Application of DuPont Analysis to the US Market.

PubMed

Turner, Jason; Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services' Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO hospitals, significant financial differences remain depending on their respective hospital characteristics. Those differences are tempered or exacerbated by location, size, teaching status, system affiliation, and critical access designation. With the exception of cost-based reimbursement for critical access hospitals, emerging payment systems are placing additional financial pressures on hospitals. The financial pressures being applied treat hospitals as a monolithic category and, given the delicate and often negative ROE for many hospitals, the long-term stability of the healthcare facility infrastructure may be negatively impacted.

A Decomposition of Hospital Profitability

PubMed Central

Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO hospitals, significant financial differences remain depending on their respective hospital characteristics. Those differences are tempered or exacerbated by location, size, teaching status, system affiliation, and critical access designation. With the exception of cost-based reimbursement for critical access hospitals, emerging payment systems are placing additional financial pressures on hospitals. The financial pressures being applied treat hospitals as a monolithic category and, given the delicate and often negative ROE for many hospitals, the long-term stability of the healthcare facility infrastructure may be negatively impacted. PMID:28462258

77 FR 48192 - Self-Regulatory Organizations; Chicago Mercantile Exchange, Inc.; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-13

... Liquidity Factor of Its Credit Default Swap Margin Methodology August 7, 2012. Pursuant to Section 19(b)(1... model. The liquidity margin component of the CME CDS margin model is designed to capture the risk... CDS Clearing Member. The current methodology for the liquidity factor is a function of a portfolio's...

76 FR 43360 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Notice of Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

.... The text of the proposed rule change is set forth below. Proposed new language is italicized; proposed... methodology approved by FINRA as announced in a Regulatory Notice (``approved margin methodology''). The... an Approved Margin Methodology. Members shall require as a minimum for computing customer or broker...

Program Risk Planning with Risk as a Resource

NASA Technical Reports Server (NTRS)

Ray, Paul S.

1998-01-01

The current focus of NASA on cost effective ways of achieving mission objectives has created a demand for a change in the risk management process of a program. At present, there is no guidelines as to when risk taking is justified due to high cost for a marginal improvement in risk. As a remedial step, Dr. Greenfield of NASA, developed a concept of risk management with risk as a resource. In the report, the following topics are addressed: (1) the risk management approach; (2) planning risk and program life cycle; (3) key components of a typical program; (4) the risk trading methodology; (5) review and decision process; (6) merits of the proposed risk planning approach; and (7) recommendations.

Marginal abatement cost curves for NOx incorporating both controls and alternative measures

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the efficient marginal abatement cost level for any aggregate emissions target when a least cost approach is implemented. In order for it to represent the efficient MAC level, all abatement opportunities across all sectors and loc...

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

Ramuhalli, Pradeep; Hirt, Evelyn H.; Veeramany, Arun

This research report summaries the development and evaluation of a prototypic enhanced risk monitor (ERM) methodology (framework) that includes alternative risk metrics and uncertainty analysis. This updated ERM methodology accounts for uncertainty in the equipment condition assessment (ECA), the prognostic result, and the probabilistic risk assessment (PRA) model. It is anticipated that the ability to characterize uncertainty in the estimated risk and update the risk estimates in real time based on equipment condition assessment (ECA) will provide a mechanism for optimizing plant performance while staying within specified safety margins. These results (based on impacting active component O&M using real-time equipmentmore » condition information) are a step towards ERMs that, if integrated with AR supervisory plant control systems, can help control O&M costs and improve affordability of advanced reactors.« less

Marginal cost curves for water footprint reduction in irrigated agriculture: a policy and decision making guide for efficient water use in crop production

NASA Astrophysics Data System (ADS)

Chukalla, Abebe; Krol, Maarten; Hoekstra, Arjen

2016-04-01

Reducing water footprints (WF) in irrigated crop production is an essential element in water management, particularly in water-scarce areas. To achieve this, policy and decision making need to be supported with information on marginal cost curves that rank measures to reduce the WF according to their cost-effectiveness and enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a certain reasonable WF benchmark. This paper aims to develop marginal cost curves (MCC) for WF reduction. The AquaCrop model is used to explore the effect of different measures on evapotranspiration and crop yield and thus WF that is used as input in the MCC. Measures relate to three dimensions of management practices: irrigation techniques (furrow, sprinkler, drip and subsurface drip); irrigation strategies (full and deficit irrigation); and mulching practices (no mulching, organic and synthetic mulching). A WF benchmark per crop is calculated as resulting from the best-available production technology. The marginal cost curve is plotted using the ratios of the marginal cost to WF reduction of the measures as ordinate, ranking with marginal costs rise with the increase of the reduction effort. For each measure, the marginal cost to reduce WF is estimated by comparing the associated WF and net present value (NPV) to the reference case (furrow irrigation, full irrigation, no mulching). The NPV for each measure is based on its capital costs, operation and maintenances costs (O&M) and revenues. A range of cases is considered, including: different crops, soil types and different environments. Key words: marginal cost curve, water footprint benchmark, soil water balance, crop growth, AquaCrop

SELECTION AND TREATMENT OF STRIPPER GAS WELLS FOR PRODUCTION ENHANCEMENT IN THE MID-CONTINENT

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

Scott Reeves

2003-08-01

Stripper gas wells are an important source of domestic energy supply and under constant threat of permanent loss (shut-in) due to marginal economics. In 1998, 192 thousand stripper gas wells produced over a Tcf of gas, at an average rate of less than 16 Mcfd. This represents about 57% of all producing gas wells in the onshore lower-48 states, yet only 8% of production. Reserves of stripper gas wells are estimated to be only 1.6 Tcf, or slightly over 1% of the onshore lower-48 total (end of year 1996 data). Obviously, stripper gas wells are at the very margin of economic sustenance. As the demand for natural gas in the U.S. grows to the forecasted estimate of over 30 Tcf annually by the year 2010, supply from current conventional sources is expected to decline. Therefore, an important need exists to fully exploit known domestic resources of natural gas, including those represented by stripper gas wells. The overall objectives of this project are to develop an efficient and low-cost methodology to broadly categorize the well performance characteristics for a stripper gas field, identify the high-potential candidate wells for remediation, and diagnose the specific causes for well underperformance. With this capability, stripper gas well operators can more efficiently and economically produce these resources and maximize these gas reserves. A further objective is to identify/develop, evaluate and test ''new and novel,'' economically viable remediation options. Finally, it is the objective of this project that all the methods and technologies developed in this project, while being tested in the Mid-Continent, be widely applicable to stripper gas wells of all types across the country. The project activities during the reporting period were: (1) Compiled information and results of field activities that Oneok has conducted in relation to the project. Field activities have included performing six pressure transient tests, and implementing six workovers, four of which were Gas-Gun treatments. (2) Results indicate that the candidate selection methodology was marginally successful based on the pressure transient test results, but highly successful based on the workovers. For the selected candidate wells that were worked over, incremental reserve costs were $$1.00/Mcf. (3) Based on the combined results, the accuracy of the candidate selection methodology tested under this project is unclear. Generally, however, the technique should provide better-than-average candidate selections.« less

The Short- and Long-Run Marginal Cost Curves: An Alternative Explanation.

ERIC Educational Resources Information Center

Boyd, Laura A.; Boyd, David W.

1994-01-01

Discusses issues related to short-run marginal cost and long-run marginal cost in economic theory. Asserts that few economics textbooks deal with important aspects of this concept. Includes four figures illustrating the approach suggested by the authors. (CFR)

Mental Depreciation and Marginal Decision Making

PubMed

Heath; Fennema

1996-11-01

We propose that individuals practice "mental depreciation," that is, they implicitly spread the fixed costs of their expenses over time or use. Two studies explore how people spread fixed costs on durable goods. A third study shows that depreciation can lead to two distinct errors in marginal decisions: First, people sometimes invest too much effort to get their money's worth from an expense (e.g., they may use a product a lot to spread the fixed expense across more uses). Second, people sometimes invest too little effort to get their money's worth: When people add a portion of the fixed cost to the current costs, their perceived marginal (i.e., incremental) costs exceed their true marginal costs. In response, they may stop investing because their perceived costs surpass the marginal benefits they are receiving. The latter effect is supported by two field studies that explore real board plan decisions by university students.

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

PubMed

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Electricity Prices in a Competitive Environment: Marginal Cost Pricing

EIA Publications

1997-01-01

Presents the results of an analysis that focuses on two questions: (1) How are prices for competitive generation services likely to differ from regulated prices if competitive prices are based on marginal costs rather than regulated cost-of-service pricing? (2) What impacts will the competitive pricing of generation services (based on marginal costs) have on electricity consumption patterns, production costs, and the financial integrity of electricity suppliers?

Forecast of long term coal supply and mining conditions: Model documentation and results

NASA Technical Reports Server (NTRS)

1980-01-01

A coal industry model was developed to support the Jet Propulsion Laboratory in its investigation of advanced underground coal extraction systems. The model documentation includes the programming for the coal mining cost models and an accompanying users' manual, and a guide to reading model output. The methodology used in assembling the transportation, demand, and coal reserve components of the model are also described. Results presented for 1986 and 2000, include projections of coal production patterns and marginal prices, differentiated by coal sulfur content.

Analysis of the production and transaction costs of forest carbon offset projects in the USA.

PubMed

Galik, Christopher S; Cooley, David M; Baker, Justin S

2012-12-15

Forest carbon offset project implementation costs, comprised of both production and transaction costs, could present an important barrier to private landowner participation in carbon offset markets. These costs likewise represent a largely undocumented component of forest carbon offset potential. Using a custom spreadsheet model and accounting tool, this study examines the implementation costs of different forest offset project types operating in different forest types under different accounting and sampling methodologies. Sensitivity results are summarized concisely through response surface regression analysis to illustrate the relative effect of project-specific variables on total implementation costs. Results suggest that transaction costs may represent a relatively small percentage of total project implementation costs - generally less than 25% of the total. Results also show that carbon accounting methods, specifically the method used to establish project baseline, may be among the most important factors in driving implementation costs on a per-ton-of-carbon-sequestered basis, dramatically increasing variability in both transaction and production costs. This suggests that accounting could be a large driver in the financial viability of forest offset projects, with transaction costs likely being of largest concern to those projects at the margin. Copyright © 2012 Elsevier Ltd. All rights reserved.

Wastewater Treatment Costs and Outlays in Organic Petrochemicals: Standards Versus Taxes With Methodology Suggestions for Marginal Cost Pricing and Analysis

NASA Astrophysics Data System (ADS)

Thompson, Russell G.; Singleton, F. D., Jr.

1986-04-01

With the methodology recommended by Baumol and Oates, comparable estimates of wastewater treatment costs and industry outlays are developed for effluent standard and effluent tax instruments for pollution abatement in five hypothetical organic petrochemicals (olefins) plants. The computational method uses a nonlinear simulation model for wastewater treatment to estimate the system state inputs for linear programming cost estimation, following a practice developed in a National Science Foundation (Research Applied to National Needs) study at the University of Houston and used to estimate Houston Ship Channel pollution abatement costs for the National Commission on Water Quality. Focusing on best practical and best available technology standards, with effluent taxes adjusted to give nearly equal pollution discharges, shows that average daily treatment costs (and the confidence intervals for treatment cost) would always be less for the effluent tax than for the effluent standard approach. However, industry's total outlay for these treatment costs, plus effluent taxes, would always be greater for the effluent tax approach than the total treatment costs would be for the effluent standard approach. Thus the practical necessity of showing smaller outlays as a prerequisite for a policy change toward efficiency dictates the need to link the economics at the microlevel with that at the macrolevel. Aggregation of the plants into a programming modeling basis for individual sectors and for the economy would provide a sound basis for effective policy reform, because the opportunity costs of the salient regulatory policies would be captured. Then, the government's policymakers would have the informational insights necessary to legislate more efficient environmental policies in light of the wealth distribution effects.

Area-Specific Marginal Costing for Electric Utilities: a Case Study of Transmission and Distribution Costs

NASA Astrophysics Data System (ADS)

Orans, Ren

1990-10-01

Existing procedures used to develop marginal costs for electric utilities were not designed for applications in an increasingly competitive market for electric power. The utility's value of receiving power, or the costs of selling power, however, depend on the exact location of the buyer or seller, the magnitude of the power and the period of time over which the power is used. Yet no electric utility in the United States has disaggregate marginal costs that reflect differences in costs due to the time, size or location of the load associated with their power or energy transactions. The existing marginal costing methods used by electric utilities were developed in response to the Public Utilities Regulatory Policy Act (PURPA) in 1978. The "ratemaking standards" (Title 1) established by PURPA were primarily concerned with the appropriate segmentation of total revenues to various classes-of-service, designing time-of-use rating periods, and the promotion of efficient long-term resource planning. By design, the methods were very simple and inexpensive to implement. Now, more than a decade later, the costing issues facing electric utilities are becoming increasingly complex, and the benefits of developing more specific marginal costs will outweigh the costs of developing this information in many cases. This research develops a framework for estimating total marginal costs that vary by the size, timing, and the location of changes in loads within an electric distribution system. To complement the existing work at the Electric Power Research Institute (EPRI) and Pacific Gas and Electric Company (PGandE) on estimating disaggregate generation and transmission capacity costs, this dissertation focuses on the estimation of distribution capacity costs. While the costing procedure is suitable for the estimation of total (generation, transmission and distribution) marginal costs, the empirical work focuses on the geographic disaggregation of marginal costs related to electric utility distribution investment. The study makes use of data from an actual distribution planning area, located within PGandE's service territory, to demonstrate the important characteristics of this new costing approach. The most significant result of this empirical work is that geographic differences in the cost of capacity in distribution systems can be as much as four times larger than the current system average utility estimates. Furthermore, lumpy capital investment patterns can lead to significant cost differences over time.

Marginal abatement cost curves for NOx that account for renewable electricity, energy efficiency, and fuel switching

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their resp...

Regional and sectoral marginal abatement cost curves for NOx incorporating controls, renewable electricity, energy efficiency and fuel switching

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their resp...

Marginal abatement cost curve for NOx incorporating controls, renewable electricity, energy efficiency and fuel switching

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their resp...

The Short- and Long-Run Marginal Cost Curve: A Pedagogical Note.

ERIC Educational Resources Information Center

Sexton, Robert L.; And Others

1993-01-01

Contends that the standard description of the relationship between the long-run marginal cost curve and the short-run marginal cost curve is often misleading and imprecise. Asserts that a sampling of college-level textbooks confirms this confusion. Provides a definition and instructional strategy that can be used to promote student understanding…

Marginal abatement cost curve for NOx incorporating controls, renewable electricity, energy efficiency and fuel switching

EPA Science Inventory

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their rela...

78 FR 25116 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-29

... Liquidity Factor of CME's CDS Margin Methodology April 23, 2013. Pursuant to Section 19(b)(1) of the... additions; bracketed text indicates deletions. * * * * * CME CDS Liquidity Margin Factor Calculation Methodology The Liquidity Factor will be calculated as the sum of two components: (1) A concentration charge...

77 FR 77160 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

... Liquidity Factor of CME's CDS Margin Methodology December 21, 2012. Pursuant to Section 19(b)(1) of the.... * * * * * CME CDS Liquidity Margin Factor Calculation Methodology The Liquidity Factor will be calculated as the... Liquidity Factor using the current Gross Notional Function with the following modifications: (1) the...

Evaluation of Margins of Safety in Brazed Joints

NASA Technical Reports Server (NTRS)

Flom, Yury; Wang, Len; Powell, Mollie M.; Soffa, Matthew A.; Rommel, Monica L.

2009-01-01

One of the essential steps in assuring reliable performance of high cost critical brazed structures is the assessment of the Margin of Safety (MS) of the brazed joints. In many cases the experimental determination of the failure loads by destructive testing of the brazed assembly is not practical and cost prohibitive. In such cases the evaluation of the MS is performed analytically by comparing the maximum design loads with the allowable ones and incorporating various safety or knock down factors imposed by the customer. Unfortunately, an industry standard methodology for the design and analysis of brazed joints has not been developed. This paper provides an example of an approach that was used to analyze an AlBeMet 162 (38%Be-62%Al) structure brazed with the AWS BAlSi-4 (Al-12%Si) filler metal. A practical and conservative interaction equation combining shear and tensile allowables was developed and validated to evaluate an acceptable (safe) combination of tensile and shear stresses acting in the brazed joint. These allowables are obtained from testing of standard tensile and lap shear brazed specimens. The proposed equation enables the assessment of the load carrying capability of complex brazed joints subjected to multi-axial loading.

The Marginal Costs of Instruction.

ERIC Educational Resources Information Center

Hoenack, Stephen A.; And Others

1986-01-01

A study of instructional costs in a large university focuses on graduate education, draws inferences about the economic costs of incremental or marginal enrollments, and examines how the costs facing faculty differ from those incurred by the administration and the state legislature. (MSE)

Estimating the Cost of Standardized Student Testing in the United States.

ERIC Educational Resources Information Center

Phelps, Richard P.

2000-01-01

Describes and contrasts different methods of estimating costs of standardized testing. Using a cost-accounting approach, compares gross and marginal costs and considers testing objects (test materials and services, personnel and student time, and administrative/building overhead). Social marginal costs of replacing existing tests with a national…

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

PubMed

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

2016-04-01

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

77 FR 76318 - Self-Regulatory Organizations; ICE Clear Europe Limited; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-27

... Methodology is an enhancement to the SPAN for the ICE Margining algorithm employed to calculate Original... Margining algorithm employed to calculate Original Margin and was designed to optimize and improve margin... framework algorithm. The enhancement will be additionally applied to: GOA: Gas Oil 1-Month CSO; BRZ: Brent...

Marginal-cost contracting in the NHS: results of a preliminary survey.

PubMed

Beddow, A J; Cohen, D R

2001-05-01

Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an 'internal market' in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery.

77 FR 76316 - Self-Regulatory Organizations; ICE Clear Europe Limited; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-27

... enhancement to the SPAN for the ICE Margining algorithm employed to calculate Original Margin. All capitalized... Allocation Methodology is an enhancement to the SPAN[supreg] \\6\\ for the ICE Margining algorithm employed to... the SPAN margin calculation algorithm itself has not been changed. As of August 30, 2011, Position...

Methodology for determining elevon deflections to trim and maneuver the DAST vehicle with negative static margin

NASA Technical Reports Server (NTRS)

Perry, B., III

1982-01-01

The relationships between elevon deflection and static margin using elements from static and dynamic stability and control and from classical control theory are emphasized. Expressions are derived and presented for calculating elevon deflections required to trim the vehicle in lg straight-and-level flight and to perform specified longitudinal and lateral maneuvers. Applications of this methodology are made at several flight conditions for the ARW-2 wing. On the basis of these applications, it appears possible to trim and maneuver the vehicle with the existing elevons at -15% static margin.

Three-Phase AC Optimal Power Flow Based Distribution Locational Marginal Price: Preprint

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

Yang, Rui; Zhang, Yingchen

2017-05-17

Designing market mechanisms for electricity distribution systems has been a hot topic due to the increased presence of smart loads and distributed energy resources (DERs) in distribution systems. The distribution locational marginal pricing (DLMP) methodology is one of the real-time pricing methods to enable such market mechanisms and provide economic incentives to active market participants. Determining the DLMP is challenging due to high power losses, the voltage volatility, and the phase imbalance in distribution systems. Existing DC Optimal Power Flow (OPF) approaches are unable to model power losses and the reactive power, while single-phase AC OPF methods cannot capture themore » phase imbalance. To address these challenges, in this paper, a three-phase AC OPF based approach is developed to define and calculate DLMP accurately. The DLMP is modeled as the marginal cost to serve an incremental unit of demand at a specific phase at a certain bus, and is calculated using the Lagrange multipliers in the three-phase AC OPF formulation. Extensive case studies have been conducted to understand the impact of system losses and the phase imbalance on DLMPs as well as the potential benefits of flexible resources.« less

26 CFR 1.925(b)-1T - Temporary regulations; marginal costing rules.

Code of Federal Regulations, 2010 CFR

2010-04-01

... rules—(1) In general. Marginal costing is a method under which only direct production costs of producing... combined taxable income of the FSC and its related supplier under section 925(a)(2). The costs to be taken into account are the related supplier's direct material and labor costs (as defined in § 1.471-11(b)(2...

Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

PubMed

Fanning, James; Fenton, Bradford; Jean, Geraldine Marie; Chae, Clara

2011-12-01

Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as scientific data suggesting a lack of effectiveness, the authors argue that prophylactic intraoperative ureteral stenting should not be used in gynecologic surgery to decrease operative ureteric injury.

Paying a Premium: How Patient Complexity Affects Costs and Profit Margins

PubMed Central

Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.

1999-01-01

Objective and Background Tertiary medical centers continue to be under extreme pressure to deliver high-complexity care, but paradoxically there is considerable pressure within these institutions to reduce their emphasis on tertiary care and refocus their efforts to develop a more community-like practice. The genesis of this pressure is the perceived profitability of routine surgical activity when compared with more complex care. The purpose of this study is to assess how the total cost and profit (loss) margin can vary for an entire trauma service. The authors also evaluate payments for specific trauma-related diagnostic-related groups (DRGs) and analyze how hospital margins were affected based on mortality outcome. Materials and Methods The authors analyzed the actual cost of all trauma discharges (n = 692) at their level I trauma center for fiscal year 1997. Data were obtained from the trauma registry and the hospital cost accounting system. Total cost was defined as the sum of the variable, fixed, and indirect costs associated with each patient. Margin was defined as expected payments minus total cost. The entire population and all DRGs with 10 or more patients were stratified based on survival outcome, Injury Severity Score, insurance status, and length of stay. The mean total costs for survivors and nonsurvivors within these various categories and their margins were evaluated. Results The profit margin on nonsurvivors was $5898 greater than for survivors, even though the mean total cost for nonsurvivors was $28,821 greater. Within the fixed fee arrangement, approximately 44% of transfers had a negative margin. Both survivors and nonsurvivors become increasingly profitable out to 20 days and subsequently become unprofitable beyond 21 days, but nonsurvivors were more profitable than survivors. Conclusions There is a wide variance in both the costs and margins within trauma-related DRGs. The DRG payment system disproportionately reimburses providers for nonsurvivors, even though on average they are more costly. Because payers are likely to engage in portfolio management, patients can be transferred between hospitals based on the contractual relationship between the payer and the provider. This payment system potentially allows payers to act strategically, sending relatively low-cost patients to hospitals where they use fee-for-service reimbursement and high-cost patients to hospitals where their reimbursement is contractually capped. Although specific to the authors’ trauma center and its payer mix, these data demonstrate the profitability of maintaining a level I trauma center and preserving the mission of delivering care to the severely injured. PMID:10363894

Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines.

PubMed

Singer, Lauren; Brown, Eric; Lanni, Thomas

2016-08-01

In this study, we compare the indications for re-excision, the findings of additional tumor in the re-excision specimen as they relate to margin status, and costs associated with re-excision based on recent new consensus statements. A retrospective analysis was performed on 462 patients with invasive breast carcinoma who underwent at least one lumpectomy between January 2011 and December 2013. Postoperative data was analyzed based on where additional disease was found, as it relates to the margin status of the initial lumpectomy and the additional direct costs associated with additional procedures. Of the 462 patients sampled, 149 underwent a re-excision surgery (32.2%). Four patients underwent mastectomy as their second operation. In the 40 patients with additional disease found on re-excision, 36 (90.0%) of them had a positive margin on their initial lumpectomy. None of the four mastectomy patients had residual disease. The mean cost of the initial lumpectomy for all 462 patients was $2118.01 plus an additional $1801.92 for those who underwent re-excision. A positive margin was most predictive of finding residual tumor on re-excision as would be expected. Using old criteria only 0.07% (4/61) of patients who had undergone re-excision with a 'clear' margin, had additional tumor found, at a total cost of $106,354.11. Thus, the new consensus guidelines will lead to less overall cost, at no clinical risk to patients while reducing a patient's surgical risk and essentially eliminating delays in adjuvant care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Applicability of a Conservative Margin Approach for Assessing NDE Flaw Detectability

NASA Technical Reports Server (NTRS)

Koshti, ajay M.

2007-01-01

Nondestructive Evaluation (NDE) procedures are required to detect flaws in structures with a high percentage detectability and high confidence. Conventional Probability of Detection (POD) methods are statistical in nature and require detection data from a relatively large number of flaw specimens. In many circumstances, due to the high cost and long lead time, it is impractical to build the large set of flaw specimens that is required by the conventional POD methodology. Therefore, in such situations it is desirable to have a flaw detectability estimation approach that allows for a reduced number of flaw specimens but provides a high degree of confidence in establishing the flaw detectability size. This paper presents an alternative approach called the conservative margin approach (CMA). To investigate the applicability of the CMA approach, flaw detectability sizes determined by the CMA and POD approaches have been compared on actual datasets. The results of these comparisons are presented and the applicability of the CMA approach is discussed.

Criterios Farmacoeconómicos Usados en México para la Evaluación de Tratamientos en Personas en Fases Terminales.

PubMed

Rizo Ríos, Pedro; González Rivera, Aurora; Campos Ramírez, Odette; Lifshitz Guinzberg, Alberto

2012-12-01

In Mexico, the primary aim of "Healthcare Supplies Catalog" (CBCISS) is guide the optimization of public resources to the attention of the health problems of the country, through the use of medicines, treatments, procedures and devices which have proven safety, efficacy and efficiency. Since May 2003, the Commission of CBCISS established as a requirement for updating submits a Health Economic Evaluation (EE) of the product. Therefore, in 2008, was a prepared and published methodological guideline for the conduct of studies of economic value (GCEEE). In 2011 was developed some strategies as updated the Internal Regulations and developed the Evaluation Guide Health Products (GEIS); both complement the GCEEE and oriented between other things, to increased the availability of technologies in different public institutions, decreased likelihood to commit injustices and inequities in access to supplies and standardize a transparent process. With the epidemiological transition, the cares of patients with chronic or terminal phase are contributing to the escalating costs of health care. The escalating costs are driven by the use of therapies that unfortunately have only marginal benefits, increasing the health and social costs, and upholding financial sustainability of healthcare systems. Therefore the stakeholders must decide the order of preference and establish an allocation methodology. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies.

PubMed

Koopmann, M C; Harms, B A; Heise, C P

2007-10-01

Cost analysis after laparoscopic colectomy has been examined, although reports evaluating the effects of laparoscopy on hospital operating margin are lacking. We compared several cost/revenue measures, including hospital operating margin, between open and laparoscopic colectomies at an academic center. Our cost-accounting database was queried for laparoscopic partial (LPC) and total colectomies (LTC), and open partial (OPC) and total colectomies (OTC) to analyze net revenue, total costs, and total hospital operating margin over a 4-year period. Laparoscopic and open colectomy cases were compared, with mean operating margin as the primary outcome. From July, 2002 through May, 2006, 842 patients were included for analysis with 138 undergoing laparoscopic colectomy. Net revenue was higher in the LTC group compared with open (US dollars 30,300 vs US dollars 26,800 [P = .02]), and lower in the LPC group (US dollars 15,300 vs US dollars 21,300 open [P < .0001]). Total costs were reduced in both the LPC and LTC groups compared with open [US dollars 11,700 vs US dollars 17,600 [P < .0001] and US dollars 18,000 vs US dollars 19,400 [P = .0019], respectively). LPC resulted in a similar HOM (US dollars 3,602) compared with OPC (US dollars 3,647; P = .35). LTC resulted in a higher HOM (US dollars 12,300) compared with OTC (US dollars 7,400; P = .02). LTC generates a significantly higher hospital operating margin than an OTC, although the margins are similar for LPC and OPC.

Bridging the Gap between Theory and Practice in Educational Research: Methods at the Margins

ERIC Educational Resources Information Center

Winkle-Wagner, Rachelle, Ed.; Hunter, Cheryl A., Ed.; Ortloff, Debora Hinderliter, Ed.

2009-01-01

This book provides new ways of thinking about educational processes, using quantitative and qualitative methodologies. Concrete examples of research techniques are provided for those conducting research with marginalized populations or about marginalized ideas. This volume asserts theoretical models related to research methods and the study of…

A non-stationary cost-benefit based bivariate extreme flood estimation approach

NASA Astrophysics Data System (ADS)

Qi, Wei; Liu, Junguo

2018-02-01

Cost-benefit analysis and flood frequency analysis have been integrated into a comprehensive framework to estimate cost effective design values. However, previous cost-benefit based extreme flood estimation is based on stationary assumptions and analyze dependent flood variables separately. A Non-Stationary Cost-Benefit based bivariate design flood estimation (NSCOBE) approach is developed in this study to investigate influence of non-stationarities in both the dependence of flood variables and the marginal distributions on extreme flood estimation. The dependence is modeled utilizing copula functions. Previous design flood selection criteria are not suitable for NSCOBE since they ignore time changing dependence of flood variables. Therefore, a risk calculation approach is proposed based on non-stationarities in both marginal probability distributions and copula functions. A case study with 54-year observed data is utilized to illustrate the application of NSCOBE. Results show NSCOBE can effectively integrate non-stationarities in both copula functions and marginal distributions into cost-benefit based design flood estimation. It is also found that there is a trade-off between maximum probability of exceedance calculated from copula functions and marginal distributions. This study for the first time provides a new approach towards a better understanding of influence of non-stationarities in both copula functions and marginal distributions on extreme flood estimation, and could be beneficial to cost-benefit based non-stationary bivariate design flood estimation across the world.

Mohs micrographic surgery vs traditional surgical excision: a cost comparison analysis.

PubMed

Bialy, Tracy L; Whalen, James; Veledar, Emir; Lafreniere, Denis; Spiro, Jeffrey; Chartier, Timothy; Chen, Suephy C

2004-06-01

To compare the cost and margin adequacy of Mohs micrographic surgery (Mohs) and traditional surgical excision (TSE) for the treatment of facial and auricular nonmelanoma skin cancer (NMSC). Prospective cost analysis with each patient serving as his or her own control. Study was performed from 1999 to 2001 at the University of Connecticut dermatology clinic, a tertiary care referral center. A total of 98 consecutive patients with a primary diagnosis of NMSC on the face and ears. The average cost of Mohs and TSE per patient for the treatment and repair of NMSC; adequacy of TSE margins after the initial procedure(because this outcome affects overall cost). Mohs was cost comparable to TSE when the subsequent procedure for inadequate TSE margins after permanent section was Mohs (937 vs 1029 US dollars; P =.16) or a subsequent TSE (937 vs 944 US dollars; P =.53). When facility-based frozen sections were requested for TSE, Mohs was significantly less costly (956 vs 1399 US dollars; P<.001). The cost difference between Mohs and TSE was sensitive to the type of repair chosen. If the end point is clear margins, Mohs is cost comparable to TSE performed by otolaryngologic surgeons. Some caution is needed when evaluating the cost of facial and auricular NMSC treatment because the choice of repair can significantly affect the cost conclusions.

The Welfare Effects of Monopoly versus Competition: A Clarification of Textbook Presentations.

ERIC Educational Resources Information Center

Lamdin, Douglas J.

1992-01-01

Addresses effects of monopoly and competition on societal welfare. Discusses inadequacy of economics textbooks. Concludes that most texts fail to explain the shape of monopolists' underlying cost curves. Argues that the monopolist's long run marginal cost curve cannot be obtained by horizontal summation of the long run marginal cost curves of…

Impact of Coverage-Dependent Marginal Costs on Optimal HPV Vaccination Strategies

PubMed Central

Ryser, Marc D.; McGoff, Kevin; Herzog, David P.; Sivakoff, David J.; Myers, Evan R.

2015-01-01

The effectiveness of vaccinating males against the human papillomavirus (HPV) remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs. PMID:25979280

Endovascular abdominal aortic aneurysm repair is more profitable than open repair based on contribution margin per day.

PubMed

Rosenberg, Barry L; Comstock, Matthew C; Butz, David A; Taheri, Paul A; Williams, David M; Upchurch, Gilbert R

2005-03-01

Earlier studies have reported that endovascular abdominal aortic aneurysm (EAAA) repair yields lower total profit margins than open AAA (OAAA) repair. This study compared EAAA versus OAAA based on contribution margin per day, which may better measure profitability of new clinical technologies. Contribution margin equals revenue less variable direct costs (VDCs). VDCs capture incremental resources tied directly to individual patients' activity (eg, invoice price of endograft device, nursing labor). Overhead costs factor into total margin, but not contribution margin. The University of Michigan Health System's cost accounting system was used to extract fiscal year 2002-2003 information on revenue, total margin, contribution margin, and duration of stay for Medicare patients with principal diagnosis of AAA (ICD-9 code 441.4). OAAA had revenues of $37,137 per case versus $28,960 for EAAA, similar VDCs per case, and thus higher contribution margin per case ($24,404 for OAAA vs $13,911 for EAAA, P < .001). However, OAAA had significantly longer mean duration of stay per case (10.2 days vs 2.2 days, P < .001). Therefore, mean contribution margin per day was $2948 for OAAA, but $8569 for EAAA ( P < .001). On the basis of contribution margin per day, EAAA repair dominates OAAA repair. The shorter duration of stay with EAAA allows higher throughput, fuller overhead amortization, better use of scarce inpatient beds, and higher health system profits. Surgeons must understand overhead allocation to devices, especially when new technologies cut duration of stay markedly.

Automatic control of electric thermal storage (heat) under real-time pricing. Final report

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

Daryanian, B.; Tabors, R.D.; Bohn, R.E.

1995-01-01

Real-time pricing (RTP) can be used by electric utilities as a control signal for responsive demand-side management (DSM) programs. Electric thermal storage (ETS) systems in buildings provide the inherent flexibility needed to take advantage of variations in prices. Under RTP, optimal performance for ETS operations is achieved under market conditions where reductions in customers` costs coincide with the lowering of the cost of service for electric utilities. The RTP signal conveys the time-varying actual marginal cost of the electric service to customers. The RTP rate is a combination of various cost components, including marginal generation fuel and maintenance costs, marginalmore » costs of transmission and distribution losses, and marginal quality of supply and transmission costs. This report describes the results of an experiment in automatic control of heat storage systems under RTP during the winter seasons of 1989--90 and 1990--91.« less

Electricity prices in a competitive environment: Marginal cost pricing of generation services and financial status of electric utilities. A preliminary analysis through 2015

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

NONE

1997-08-01

The emergence of competitive markets for electricity generation services is changing the way that electricity is and will be priced in the United States. This report presents the results of an analysis that focuses on two questions: (1) How are prices for competitive generation services likely to differ from regulated prices if competitive prices are based on marginal costs rather than regulated {open_quotes}cost-of-service{close_quotes} pricing? (2) What impacts will the competitive pricing of generation services (based on marginal costs) have on electricity consumption patterns, production costs, and the financial integrity patterns, production costs, and the financial integrity of electricity suppliers? Thismore » study is not intended to be a cost-benefit analysis of wholesale or retail competition, nor does this report include an analysis of the macroeconomic impacts of competitive electricity prices.« less

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

PubMed

Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

Fragility Analysis of Concrete Gravity Dams

NASA Astrophysics Data System (ADS)

Tekie, Paulos B.; Ellingwood, Bruce R.

2002-09-01

Concrete gravity dams are an important part ofthe nation's infrastructure. Many dams have been in service for over 50 years, during which time important advances in the methodologies for evaluation of natural phenomena hazards have caused the design-basis events to be revised upwards, in some cases significantly. Many existing dams fail to meet these revised safety criteria and structural rehabilitation to meet newly revised criteria may be costly and difficult. A probabilistic safety analysis (PSA) provides a rational safety assessment and decision-making tool managing the various sources of uncertainty that may impact dam performance. Fragility analysis, which depicts fl%e uncertainty in the safety margin above specified hazard levels, is a fundamental tool in a PSA. This study presents a methodology for developing fragilities of concrete gravity dams to assess their performance against hydrologic and seismic hazards. Models of varying degree of complexity and sophistication were considered and compared. The methodology is illustrated using the Bluestone Dam on the New River in West Virginia, which was designed in the late 1930's. The hydrologic fragilities showed that the Eluestone Dam is unlikely to become unstable at the revised probable maximum flood (PMF), but it is likely that there will be significant cracking at the heel ofthe dam. On the other hand, the seismic fragility analysis indicated that sliding is likely, if the dam were to be subjected to a maximum credible earthquake (MCE). Moreover, there will likely be tensile cracking at the neck of the dam at this level of seismic excitation. Probabilities of relatively severe limit states appear to be only marginally affected by extremely rare events (e.g. the PMF and MCE). Moreover, the risks posed by the extreme floods and earthquakes were not balanced for the Bluestone Dam, with seismic hazard posing a relatively higher risk.

77 FR 41109 - Margin Requirements for Uncleared Swaps for Swap Dealers and Major Swap Participants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-12

... and specifically requests quantitative data and analysis on the comparative costs and benefits of the... quantitative impact study (``QIS'') to assess the costs and benefits of margin requirements. The results of the...

Losses from effluent taxes and quotas under uncertainty

USGS Publications Warehouse

Watson, W.D.; Ridker, R.G.

1984-01-01

Recent theoretical papers by Adar and Griffin (J. Environ. Econ. Manag.3, 178-188 (1976)), Fishelson (J. Environ. Econ. Manag.3, 189-197 (1976)), and Weitzman (Rev. Econ. Studies41, 477-491 (1974)) show that,different expected social losses arise from using effluent taxes and quotas as alternative control instruments when marginal control costs are uncertain. Key assumptions in these analyses are linear marginal cost and benefit functions and an additive error for the marginal cost function (to reflect uncertainty). In this paper, empirically derived nonlinear functions and more realistic multiplicative error terms are used to estimate expected control and damage costs and to identify (empirically) the mix of control instruments that minimizes expected losses. ?? 1984.

Zonal characterization of hillslope erosion processes in a semi-arid high mountain catchment

NASA Astrophysics Data System (ADS)

Torres, Raquel; Millares, Agustín; Aguilar, Cristina; Moñino, Antonio; Ángel Losada, Miguel; José Polo, María

2013-04-01

Mediterranean and semi-arid catchments, generally suffer heterogeneous erosive processes at different spatio-temporal scales which produce, in a synergistic manner, a large amount of sediment supply. In mountainous catchments, the influence of pluvio-nival hydrological regime leads to a clear subdivision into homogeneous zones regarding the nature of hillslope processes. Here, a distinction could be addressed with 1) subsurface erosion due to saturated soil by intense snowmelt pulses and 2) steepest mid-mountain soil loss with rill/interrill, small-scale landslides and ephemeral or permanent gullying. Furthermore, the associated channels in these areas are formed by wide alluvial floodplains with important bedload contributions. This complexity conditions the evaluation of erosion and monitoring at catchment scale with elevated costs in time, devices and staff. The catchment of the Guadalfeo river encloses 1200 km², with important presence of snow in the summits height on its right margin, and semiarid low range hills with very erodible soils on its left margin. Gully erosion, landslides and stream bed-load processes, extremely actives in this area, are responsible of a real problem of soil loss and desertification with a high associated cost. This work suggests a methodology for the zonal assessment of different erosive processes taking into account the described heterogeneity and the reduction of research costs. To do this, high resolution bathymetric and topographic surveys supported in a reservoir (110 hm3) allowed the differentiation of bedload and suspended sediments as both are deposited in different locations and hence the validation of the hillslope sediment yield. In parallel, measurements in homogeneous areas were selected in order to obtain zonal results to achieve the representative processes involved. The use of portable samplers allows the remote changing of sampling routines, and thus to capture the temporal scale of the processes and the associated forcing agents. The obtained results validate the proposed methodology with adjustments/fitting between measured suspended sediment regarding the increase of volume registered at the dam. Furthermore, the measures obtained reveal a clear zonal differentiation in sediment yield which represents the heterogeneous dynamic of the processes involved.

Managerial accounting applications in radiology.

PubMed

Lexa, Frank James; Mehta, Tushar; Seidmann, Abraham

2005-03-01

We review the core issues in managerial accounting for radiologists. We introduce the topic and then explore its application to diagnostic imaging. We define key terms such as fixed cost, variable cost, marginal cost, and marginal revenue and discuss their role in understanding the operational and financial implications for a radiology facility by using a cost-volume-profit model. Our work places particular emphasis on the role of managerial accounting in understanding service costs, as well as how it assists executive decision making.

Costs and Benefits of Fly Ash Control (1973)

EPA Pesticide Factsheets

The purpose of this paper is to provide qualified answers to these questions: What level of charge will induce a power plant operator to meet the standards? Is the standard one at which marginal costs are approximately equal to marginal benefits?

Marginal costs of water savings from cooling system retrofits: a case study for Texas power plants

NASA Astrophysics Data System (ADS)

Loew, Aviva; Jaramillo, Paulina; Zhai, Haibo

2016-10-01

The water demands of power plant cooling systems may strain water supply and make power generation vulnerable to water scarcity. Cooling systems range in their rates of water use, capital investment, and annual costs. Using Texas as a case study, we examined the cost of retrofitting existing coal and natural gas combined-cycle (NGCC) power plants with alternative cooling systems, either wet recirculating towers or air-cooled condensers for dry cooling. We applied a power plant assessment tool to model existing power plants in terms of their key plant attributes and site-specific meteorological conditions and then estimated operation characteristics of retrofitted plants and retrofit costs. We determined the anticipated annual reductions in water withdrawals and the cost-per-gallon of water saved by retrofits in both deterministic and probabilistic forms. The results demonstrate that replacing once-through cooling at coal-fired power plants with wet recirculating towers has the lowest cost per reduced water withdrawals, on average. The average marginal cost of water withdrawal savings for dry-cooling retrofits at coal-fired plants is approximately 0.68 cents per gallon, while the marginal recirculating retrofit cost is 0.008 cents per gallon. For NGCC plants, the average marginal costs of water withdrawal savings for dry-cooling and recirculating towers are 1.78 and 0.037 cents per gallon, respectively.

Considering consumer choice in the economic evaluation of mandatory health programmes: a review.

PubMed

Parkinson, Bonny; Goodall, Stephen

2011-08-01

Governments are increasing their focus on mandatory public health programmes following positive economic evaluations of their impact. This review aims to examine whether loss of consumer choice should be included in economic evaluations of mandatory health programmes (MHP). A systematic literature review was conducted to identify economic evaluations of MHP, whether they discuss the impact on consumer choice and any methodological limitations. Overall 39 economic evaluations were identified, of which 10 discussed the loss of consumer choice and 6 attempted to place a value on the loss of consumer choice. Methodological limitations included: measuring the marginal cost of compliance, unavailability of price elasticity estimates, the impact of income effects, double counting health impacts, biased willingness-to-pay responses, and "protest" responses. Overall it was found that the inclusion of the loss of consumer choice rarely impacted on the final outcome of the study. The impact of MHP on the loss of consumer choice has largely been ignored in economic evaluations. Its importance remains uncertain due to its infrequent inclusion and significant methodological limitations. Further research regarding which methodology is best for valuing the loss of consumer choice and whether it is important to the final implementation decision is warranted. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

10 CFR 436.12 - Life cycle cost methodology.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

10 CFR 436.12 - Life cycle cost methodology.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

10 CFR 436.12 - Life cycle cost methodology.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

10 CFR 436.12 - Life cycle cost methodology.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

10 CFR 436.12 - Life cycle cost methodology.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

The financial implications of endovascular aneurysm repair in the cost containment era.

PubMed

Stone, David H; Horvath, Alexander J; Goodney, Philip P; Rzucidlo, Eva M; Nolan, Brian W; Walsh, Daniel B; Zwolak, Robert M; Powell, Richard J

2014-02-01

Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

The policy implications of the cost structure of home health agencies.

PubMed

Mukamel, Dana B; Fortinsky, Richard H; White, Alan; Harrington, Charlene; White, Laura M; Ngo-Metzger, Quyen

2014-01-01

To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.

Tsunami hazard assessments with consideration of uncertain earthquakes characteristics

NASA Astrophysics Data System (ADS)

Sepulveda, I.; Liu, P. L. F.; Grigoriu, M. D.; Pritchard, M. E.

2017-12-01

The uncertainty quantification of tsunami assessments due to uncertain earthquake characteristics faces important challenges. First, the generated earthquake samples must be consistent with the properties observed in past events. Second, it must adopt an uncertainty propagation method to determine tsunami uncertainties with a feasible computational cost. In this study we propose a new methodology, which improves the existing tsunami uncertainty assessment methods. The methodology considers two uncertain earthquake characteristics, the slip distribution and location. First, the methodology considers the generation of consistent earthquake slip samples by means of a Karhunen Loeve (K-L) expansion and a translation process (Grigoriu, 2012), applicable to any non-rectangular rupture area and marginal probability distribution. The K-L expansion was recently applied by Le Veque et al. (2016). We have extended the methodology by analyzing accuracy criteria in terms of the tsunami initial conditions. Furthermore, and unlike this reference, we preserve the original probability properties of the slip distribution, by avoiding post sampling treatments such as earthquake slip scaling. Our approach is analyzed and justified in the framework of the present study. Second, the methodology uses a Stochastic Reduced Order model (SROM) (Grigoriu, 2009) instead of a classic Monte Carlo simulation, which reduces the computational cost of the uncertainty propagation. The methodology is applied on a real case. We study tsunamis generated at the site of the 2014 Chilean earthquake. We generate earthquake samples with expected magnitude Mw 8. We first demonstrate that the stochastic approach of our study generates consistent earthquake samples with respect to the target probability laws. We also show that the results obtained from SROM are more accurate than classic Monte Carlo simulations. We finally validate the methodology by comparing the simulated tsunamis and the tsunami records for the 2014 Chilean earthquake. Results show that leading wave measurements fall within the tsunami sample space. At later times, however, there are mismatches between measured data and the simulated results, suggesting that other sources of uncertainty are as relevant as the uncertainty of the studied earthquake characteristics.

The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

ERIC Educational Resources Information Center

Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

2011-01-01

The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

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

Yang, Rui; Zhang, Yingchen

Designing market mechanisms for electricity distribution systems has been a hot topic due to the increased presence of smart loads and distributed energy resources (DERs) in distribution systems. The distribution locational marginal pricing (DLMP) methodology is one of the real-time pricing methods to enable such market mechanisms and provide economic incentives to active market participants. Determining the DLMP is challenging due to high power losses, the voltage volatility, and the phase imbalance in distribution systems. Existing DC Optimal Power Flow (OPF) approaches are unable to model power losses and the reactive power, while single-phase AC OPF methods cannot capture themore » phase imbalance. To address these challenges, in this paper, a three-phase AC OPF based approach is developed to define and calculate DLMP accurately. The DLMP is modeled as the marginal cost to serve an incremental unit of demand at a specific phase at a certain bus, and is calculated using the Lagrange multipliers in the three-phase AC OPF formulation. Extensive case studies have been conducted to understand the impact of system losses and the phase imbalance on DLMPs as well as the potential benefits of flexible resources.« less

Global budgets in Maryland: early evidence on revenues, expenses, and margins in regulated and unregulated services.

PubMed

Malmmose, Margit; Mortensen, Karoline; Holm, Claus

2018-04-02

Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state. We analyze financial results for both regulated (included in the global budget and subject to rate-setting) and unregulated services in order to capture a holistic image of the hospitals' actual revenue, cost and margin structures. Common size and difference-in-differences analyses of the data suggest that regulated profit ratios for treatment hospitals increased (from 5% in 2007 to 8% in 2013) and regulated expense-to-gross patient revenue ratios decreased (75% in 2007 and 68% in 2013) relative to the controls. Simultaneously, the profit margins for treatment hospitals' unregulated services decreased (- 12% in 2007 and - 17% in 2013), which reduced the overall margin significantly. This analysis therefore indicates cost shifting and less profit gain from the program than identified by solely focusing on the regulated margins.

Application of the WFD cost proportionality principle to diffuse pollution mitigation: a case study for Scottish Lochs.

PubMed

Vinten, A J A; Martin-Ortega, J; Glenk, K; Booth, P; Balana, B B; MacLeod, M; Lago, M; Moran, D; Jones, M

2012-04-30

The Water Framework Directive (WFD) aims to deliver good ecological status (GES) for Europe's waters. It prescribes the use of economic principles, such as derogation from GES on grounds of disproportionate costs of mitigation. This paper proposes an application of the proportionality principle to mitigation of phosphorus (P) pollution of 544 Scottish lochs at national and local water body scales. P loading estimates were derived from a national diffuse pollution screening tool. For 293 of these lochs (31% of the loch area), GES already occurred. Mitigation cost-effectiveness was assessed using combined mitigation cost curves for managed grassland, rough grazing, arable land, sewage and septic tank sources. These provided sufficient mitigation (92% of national P load) for GES to be achieved on another 31% of loch area at annualised cost of £2.09 m/y. Mitigation of the residual P loading preventing other lochs achieving GES was considered by using a "mop-up" cost of £200/kg P (assumed cost effectiveness of removal of P directly from lochs), leading to a total cost of £189 m/y. Lochs were ranked by mitigation costs per loch area to give a national scale marginal mitigation cost curve. A published choice experiment valuation of WFD targets for Scottish lochs was used to estimate marginal benefits at national scale and combined with the marginal cost curve. This gave proportionate costs of £5.7 m/y leading to GES in 72% of loch area. Using national mean marginal benefits with a scheme to estimate changes in individual loch value with P loading gave proportionate costs of £25.6 m/y leading to GES in 77% of loch area (491 lochs). Copyright © 2011 Elsevier Ltd. All rights reserved.

Pricing hospital care: Global budgets and marginal pricing strategies.

PubMed

Sutherland, Jason M

2015-08-01

The Canadian province of British Columbia (BC) is adding financial incentives to increase the volume of surgeries provided by hospitals using a marginal pricing approach. The objective of this study is to calculate marginal costs of surgeries based on assumptions regarding hospitals' availability of labor and equipment. This study is based on observational clinical, administrative and financial data generated by hospitals. Hospital inpatient and outpatient discharge summaries from the province are linked with detailed activity-based costing information, stratified by assigned case mix categorizations. To reflect a range of operating constraints governing hospitals' ability to increase their volume of surgeries, a number of scenarios are proposed. Under these scenarios, estimated marginal costs are calculated and compared to prices being offered as incentives to hospitals. Existing data can be used to support alternative strategies for pricing hospital care. Prices for inpatient surgeries do not generate positive margins under a range of operating scenarios. Hip and knee surgeries generate surpluses for hospitals even under the most costly labor conditions and are expected to generate additional volume. In health systems that wish to fine-tune financial incentives, setting prices that create incentives for additional volume should reflect knowledge of hospitals' underlying cost structures. Possible implications of mis-pricing include no response to the incentives or uneven increases in supply. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Incentive pricing and cost recovery at the basin scale.

PubMed

Ward, Frank A; Pulido-Velazquez, Manuel

2009-01-01

Incentive pricing programs have potential to promote economically efficient water use patterns and provide a revenue source to compensate for environmental damages. However, incentive pricing may impose disproportionate costs and aggravate poverty where high prices are levied for basic human needs. This paper presents an analysis of a two-tiered water pricing system that sets a low price for subsistence needs, while charging a price equal to marginal cost, including environmental cost, for discretionary uses. This pricing arrangement can promote efficient and sustainable water use patterns, goals set by the European Water Framework Directive, while meeting subsistence needs of poor households. Using data from the Rio Grande Basin of North America, a dynamic nonlinear program, maximizes the basin's total net economic and environmental benefits subject to several hydrological and institutional constraints. Supply costs, environmental costs, and resource costs are integrated in a model of a river basin's hydrology, economics, and institutions. Three programs are compared: (1) Law of the River, in which water allocations and prices are determined by rules governing water transfers; (2) marginal cost pricing, in which households pay the full marginal cost of supplying treated water; (3) two-tiered pricing, in which households' subsistence water needs are priced cheaply, while discretionary uses are priced at efficient levels. Compared to the Law of the River and marginal cost pricing, two-tiered pricing performs well for efficiency and adequately for sustainability and equity. Findings provide a general framework for formulating water pricing programs that promote economically and environmentally efficient water use programs while also addressing other policy goals.

Local Telephone Costs and the Design of Rate Structures,

DTIC Science & Technology

1981-05-01

guide the setting of prices for the multi-product regulated firm. Economic effi- ciency can be increased by designing rate structures that incorporate the... basic principles developed from this theory. These principles call for provisionally pricing each of the firm’s outputs at its marginal cost, testing...rule--prices are increased above marginal costs in inverse proportion to the individual price elasticities of demand. This paper applies ratemaking

Local health care expenditure plans and their opportunity costs.

PubMed

Karlsberg Schaffer, Sarah; Sussex, Jon; Devlin, Nancy; Walker, Andrew

2015-09-01

In the UK, approval decisions by Health Technology Assessment bodies are made using a cost per quality-adjusted life year (QALY) threshold, the value of which is based on little empirical evidence. We test the feasibility of estimating the "true" value of the threshold in NHS Scotland using information on marginal services (those planned to receive significant (dis)investment). We also explore how the NHS makes spending decisions and the role of cost per QALY evidence in this process. We identify marginal services using NHS Board-level responses to the 2012/13 Budget Scrutiny issued by the Scottish Government, supplemented with information on prioritisation processes derived from interviews with Finance Directors. We search the literature for cost-effectiveness evidence relating to marginal services. The cost-effectiveness estimates of marginal services vary hugely and thus it was not possible to obtain a reliable estimate of the threshold. This is unsurprising given the finding that cost-effectiveness evidence is rarely used to justify expenditure plans, which are driven by a range of other factors. Our results highlight the differences in objectives between HTA bodies and local health service decision makers. We also demonstrate that, even if it were desirable, the use of cost-effectiveness evidence at local level would be highly challenging without extensive investment in health economics resources. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Marginal abatement cost curves for NOx that account for ...

EPA Pesticide Factsheets

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their respective cost effectiveness. Alternative measures, such as renewable electricity, energy efficiency, and fuel switching (RE/EE/FS), are not considered as it is difficult to quantify their abatement potential. In this paper, we demonstrate the use of an energy system model to develop a MACC for nitrogen oxides (NOx) that incorporates both end-of-pipe controls and these alternative measures. We decompose the MACC by sector, and evaluate the cost-effectiveness of RE/EE/FS relative to end-of-pipe controls. RE/EE/FS are shown to produce considerable emission reductions after end-of-pipe controls have been exhausted. Furthermore, some RE/EE/FS are shown to be cost-competitive with end-of-pipe controls. Demonstrate how the MARKAL energy system model can be used to evaluate the potential role of renewable electricity, energy efficiency and fuel switching (RE/EE/FS) in achieving NOx reductions. For this particular analysis, we show that RE/EE/FSs are able to increase the quantity of NOx reductions available for a particular marginal cost (ranging from $5k per ton to $40k per ton) by approximately 50%.

Setting the most robust effluent level under severe uncertainty: application of information-gap decision theory to chemical management.

PubMed

Yokomizo, Hiroyuki; Naito, Wataru; Tanaka, Yoshinari; Kamo, Masashi

2013-11-01

Decisions in ecological risk management for chemical substances must be made based on incomplete information due to uncertainties. To protect the ecosystems from the adverse effect of chemicals, a precautionary approach is often taken. The precautionary approach, which is based on conservative assumptions about the risks of chemical substances, can be applied selecting management models and data. This approach can lead to an adequate margin of safety for ecosystems by reducing exposure to harmful substances, either by reducing the use of target chemicals or putting in place strict water quality criteria. However, the reduction of chemical use or effluent concentrations typically entails a financial burden. The cost effectiveness of the precautionary approach may be small. Hence, we need to develop a formulaic methodology in chemical risk management that can sufficiently protect ecosystems in a cost-effective way, even when we do not have sufficient information for chemical management. Information-gap decision theory can provide the formulaic methodology. Information-gap decision theory determines which action is the most robust to uncertainty by guaranteeing an acceptable outcome under the largest degree of uncertainty without requiring information about the extent of parameter uncertainty at the outset. In this paper, we illustrate the application of information-gap decision theory to derive a framework for setting effluent limits of pollutants for point sources under uncertainty. Our application incorporates a cost for reduction in pollutant emission and a cost to wildlife species affected by the pollutant. Our framework enables us to settle upon actions to deal with severe uncertainty in ecological risk management of chemicals. Copyright © 2013 Elsevier Ltd. All rights reserved.

Marginal Cost Pricing in a World without Perfect Competition: Implications for Electricity Markets with High Shares of Low Marginal Cost Resources

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

Frew, Bethany A.; Clark, Kara; Bloom, Aaron P.

A common approach to regulating electricity is through auction-based competitive wholesale markets. The goal of this approach is to provide a reliable supply of power at the lowest reasonable cost to the consumer. This necessitates market structures and operating rules that ensure revenue sufficiency for all generators needed for resource adequacy purposes. Wholesale electricity markets employ marginal-cost pricing to provide cost-effective dispatch such that resources are compensated for their operational costs. However, marginal-cost pricing alone cannot guarantee cost recovery outside of perfect competition, and electricity markets have at least six attributes that preclude them from functioning as perfectly competitive markets.more » These attributes include market power, externalities, public good attributes, lack of storage, wholesale price caps, and ineffective demand curve. Until (and unless) these failures are ameliorated, some form of corrective action(s) will be necessary to improve market efficiency so that prices can correctly reflect the needed level of system reliability. Many of these options necessarily involve some form of administrative or out-of-market actions, such as scarcity pricing, capacity payments, bilateral or other out-of-market contracts, or some hybrid combination. A key focus with these options is to create a connection between the electricity market and long-term reliability/loss-of-load expectation targets, which are inherently disconnected in the native markets because of the aforementioned market failures. The addition of variable generation resources can exacerbate revenue sufficiency and resource adequacy concerns caused by these underlying market failures. Because variable generation resources have near-zero marginal costs, they effectively suppress energy prices and reduce the capacity factors of conventional generators through the merit-order effect in the simplest case of a convex market; non-convexities can also suppress prices.« less

The Policy Implications of the Cost Structure of Home Health Agencies

PubMed Central

Mukamel, Dana B; Fortinsky, Richard H; White, Alan; Harrington, Charlene; White, Laura M; Ngo-Metzger, Quyen

2014-01-01

Purpose To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. Design and Methods 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. Results The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. Implications Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study. PMID:24949224

A New Approach to Hospital Cost Functions and Some Issues in Revenue Regulation

PubMed Central

Friedman, Bernard; Pauly, Mark V.

1983-01-01

An important aspect of hospital revenue regulation at the State level is the use of retroactive allowances for changes in the volume of service. Arguments favoring non-proportional allowances have been based on statistical studies of marginal cost, together with concerns about fairness toward non-profit enterprises or concerns about various inflationary biases in hospital management. This article attempts to review and clarify the regulatory issues and choices, with the aid of new econometric work that explicitly allows for the effects of transitory as well as expected demand changes on hospital expense. The present analysis is also novel in treating length of stay as an endogenous variable in cost functions. We analyzed cost variation for a panel of over 800 hospitals that reported monthly to Hospital Administrative Services between 1973 and 1978. The central results are that marginal cost of unexpected admissions is about half of average cost, while marginal cost of forecasted admissions is about equal to average cost. We obtained relatively low estimates of the cost of an “empty bed.” The study tends to support proportional volume allowances in revenue regulation programs, with perhaps a residual role for selective case review. PMID:10309853

Evaluation of the effects of nursery depopulation of the profitability of 34 pig farms.

PubMed

Dee, S A; Joo, H S; Polson, D D; Marsh, W E

1997-05-10

The financial impact of nursery depopulation was assessed on 34 pig farms by constructing a partial budget model to measure the profitability of the nursery production. The model measured margin over variable cost and used production data generated from a previous study; it assumed that fixed costs remained constant throughout the study and that feed cost, weaned pig cost and market price per nursery pig also remained fixed. The mean margin over variable cost per sow on the 34 farm after nursery depopulation was Pounds 116. Thirty-two of the farms showed reductions in this cost, ranging from Pounds 20 to Pounds 408 per sow, in the 12 months after nursery depopulation compared with the previous 12 months. Of the two farms which did not show an increase in profitability, one showed no change and the other showed a net loss of Pounds 8 per sow. The sows' serostatus for porcine reproductive and respiratory syndrome virus infection was monitored but there was no significant difference between the margin over variable cost per sow of the seropositive (Pounds 130) and seronegative (Pounds 170) herds.

RISMC Toolkit and Methodology Research and Development Plan for External Hazards Analysis

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

Coleman, Justin Leigh

This report includes the description and development plan for a Risk Informed Safety Margins Characterization (RISMC) toolkit and methodology that will evaluate multihazard risk in an integrated manner to support the operating nuclear fleet.

26 CFR 1.994-2 - Marginal costing rules.

Code of Federal Regulations, 2010 CFR

2010-04-01

... supplier (as defined in § 1.994-1(a)(3)(ii)) chooses, provided that the requirements of both subparagraphs... with Y whereby Y is granted a sales franchise with respect to exporting such product line from which...), combined taxable income under marginal costing is limited to $28.50. Since under the franchise agreement Y...

Three essays on pricing and risk management in electricity markets

NASA Astrophysics Data System (ADS)

Kotsan, Serhiy

2005-07-01

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

A model for predicting propagation-related DSCS (Defense Communications Engineering Center) margin requirements

NASA Astrophysics Data System (ADS)

Shultheis, C. F.

1985-02-01

This technical report describes an analysis of the performance allocations for a satellite link, focusing specifically on a single-hop 7 to 8 GHz link of the Defense Satellite Communications System (DSCS). The analysis is performed for three primary reasons: (1) to reevaluate link power margin requirements for DSCS links based on digital signalling; (2) to analyze the implications of satellite availability and error rate allocations contained in proposed MIL-STD-188-323, system design and engineering standards for long haul digital transmission system performance; and (3) to standardize a methodology for determination of rain-related propagation constraints. The aforementioned methodology is then used to calculate the link margin requirements of typical DSCS binary/quaternary phase shift keying (BPSK/QPSK) links at 7 to 8 GHz for several different Earth terminal locations.

In Space Nuclear Power as an Enabling Technology for Deep Space Exploration

NASA Technical Reports Server (NTRS)

Sackheim, Robert L.; Houts, Michael

2000-01-01

Deep Space Exploration missions, both for scientific and Human Exploration and Development (HEDS), appear to be as weight limited today as they would have been 35 years ago. Right behind the weight constraints is the nearly equally important mission limitation of cost. Launch vehicles, upper stages and in-space propulsion systems also cost about the same today with the same efficiency as they have had for many years (excluding impact of inflation). Both these dual mission constraints combine to force either very expensive, mega systems missions or very light weight, but high risk/low margin planetary spacecraft designs, such as the recent unsuccessful attempts for an extremely low cost mission to Mars during the 1998-99 opportunity (i.e., Mars Climate Orbiter and the Mars Polar Lander). When one considers spacecraft missions to the outer heliopause or even the outer planets, the enormous weight and cost constraints will impose even more daunting concerns for mission cost, risk and the ability to establish adequate mission margins for success. This paper will discuss the benefits of using a safe in-space nuclear reactor as the basis for providing both sufficient electric power and high performance space propulsion that will greatly reduce mission risk and significantly increase weight (IMLEO) and cost margins. Weight and cost margins are increased by enabling much higher payload fractions and redundant design features for a given launch vehicle (higher payload fraction of IMLEO). The paper will also discuss and summarize the recent advances in nuclear reactor technology and safety of modern reactor designs and operating practice and experience, as well as advances in reactor coupled power generation and high performance nuclear thermal and electric propulsion technologies. It will be shown that these nuclear power and propulsion technologies are major enabling capabilities for higher reliability, higher margin and lower cost deep space missions design to reliably reach the outer planets for scientific exploration.

The Development of a Methodology for Estimating the Cost of Air Force On-the-Job Training.

ERIC Educational Resources Information Center

Samers, Bernard N.; And Others

The Air Force uses a standardized costing methodology for resident technical training schools (TTS); no comparable methodology exists for computing the cost of on-the-job training (OJT). This study evaluates three alternative survey methodologies and a number of cost models for estimating the cost of OJT for airmen training in the Administrative…

The impact of age and gender on resource utilization and profitability in ED patients seen and released.

PubMed

Henneman, Philip L; Nathanson, Brian H; Ribeiro, Kara; Balasubramanian, Hari

2014-10-01

To determine how age and gender impact resource utilization and profitability in patients seen and released from an Emergency Department (ED). Billing data for patients seen and released from an Emergency Department (ED) with >100,000 annual visits between 2003 and 2009 were collected. Resource utilization was measured by length of stay (placement in ED bed to leaving the bed) and direct clinical costs (e.g., ED nursing salary and benefits, pharmacy and supply costs, etc.) estimated using relative value unit cost accounting. The primary outcome of profitability was defined as contribution margin per hour. A patient's contribution margin by insurance type (excluding self-pay) was determined by subtracting direct clinical costs from facility contractual revenue. Results are expressed as medians and US dollars. In 523 882 outpatient ED encounters, as patients' aged, length of stay and direct clinical cost increased while the contribution margin and contribution margin by hour decreased. Women of childbearing age (15-44) had higher median length of stay (2.1 hours), direct clinical cost ($149), and contribution margin per hour ($103/hour) than men of same age (1.7, $131, $85/hour, respectively). Resource utilization and profitability by gender were similar in children and adults over 45. Resource utilization increased and profitability decreased with increasing age in patients seen and released from an ED. The care of women of childbearing age resulted in higher resource utilization and higher profitability than men of the same age. No differences in resource utilization or profitability by gender were observed in children and adults over 45. Copyright © 2014 Elsevier Inc. All rights reserved.

Drivers of Hospital Costs in the Self-Pay Facelift (Rhytidectomy) Patient: Analysis of Hospital Resource Utilization in 1890 Patients.

PubMed

Chattha, Anmol; Bucknor, Alexandra; Chi, David; Ultee, Klaas; Chen, Austin D; Lin, Samuel J

2018-04-01

Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority in the USA. This study aims to analyze specific patient and hospital factors affecting the cost of this procedure. We conducted a retrospective cohort study of self-pay patients over the age of 18 who underwent rhytidectomy using the Healthcare Utilization Cost Project National Inpatient Sample database between 2013 and 2014. Mean marginal cost increases patient characteristics, and outcomes were studied. Generalized linear modeling with gamma regression and a log-link function were performed along with estimated marginal means to provide cost estimates. A total of 1890 self-pay patients underwent rhytidectomy. Median cost was $11,767 with an interquartile range of $8907 [$6976-$15,883]. The largest marginal cost increases were associated with postoperative hematoma ($12,651; CI $8181-$17,120), West coast region ($7539; 95% CI $6412-$8666), and combined rhinoplasty ($7824; 95% CI $3808-$11,840). The two risk factors associated with the generation of highest marginal inpatient costs were smoking ($4147; 95% CI $2804-$5490) and diabetes mellitus ($5622; 95% CI $3233-8011). High-volume hospitals had a decreased cost of - $1331 (95% CI - $2032 to - $631). Cost variation for inpatient rhytidectomy procedures is dependent on preoperative risk factors (diabetes and smoking), postoperative complications (hematoma), and regional trends (West region). Rhytidectomy surgery is highly centralized and increasing hospital volume significantly decreases costs. Clinicians and hospitals can use this information to discuss the drivers of cost in patients undergoing rhytidectomy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Methodological considerations in cost of illness studies on Alzheimer disease

PubMed Central

2012-01-01

Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable. PMID:22963680

17 CFR 39.5 - Review of swaps for Commission determination on clearing requirement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... publicly; (vi) Risk management procedures, including measurement and monitoring of credit exposures, initial and variation margin methodology, methodologies for stress testing and back testing, settlement procedures, and default management procedures; (vii) Applicable rules, manuals, policies, or procedures...

77 FR 59348 - Revisions to Page 700 of FERC Form No. 6

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-27

.... The components of an oil pipeline's rate base are governed by the Trended Original Cost Methodology... ratemaking methodology to the Trended Original Cost methodology as adopted in Opinion 154-B. The SRB was to... trended original cost methodology divides the nominal return on equity component of the cost of service...

Voices Unheard: Using Intersectionality to Understand Identity among Sexually Marginalized Undergraduate College Students of Color

ERIC Educational Resources Information Center

Russell, Elizabeth Irene Ann Annie

2012-01-01

This study used intersectionality as a framework and methodology to understand identity among sexually marginalized undergraduate college students of color. The research questions were as follows: (1) What are the experiences of QLGBTSGL (Queer, Lesbian, Gay, Bisexual, Transgender, Same Gender Loving) undergraduate students of color on a college…

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

PubMed

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

Reinventing The Design Process: Teams and Models

NASA Technical Reports Server (NTRS)

Wall, Stephen D.

1999-01-01

The future of space mission designing will be dramatically different from the past. Formerly, performance-driven paradigms emphasized data return with cost and schedule being secondary issues. Now and in the future, costs are capped and schedules fixed-these two variables must be treated as independent in the design process. Accordingly, JPL has redesigned its design process. At the conceptual level, design times have been reduced by properly defining the required design depth, improving the linkages between tools, and managing team dynamics. In implementation-phase design, system requirements will be held in crosscutting models, linked to subsystem design tools through a central database that captures the design and supplies needed configuration management and control. Mission goals will then be captured in timelining software that drives the models, testing their capability to execute the goals. Metrics are used to measure and control both processes and to ensure that design parameters converge through the design process within schedule constraints. This methodology manages margins controlled by acceptable risk levels. Thus, teams can evolve risk tolerance (and cost) as they would any engineering parameter. This new approach allows more design freedom for a longer time, which tends to encourage revolutionary and unexpected improvements in design.

Results of a Demonstration Assessment of Passive System Reliability Utilizing the Reliability Method for Passive Systems (RMPS)

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

Bucknor, Matthew; Grabaskas, David; Brunett, Acacia

2015-04-26

Advanced small modular reactor designs include many advantageous design features such as passively driven safety systems that are arguably more reliable and cost effective relative to conventional active systems. Despite their attractiveness, a reliability assessment of passive systems can be difficult using conventional reliability methods due to the nature of passive systems. Simple deviations in boundary conditions can induce functional failures in a passive system, and intermediate or unexpected operating modes can also occur. As part of an ongoing project, Argonne National Laboratory is investigating various methodologies to address passive system reliability. The Reliability Method for Passive Systems (RMPS), amore » systematic approach for examining reliability, is one technique chosen for this analysis. This methodology is combined with the Risk-Informed Safety Margin Characterization (RISMC) approach to assess the reliability of a passive system and the impact of its associated uncertainties. For this demonstration problem, an integrated plant model of an advanced small modular pool-type sodium fast reactor with a passive reactor cavity cooling system is subjected to a station blackout using RELAP5-3D. This paper discusses important aspects of the reliability assessment, including deployment of the methodology, the uncertainty identification and quantification process, and identification of key risk metrics.« less

Methodology Development for Passive Component Reliability Modeling in a Multi-Physics Simulation Environment

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

Aldemir, Tunc; Denning, Richard; Catalyurek, Umit

Reduction in safety margin can be expected as passive structures and components undergo degradation with time. Limitations in the traditional probabilistic risk assessment (PRA) methodology constrain its value as an effective tool to address the impact of aging effects on risk and for quantifying the impact of aging management strategies in maintaining safety margins. A methodology has been developed to address multiple aging mechanisms involving large numbers of components (with possibly statistically dependent failures) within the PRA framework in a computationally feasible manner when the sequencing of events is conditioned on the physical conditions predicted in a simulation environment, suchmore » as the New Generation System Code (NGSC) concept. Both epistemic and aleatory uncertainties can be accounted for within the same phenomenological framework and maintenance can be accounted for in a coherent fashion. The framework accommodates the prospective impacts of various intervention strategies such as testing, maintenance, and refurbishment. The methodology is illustrated with several examples.« less

10 CFR 455.64 - Life-cycle cost methodology.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Life-cycle cost methodology. 455.64 Section 455.64 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.64 Life-cycle cost methodology. (a) The life-cycle cost methodology under § 455.63(b) of this part is a systematic comparison of the...

10 CFR 455.64 - Life-cycle cost methodology.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Life-cycle cost methodology. 455.64 Section 455.64 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.64 Life-cycle cost methodology. (a) The life-cycle cost methodology under § 455.63(b) of this part is a systematic comparison of the...

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

PubMed

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

PubMed Central

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-01-01

Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

Value analysis for advanced technology products

NASA Astrophysics Data System (ADS)

Soulliere, Mark

2011-03-01

Technology by itself can be wondrous, but buyers of technology factor in the price they have to pay along with performance in their decisions. As a result, the ``best'' technology may not always win in the marketplace when ``good enough'' can be had at a lower price. Technology vendors often set pricing by ``cost plus margin,'' or by competitors' offerings. What if the product is new (or has yet to be invented)? Value pricing is a methodology to price products based on the value generated (e.g. money saved) by using one product vs. the next best technical alternative. Value analysis can often clarify what product attributes generate the most value. It can also assist in identifying market forces outside of the control of the technology vendor that also influence pricing. These principles are illustrated with examples.

[Risk Management: concepts and chances for public health].

PubMed

Palm, Stefan; Cardeneo, Margareta; Halber, Marco; Schrappe, Matthias

2002-01-15

Errors are a common problem in medicine and occur as a result of a complex process involving many contributing factors. Medical errors significantly reduce the safety margin for the patient and contribute additional costs in health care delivery. In most cases adverse events cannot be attributed to a single underlying cause. Therefore an effective risk management strategy must follow a system approach, which is based on counting and analysis of near misses. The development of defenses against the undesired effects of errors should be the main focus rather than asking the question "Who blundered?". Analysis of near misses (which in this context can be compared to indicators) offers several methodological advantages as compared to the analysis of errors and adverse events. Risk management is an integral element of quality management.

Design, Fabrication, and Performance of Foil Gas Thrust Bearings for Microturbomachinery Applications

NASA Technical Reports Server (NTRS)

Dykas, Brian; Bruckner, Robert; DellaCorte, Christopher; Edmonds, Brian; Prahl, Joseph

2008-01-01

A methodology for the design and construction of simple foil thrust bearings intended for parametric performance testing and low marginal costs is presented. Features drawn from a review of the open literature are discussed as they relate to bearing performance. The design of fixtures and tooling required to fabricate foil thrust bearings is presented, using conventional machining processes where possible. A prototype bearing with dimensions drawn from the literature is constructed, with all fabrication steps described. A load-deflection curve for the bearing is presented to illustrate structural stiffness characteristics. Start-top cycles are performed on the bearing at a temperature of 425 C to demonstrate early-life wear patterns. A test of bearing load capacity demonstrates useful performance when compared with data obtained from the open literature.

System Guidelines for EMC Safety-Critical Circuits: Design, Selection, and Margin Demonstration

NASA Technical Reports Server (NTRS)

Lawton, R. M.

1996-01-01

Demonstration of safety margins for critical points (circuits) has traditionally been required since it first became a part of systems-level Electromagnetic Compatibility (EMC) requirements of MIL-E-6051C. The goal of this document is to present cost-effective guidelines for ensuring adequate Electromagnetic Effects (EME) safety margins on spacecraft critical circuits. It is for the use of NASA and other government agencies and their contractors to prevent loss of life, loss of spacecraft, or unacceptable degradation. This document provides practical definition and treatment guidance to contain costs within affordable limits.

A high-resolution, empirical approach to climate impact assessment for regulatory analysis

NASA Astrophysics Data System (ADS)

Delgado, M.; Simcock, J. G.; Greenstone, M.; Hsiang, S. M.; Kopp, R. E.; Carleton, T.; Hultgren, A.; Jina, A.; Rising, J. A.; Nath, I.; Yuan, J.; Rode, A.; Chong, T.; Dobbels, G.; Hussain, A.; Wang, J.; Song, Y.; Mohan, S.; Larsen, K.; Houser, T.

2017-12-01

Recent breakthroughs in computing, data availability, and methodology have precipitated significant advances in the understanding of the relationship between climate and socioeconomic outcomes [1]. And while the use of estimates of the global marginal costs of greenhouse gas emissions (e.g. the SCC) are a mandatory component of regulatory policy in many jurisdictions, existing SCC-IAMs have lagged advances in impact assessment and valuation [2]. Recent work shows that incorporating high spatial and temporal resolution can significantly affect the observed relationships of economic outcomes to climate and socioeconomic factors [3] and that maintaining this granularity is critical to understanding the sensitivity of aggregate measures of valuation to inequality and risk adjustment methodologies [4]. We propose a novel framework that decomposes uncertainty in the SCC along multiple sources, including aggregate climate response parameters, the translation of global climate into local weather, the effect of weather on physical and economic systems, human and macro-economic responses, and impact valuation methodologies. This work extends Hsiang et al. (2017) [4] to directly estimate local response functions for multiple sectors in each of 24,378 global regions and to estimate impacts at this resolution daily, incorporating endogenous, empirically-estimated adaptation and costs. The goal of this work is to provide insight into the heterogeneity of climate impacts and to work with other modeling teams to enhance the empirical grounding of integrated climate impact assessment in more complex energy-environment-economics models. [1] T. Carleton and S. Hsiang (2016), DOI: 10.1126/science.aad9837. [2] National Academies of Sciences, Engineering, and Medicine (2017), DOI: 10.17226/24651. [3] Burke, M., S. Hsiang, and E. Miguel (2015), DOI: 10.1038/nature15725. [4] S. Hsiang et al. (2017), DOI: 10.1126/science.aal4369.

Organ recovery cost assessment in the French healthcare system from 2007 to 2014.

PubMed

Hrifach, Abdelbaste; Ganne, Christell; Couray-Targe, Sandrine; Brault, Coralie; Guerre, Pascale; Serrier, Hassan; Farge, Pierre; Colin, Cyrille

2018-03-23

Organ recovery costs should be assessed to allow efficient and sustainable integration of these costs into national healthcare budgets and policies. These costs are of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. This study assessed organ recovery costs from 2007 to 2014 in the French healthcare system based on the national hospital discharge database and a national cost study. The secondary objective was to describe the variability in the population of deceased organ donors during this period. All stays for organ recovery in French hospitals between January 2007 and December 2014 were quantified from discharge abstracts and valued using a national cost study. Five cost evaluations were conducted to explore all aspects of organ recovery activities. A sensitivity analysis was conducted to test the methodological choice. Trends regarding organ recovery practices were assessed by monitoring indicators. The analysis included 12 629 brain death donors, with 28 482 organs recovered. The mean cost of a hospital stay was €7469 (SD = €10, 894). The mean costs of separate kidney, liver, pancreas, intestine, heart, lung and heart-lung block recovery regardless of the organs recovered were €1432 (SD = €1342), €502 (SD = €782), €354 (SD = €475), €362 (SD = €1559), €542 (SD = €955), €977 (SD = €1196) and €737 (SD = €637), respectively. Despite a marginal increase in donors, the number of organs recovered increased primarily due to improved practices. Although cost management is the main challenge for successful organ recovery, other aspects such as organization modalities should be considered to improve organ availability.

Abatement costs of soil conservation in China's Loess Plateau: balancing income with conservation in an agricultural system.

PubMed

Hou, Lingling; Hoag, Dana L K; Keske, Catherine M H

2015-02-01

This study proposes the use of marginal abatement cost curves to calculate environmental damages of agricultural systems in China's Loess Plateau. Total system costs and revenues, management characteristics and pollution attributes are imputed into a directional output distance function, which is then used to determine shadow prices and abatement cost curves for soil and nitrogen loss. Marginal abatement costs curves are an effective way to compare economic and conservation tradeoffs when field-specific data are scarce. The results show that sustainable agricultural practices can balance soil conservation and agricultural production; land need not be retired, as is current policy. Published by Elsevier Ltd.

Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

PubMed

Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

2016-11-01

To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

"Latino Spaces Have Always Been the Most Violent": Afro-Latino Collegians' Perceptions of Colorism and Latino Intragroup Marginalization

ERIC Educational Resources Information Center

Haywood, Jasmine M.

2017-01-01

This study centers on the racialized experiences of Afro-Latino undergraduates at historically White institutions. Of particular interest, I examine how six Afro-Latino collegains experience intragroup marginalization due to colorism. The research design is undergirded by critical race theory and a critical race methodology. Participants'…

78 FR 20160 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Withdrawal of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-03

... change to make adjustments to the liquidity risk factor component of its credit default swap (``CDS'') margin model. The proposed rule change would permit CME to use an index portfolio's market risk rather... Liquidity Factor of CME's CDS Margin Methodology March 28, 2013. On December 10, 2012, Chicago Mercantile...

78 FR 12127 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Designation of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-21

... risk factor component of its credit default swap (``CDS'') margin model. CME proposes to use an index... with the liquidity risk factor component. The proposed rule change was published for comment in the... on Proposed Rule Change Related to the Liquidity Factor of CME's CDS Margin Methodology February 14...

Financial standards for HMOs.

PubMed

Parsons, Robert J; Gustafson, Gary; Nelson, Ray D; Murray, Bruce P; Dwore, Richard B

2002-02-01

In today's health care environment, it is important to assess the liquidity and profitability performance of HMOs. This study focuses on three liquidity ratios and three profitability ratios derived from national databases of between 740 and 776 HMOs from 1996 to 1999. Most of the HMOs appear to be using more debt and are less liquid now than they were in 1995. Since administrative overhead costs and dollars spent on medical costs have been increasing, HMOs' margins have been consistently negative. A more careful analysis of overhead costs and the cost of the delivery of medical services could result in improved HMO quality of care, efficiencies, and a return to positive profit margins.

How Big is Too Big for Hubs: Marginal Profitability in Hub-and-Spoke Networks

NASA Technical Reports Server (NTRS)

Ross, Leola B.; Schmidt, Stephen J.

1997-01-01

Increasing the scale of hub operations at major airports has led to concerns about congestion at excessively large hubs. In this paper, we estimate the marginal cost of adding spokes to an existing hub network. We observe entry/non-entry decisions on potential spokes from existing hubs, and estimate both a variable profit function for providing service in markets using that spoke as well as the fixed costs of providing service to the spoke. We let the fixed costs depend upon the scale of operations at the hub, and find the hub size at which spoke service costs are minimized.

75 FR 81533 - Antidumping Proceedings: Calculation of the Weighted Average Dumping Margin and Assessment Rate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

... non-dumped comparisons. Several World Trade Organization (``WTO'') dispute settlement reports have... methodologies have been challenged as being inconsistent with the World Trade Organization (``WTO'') General... comparisons in reviews in a manner that parallels the WTO-consistent methodology the Department currently...

Tree Species-Soil Reslationships on Marginal Soybean Lands in the Mississippi Delta

Treesearch

John W. Groninger; W. Michael Aust; Masato Miwa; John A. Stanturf

1999-01-01

In the Mississippi Alluvial Plain, marginal soybean lands are those lands that are frequently flooded and have relatively low average soybean yields. These marginal farmlands might be regenerated to bottomland hardwood species if species-site relationships and silvicultural systems were better developed. Cost effective esteblishment.and management of these stands...

Estimating workers' marginal valuation of employer health benefits: would insured workers prefer more health insurance or higher wages?

PubMed

Royalty, Anne Beeson

2008-01-01

In recent years the cost of health insurance has been increasing much faster than wages. In the face of these rising costs, many employers will have to make difficult decisions about whether to cut back health benefits or to compensate workers with lower wages or lower wage growth. In this paper, we ask the question, "Which do workers value more -- one additional dollar's worth of health benefits or one more dollar in their pockets?" Using a new approach to obtaining estimates of insured workers' marginal valuation of health benefits this paper estimates how much, on average, employees value the marginal dollar paid by employers for their workers' health insurance. We find that insured workers value the marginal health premium dollar at significantly less than the marginal wage dollar. However, workers value insurance generosity very highly. The marginal dollar spent on health insurance that adds an additional dollar's worth of observable dimensions of plan generosity, such as lower deductibles or coverage of additional services, is valued at significantly more than one dollar.

How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

PubMed

Lin, Blossom Yen-Ju; Chao, Te-Hsin; Yao, Yuh; Tu, Shu-Min; Wu, Chun-Ching; Chern, Jin-Yuan; Chao, Shiu-Hsiung; Shaw, Keh-Yuong

2007-04-01

Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment.

Alternative Fuels Data Center: Vehicle Cost Calculator Assumptions and

Science.gov Websites

Center: Vehicle Cost Calculator Assumptions and Methodology on Facebook Tweet about Alternative Fuels Data Center: Vehicle Cost Calculator Assumptions and Methodology on Twitter Bookmark Alternative Fuels Data Center: Vehicle Cost Calculator Assumptions and Methodology on Google Bookmark Alternative Fuels

The marginal cost of public funds with an aging population.

PubMed

Wildasin, D E

1991-05-01

"As populations in the United States and other advanced economies grow older, the burden of social security and health care financing is expected to rise markedly. Payroll, income, and other taxes on working populations are projected to rise accordingly. The marginal welfare cost to workers of social security and other public expenditures is analyzed within the context of a two-period life cycle model. By relaxing separability assumptions that have become common in the literature, the theoretical structure properly incorporates the effect of these public expenditures on labor supply. Comparative statics results indicate that changing age structure is likely to raise the marginal welfare to workers of social security, education, and other public expenditures. Illustrative calculations for the United States confirm this result, suggesting that the cost to workers of incremental social security benefits may easily double by 2025-2050." excerpt

The impact of managed care and current governmental policies on an urban academic health care center.

PubMed

Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

2001-10-01

Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

Alternative Fuels Data Center: Vehicle Cost Calculator Widget Assumptions

Science.gov Websites

Data Center: Vehicle Cost Calculator Widget Assumptions and Methodology on Facebook Tweet about Alternative Fuels Data Center: Vehicle Cost Calculator Widget Assumptions and Methodology on Twitter Bookmark Alternative Fuels Data Center: Vehicle Cost Calculator Widget Assumptions and Methodology on Google Bookmark

Competition in decentralized electricity markets: Three papers on electricity auctions

NASA Astrophysics Data System (ADS)

Harbord, David William Cameron

This thesis consists of three self-contained papers on the analysis of electricity auctions written over a period of twelve years. The first paper models price competition in a decentralized wholesale market for electricity as a first-price, sealed-bid, multi-unit auction. In both the pure and mixed-strategy equilibria of the model, above marginal cost pricing and inefficient despatch of generating units occur. An alternative regulatory pricing rule is considered and it is shown that offering to supply at marginal cost can be induced as a dominant strategy for all firms. The second paper analyses strategic interaction between long-term contracts and price competition in the British electricity wholesale market, and confirms that forward contracts will tend to put downward pressure on spot market prices. A 'strategic commitment' motive for selling forward contracts is also identified: a generator may commit itself to bidding lower prices into the spot market in order to ensure that it will be despatched with its full capacity. The third paper characterizes bidding behavior and market outcomes in uniform and discriminatory electricity auctions. Uniform auctions result in higher average prices than discriminatory auctions, but the ranking in terms of productive efficiency is ambiguous. The comparative effects of other market design features, such as the number of steps in suppliers' bid functions, the duration of bids and the elasticity of demand are analyzed. The paper also clarifies some methodological issues in the analysis of electricity auctions. In particular we show that analogies with continuous share auctions are misplaced so long as firms are restricted to a finite number of bids.

Cost-effectiveness analysis in markets with high fixed costs.

PubMed

Cutler, David M; Ericson, Keith M Marzilli

2010-01-01

We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

Locational Marginal Pricing in the Campus Power System at the Power Distribution Level

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

Hao, Jun; Gu, Yi; Zhang, Yingchen

2016-11-14

In the development of smart grid at distribution level, the realization of real-time nodal pricing is one of the key challenges. The research work in this paper implements and studies the methodology of locational marginal pricing at distribution level based on a real-world distribution power system. The pricing mechanism utilizes optimal power flow to calculate the corresponding distributional nodal prices. Both Direct Current Optimal Power Flow and Alternate Current Optimal Power Flow are utilized to calculate and analyze the nodal prices. The University of Denver campus power grid is used as the power distribution system test bed to demonstrate themore » pricing methodology.« less

Estimating the effect of hospital closure on areawide inpatient hospital costs: a preliminary model and application.

PubMed Central

Shepard, D S

1983-01-01

A preliminary model is developed for estimating the extent of savings, if any, likely to result from discontinuing a specific inpatient service. By examining the sources of referral to the discontinued service, the model estimates potential demand and how cases will be redistributed among remaining hospitals. This redistribution determines average cost per day in hospitals that receive these cases, relative to average cost per day of the discontinued service. The outflow rate, which measures the proportion of cases not absorbed in other acute care hospitals, is estimated as 30 percent for the average discontinuation. The marginal cost ratio, which relates marginal costs of cases absorbed in surrounding hospitals to the average costs in those hospitals, is estimated as 87 percent in the base case. The model was applied to the discontinuation of all inpatient services in the 75-bed Chelsea Memorial Hospital, near Boston, Massachusetts, using 1976 data. As the precise value of key parameters is uncertain, sensitivity analysis was used to explore a range of values. The most likely result is a small increase ($120,000) in the area's annual inpatient hospital costs, because many patients are referred to more costly teaching hospitals. A similar situation may arise with other urban closures. For service discontinuations to generate savings, recipient hospitals must be low in costs, the outflow rate must be large, and the marginal cost ratio must be low. PMID:6668181

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

The cost-effectiveness of an outreach clinical model in the management and prevention of gonorrhea and chlamydia among Chinese female sex workers in Hong Kong.

PubMed

You, Joyce H S; Wong, William C W; Sin, Chung Wah; Woo, Jean

2006-04-01

Social marginalization and stigmatization in usual medical care setting may refrain female sex workers (FSWs) from seeking usual medical care for sexually transmitted infections in Hong Kong. To evaluate the cost-effectiveness of using an outreach approach for treatment and prevention of gonorrhea and chlamydia among FSWs. A decision tree was designed to simulate the outcomes of 2 alternatives: (1) outreach service providing treatment of gonorrhea and chlamydia and counseling to FSWs (outreach arm) and (2) no outreach service (control arm). Five tiers of outcomes were estimated for each study arm: (1) total direct medical cost, (2) number of FSWs infected with gonorrhea, (3) number of new cases of gonorrhea in clients transmitted by FSWs, (4) number of FSWs infected with chlamydia, and (5) number of new cases of chlamydia in clients transmitted by FSWs. Clinical inputs were estimated from literature, and cost analysis was conducted from the perspective of a public health organization. Compared to the control group, the marginal savings per new case of infection averted (marginal cost divided by marginal cases of infection) of the outreach group were $10,988 (US dollars) per case of gonorrhea averted in FSWs, $685 per case of gonorrhea averted in clients, $9643 per case of chlamydia averted in FSWs, and $220 per case of chlamydia averted in clients ($1=7.8 Hong Kong dollars). An outreach clinic is potentially less costly and more effective in preventing transmission of gonorrhea and chlamydia between FSWs and their clients in Hong Kong.

Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care.

PubMed

Butler, Thomas N; Yellowlees, Peter

2012-01-01

Store-and-forward telepsychiatry, or asynchronous telepsychiatry (ATP), which allows clinical data, including video to be collected to be reviewed at a later time by a specialist, has been described as a feasible alternative to real-time telepsychiatry, or synchronous telepsychiatry (STP), as a consultation model for primary care. In theory, ATP should be economically more cost-effective than STP due to the increased flexibility of patient data collection and the substitution of the time of specialists with that of lower-cost providers. The aim of this study was to conduct a retrospective cost-analysis comparing ATP with STP and traditional in-person psychiatric consultations in the primary care setting. One hundred and twenty five ATP consultations were performed and fixed and marginal costs were calculated for each model using inputs such as equipment costs, time spent by providers and support staff, and hourly salaries. The fixed costs were $7,000 and $20,000 for ATP and STP and marginal costs were $68.18, $107.50, and $96.36, respectively, for the three groups. STP was the most expensive of the three types of consultations. ATP became the most cost-effective of the three models beyond 249 consultations. The marginal cost savings of ATP were due to substitution of low-cost providers for specialists. ATP represents a potential disruptive healthcare process that could allow more affordable care to be delivered to a larger population of patients. A full accounting of ATP's efficiency will require further studies, including prospective cost-benefit analyses from the perspectives of the patient, provider, and society.

Marginal abatement cost curve for nitrogen oxides incorporating controls, renewable electricity, energy efficiency, and fuel switching.

PubMed

Loughlin, Daniel H; Macpherson, Alexander J; Kaufman, Katherine R; Keaveny, Brian N

2017-10-01

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs are typically developed by sorting control technologies by their relative cost-effectiveness. Other potentially important abatement measures such as renewable electricity, energy efficiency, and fuel switching (RE/EE/FS) are often not incorporated into MACCs, as it is difficult to quantify their costs and abatement potential. In this paper, a U.S. energy system model is used to develop a MACC for nitrogen oxides (NO x ) that incorporates both traditional controls and these additional measures. The MACC is decomposed by sector, and the relative cost-effectiveness of RE/EE/FS and traditional controls are compared. RE/EE/FS are shown to have the potential to increase emission reductions beyond what is possible when applying traditional controls alone. Furthermore, a portion of RE/EE/FS appear to be cost-competitive with traditional controls. Renewable electricity, energy efficiency, and fuel switching can be cost-competitive with traditional air pollutant controls for abating air pollutant emissions. The application of renewable electricity, energy efficiency, and fuel switching is also shown to have the potential to increase emission reductions beyond what is possible when applying traditional controls alone.

Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study.

PubMed

Haun, Jolie N; Patel, Nitin R; French, Dustin D; Campbell, Robert R; Bradham, Douglas D; Lapcevic, William A

2015-06-27

Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period. This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years. In a study of 92,749 veterans with service utilization from 2007-2009, average per patient cost for those with inadequate and marginal health literacy was significantly higher ($31,581 [95 % CI: $30,186 - $32,975]; $23,508 [95 % CI: $22,749 - $24,268]) than adequate health literacy ($17,033 [95 % CI: $16,810 - $17,255]). Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy. Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs. This study confirms the association of lower health literacy with higher medical service utilization and pharmacy costs for veterans enrolled in the VHA. Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures. These analyses suggest 17.2 % (inadequate & marginal) of the Veterans in this population account for almost one-quarter (24 %) of VA medical and pharmacy cost for this 3-year period. Meeting the needs of those with marginal and inadequate health literacy could produce potential economic savings of approximately 8 % of total costs for this population.

Organizational Change Efforts: Methodologies for Assessing Organizational Effectiveness and Program Costs versus Benefits.

ERIC Educational Resources Information Center

Macy, Barry A.; Mirvis, Philip H.

1982-01-01

A standardized methodology for identifying, defining, and measuring work behavior and performance rather than production, and a methodology that estimates the costs and benefits of work innovation are presented for assessing organizational effectiveness and program costs versus benefits in organizational change programs. Factors in a cost-benefit…

Efficient Operation of a Multi-purpose Reservoir in Chile: Integration of Economic Water Value for Irrigation and Hydropower

NASA Astrophysics Data System (ADS)

Olivares, M. A.; Gonzalez Cabrera, J. M., Sr.; Moreno, R.

2016-12-01

Operation of hydropower reservoirs in Chile is prescribed by an Independent Power System Operator. This study proposes a methodology that integrates power grid operations planning with basin-scale multi-use reservoir operations planning. The aim is to efficiently manage a multi-purpose reservoir, in which hydroelectric generation is competing with other water uses, most notably irrigation. Hydropower and irrigation are competing water uses due to a seasonality mismatch. Currently, the operation of multi-purpose reservoirs with substantial power capacity is prescribed as the result of a grid-wide cost-minimization model which takes irrigation requirements as constraints. We propose advancing in the economic co-optimization of reservoir water use for irrigation and hydropower at the basin level, by explicitly introducing the economic value of water for irrigation represented by a demand function for irrigation water. The proposed methodology uses the solution of a long-term grid-wide operations planning model, a stochastic dual dynamic program (SDDP), to obtain the marginal benefit function for water use in hydropower. This marginal benefit corresponds to the energy price in the power grid as a function of the water availability in the reservoir and the hydrologic scenarios. This function allows capture technical and economic aspects to the operation of hydropower reservoir in the power grid and is generated with the dual variable of the power-balance constraint, the optimal reservoir operation and the hydrologic scenarios used in SDDP. The economic value of water for irrigation and hydropower are then integrated into a basin scale stochastic dynamic program, from which stored water value functions are derived. These value functions are then used to re-optimize reservoir operations under several inflow scenarios.

A Methodology for Flight-Time Identification of Helicopter-Slung Load Frequency Response Characteristics Using CIFER

NASA Technical Reports Server (NTRS)

Sahai, Ranjana; Pierce, Larry; Cicolani, Luigi; Tischler, Mark

1998-01-01

Helicopter slung load operations are common in both military and civil contexts. The slung load adds load rigid body modes, sling stretching, and load aerodynamics to the system dynamics, which can degrade system stability and handling qualities, and reduce the operating envelope of the combined system below that of the helicopter alone. Further, the effects of the load on system dynamics vary significantly among the large range of loads, slings, and flight conditions that a utility helicopter will encounter in its operating life. In this context, military helicopters and loads are often qualified for slung load operations via flight tests which can be time consuming and expensive. One way to reduce the cost and time required to carry out these tests and generate quantitative data more readily is to provide an efficient method for analysis during the flight, so that numerous test points can be evaluated in a single flight test, with evaluations performed in near real time following each test point and prior to clearing the aircraft to the next point. Methodology for this was implemented at Ames and demonstrated in slung load flight tests in 1997 and was improved for additional flight tests in 1999. The parameters of interest for the slung load tests are aircraft handling qualities parameters (bandwidth and phase delay), stability margins (gain and phase margin), and load pendulum roots (damping and natural frequency). A procedure for the identification of these parameters from frequency sweep data was defined using the CIFER software package. CIFER is a comprehensive interactive package of utilities for frequency domain analysis previously developed at Ames for aeronautical flight test applications. It has been widely used in the US on a variety of aircraft, including some primitive flight time analysis applications.

Valuing a Plurality of Research Methodologies and Instructional Ideologies in Classroom Research

ERIC Educational Resources Information Center

Poplin, Mary

2011-01-01

The critical issue Connor, Gallagher, Ferri, Dudley-Marling, and others have put before everyone in this special issue of the "Learning Disability Quarterly" is the hegemony of quantitative methodologies and subsequent marginalization of qualitative research. On this the author is in full agreement. When the human sciences use only quantitative…

Hospital ownership and financial performance: what explains the different findings in the empirical literature?

PubMed

Shen, Yu-Chu; Eggleston, Karen; Lau, Joseph; Schmid, Christopher H

2007-01-01

This study applies meta-analytic methods to conduct a quantitative review of the empirical literature on hospital ownership since 1990. We examine four financial outcomes across 40 studies: cost, revenue, profit margin, and efficiency. We find that variation in the magnitudes of ownership effects can be explained by a study's research focus and methodology. Studies using empirical methods that control for few confounding factors tend to find larger differences between for-profit and not-for-profit hospitals than studies that control for a wider range of confounding factors. Functional form and sample size also matter. Failure to apply log transformation to highly skewed expenditure data yields misleadingly large estimated differences between for-profits and not-for-profits. Studies with fewer than 200 observations also produce larger point estimates and wide confidence intervals.

Cost-effectiveness of strategies to enhance mammography use.

PubMed

Fishman, P; Taplin, S; Meyer, D; Barlow, W

2000-01-01

To estimate the cost-effectiveness of three strategies to increase breast cancer screening with mammography (reminder postcard, reminder telephone call, and motivational telephone call). Cost accounting for each strategy followed by cost-effectiveness analysis. DATA SOURCE FOR EFFECTIVENESS: Randomized trial of three strategies conducted at Group Health Cooperative of Puget Sound (GHC). Women 50 to 79 years of age who were enrolled in GHC's breast cancer screening program who did not schedule screening mammography within 2 months after it was recommended by letter. Health plan. Marginal cost-effectiveness of each additional woman screened. Because of its high cost (about $26 per call) and intermediate effectiveness, the motivational call was the least cost-effective strategy. If it was assumed that 50% of the women who scheduled mammography after receiving the reminder postcard would have scheduled mammography within 10 months even without it, marginal cost-effectiveness for the postcard among all women was $22 per woman screened versus $92 for the reminder call. Among women with no previous mammography, the marginal cost-effectiveness for the postcard was $70 versus $100 for the reminder call. Among women with no previous mammography, the choice between the reminder postcard and the reminder call was sensitive to assumptions about the percentage of women expected to receive mammography in the absence of other promotional strategies. A simple reminder postcard is the most cost-effective way to increase mammography. Choices about how to promote mammography will ultimately depend on plan values and willingness to invest in promotional strategies that increase participation at higher unit costs.

The Cost of Increasing Physical Activity and Maintaining Weight for Mid-Life Sedentary African American Women

PubMed Central

Johnson, Tricia; Schoeny, Michael; Fogg, Louis; Wilbur, JoEllen

2015-01-01

Objective To evaluate the marginal costs of increasing physical activity and maintaining weight for a lifestyle physical activity program targeting sedentary African American women. Methods Outcomes included change in minutes of total moderate to vigorous physical activity, leisure time moderate to vigorous physical activity and walking per week, and weight stability between baseline and maintenance at 48 weeks. Marginal cost effectiveness ratios (MCERs) were calculated for each outcome, and 95% confidence intervals were computed using a bootstrap method. The analysis was from the societal perspective and calculated in 2013 US dollars. Results For the 260 participants in the analysis, program costs were $165 ± 19, and participant costs were $164 ± 35, for a total cost of $329 ± 49. The MCER for change in walking was $1.50/min/wk (95% CI: 1.28, 1.87), $1.73/min/wk (95% CI: 1.41, 2.18) for change in moderate to vigorous physical activity, and $1.94/min/wk (95% CI: 1.58, 2.40) for leisure-time moderate to vigorous physical activity. The MCER for weight stability was $412 (95% CI: 399, 456). Discussion The Women's Lifestyle Physical Activity Program is a relatively low cost strategy for increasing physical activity. The marginal cost of increasing physical activity is lower than for weight stability. The participant costs related to time in the program were nearly half of the total costs, suggesting that practitioners and policy-makers should consider the participant cost when disseminating a lifestyle physical activity program into practice. PMID:26797232

Full cost accounting in the analysis of separated waste collection efficiency: A methodological proposal.

PubMed

D'Onza, Giuseppe; Greco, Giulio; Allegrini, Marco

2016-02-01

Recycling implies additional costs for separated municipal solid waste (MSW) collection. The aim of the present study is to propose and implement a management tool - the full cost accounting (FCA) method - to calculate the full collection costs of different types of waste. Our analysis aims for a better understanding of the difficulties of putting FCA into practice in the MSW sector. We propose a FCA methodology that uses standard cost and actual quantities to calculate the collection costs of separate and undifferentiated waste. Our methodology allows cost efficiency analysis and benchmarking, overcoming problems related to firm-specific accounting choices, earnings management policies and purchase policies. Our methodology allows benchmarking and variance analysis that can be used to identify the causes of off-standards performance and guide managers to deploy resources more efficiently. Our methodology can be implemented by companies lacking a sophisticated management accounting system. Copyright © 2015 Elsevier Ltd. All rights reserved.

How would mental health parity affect the marginal price of care?

PubMed Central

Zuvekas, S H; Banthin, J S; Selden, T M

2001-01-01

OBJECTIVE: To determine the impact of parity in mental health benefits on the marginal prices that consumers face for mental health treatment. DATA SOURCES/DATA COLLECTION: We used detailed information on health plan benefits for a nationally representative sample of the privately insured population under age 65 taken from the 1987 National Medical Expenditure Survey (Edwards and Berlin 1989). The survey was carefully aged and reweighted to represent 1995 population and coverage characteristics. STUDY DESIGN: We computed marginal out-of-pocket costs from the cost-sharing benefits described by policy booklets under current coverage and under parity for various mental health treatment expenditure levels using the MEDSIM health care microsimulation model developed by researchers at the Agency for Healthcare Research and Quality. Descriptive analyses and two-limit Tobit regression models are used to examine how insurance generosity varies across individuals by demographic and socioeconomic characteristics. Our analyses are limited to a description of how parity would change the marginal incentives faced by consumers under their existing plan's cost-sharing arrangements for mental and physical health care. We do not attempt to simulate how parity might affect the level of benefits, including whether benefits are offered at all, or the level of managed care that affects the actual benefits that plan members receive. Rather, we focus only on the nominal benefits described in their policy booklets. PRINCIPAL FINDINGS: Our results show that as of 1995 parity coverage would substantially reduce the share of mental health expenditures that consumers would pay at the margin under their existing plan's cost-sharing provisions, with larger changes for outpatient care than for inpatient care. Because current mental health coverage generally becomes less generous as expenditures rise, while coverage for other medical care becomes more generous (due to stop-loss provisions), the difference in incentives between current mental health coverage and the assumed parity coverage widens as total expenditure grows. We also find that the impact of parity on marginal incentives would vary greatly across the privately insured population. CONCLUSIONS: Based on the large variation in the impact of parity on marginal incentives across the population under current plan cost-sharing arrangements, changes in the demand for mental health treatment will likely also vary across the population. PMID:11221816

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

PubMed

Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

2016-03-01

The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. This is the first detailed analysis of the hospital department's cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

A comparative review of nurse turnover rates and costs across countries.

PubMed

Duffield, Christine M; Roche, Michael A; Homer, Caroline; Buchan, James; Dimitrelis, Sofia

2014-12-01

To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology. Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. Comparative review. Searches were carried out within CINAHL, Business Source Complete and Medline for studies that used the original Nursing Turnover Cost Calculation Methodology and reported on both costs and rates of nurse turnover, published from 2014 and prior. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. Costing data items were converted to percentages, while total turnover costs were converted to US 2014 dollars and adjusted according to inflation rates, to permit cross-country comparisons. Despite using the same methodology, Australia reported significantly higher turnover costs ($48,790) due to higher termination (~50% of indirect costs) and temporary replacement costs (~90% of direct costs). Costs were almost 50% lower in the US ($20,561), Canada ($26,652) and New Zealand ($23,711). Turnover rates also varied significantly across countries with the highest rate reported in New Zealand (44·3%) followed by the US (26·8%), Canada (19·9%) and Australia (15·1%). A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention. The authors suggest a minimum dataset is also required to eliminate potential variability across countries, states, hospitals and departments. © 2014 John Wiley & Sons Ltd.

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

PubMed

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

Piercing the veil: the marginalization of midwives in the United States.

PubMed

Goodman, Steffie

2007-08-01

This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US. This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care. Currently midwives attend only 7% of births, compared to 50-75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing. This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions. These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.

Translating Scientific Judgment, Technological Insight and Economic Theory Into Practical Policy Lessons: The Case of Climate Regulation in the United States

NASA Astrophysics Data System (ADS)

Mignone, B. K.

2008-12-01

Effective solutions to the climate change problem will require unprecedented cooperation across space, continuity across time and coordination between disciplines. One well-known methodology for synthesizing the lessons of physical science, energy engineering and economics is integrated assessment. Typically, integrated assessment models use scientific and technological relationships as physical constraints in a larger macroeconomic optimization that is designed to either balance the costs and benefits of climate change mitigation or find the least-cost path to an exogenously prescribed endpoint (e.g. atmospheric CO2 stabilization). The usefulness of these models depends to a large extent on the quality of the assumptions and the relevance of the outcome metrics chosen by the user. In this study, I show how a scientifically-based emissions reduction scenario can be combined with engineering-based assumptions about the energy system (e.g. estimates of the marginal cost premium of carbon-free technology) to yield insights about the price path of CO2 under a future regulatory regime. I then show how this outcome metric (carbon price) relates to key decisions about the design of a future cap-and-trade system and the way in which future carbon markets may be regulated.

Coupling long and short term decisions in the design of urban water supply infrastructure for added reliability and flexibility

NASA Astrophysics Data System (ADS)

Marques, G.; Fraga, C. C. S.; Medellin-Azuara, J.

2016-12-01

The expansion and operation of urban water supply systems under growing demands, hydrologic uncertainty and water scarcity requires a strategic combination of supply sources for reliability, reduced costs and improved operational flexibility. The design and operation of such portfolio of water supply sources involves integration of long and short term planning to determine what and when to expand, and how much to use of each supply source accounting for interest rates, economies of scale and hydrologic variability. This research presents an integrated methodology coupling dynamic programming optimization with quadratic programming to optimize the expansion (long term) and operations (short term) of multiple water supply alternatives. Lagrange Multipliers produced by the short-term model provide a signal about the marginal opportunity cost of expansion to the long-term model, in an iterative procedure. A simulation model hosts the water supply infrastructure and hydrologic conditions. Results allow (a) identification of trade offs between cost and reliability of different expansion paths and water use decisions; (b) evaluation of water transfers between urban supply systems; and (c) evaluation of potential gains by reducing water system losses as a portfolio component. The latter is critical in several developing countries where water supply system losses are high and often neglected in favor of more system expansion.

Cost of practice in a tertiary/quaternary referral center: is it sustainable?

PubMed

Cologne, K G; Hwang, G S; Senagore, A J

2014-11-01

Third-party payers are moving toward a bundled care payment system. This means that there will need to be a warranty cost of care-where the cost of complexity and complication rates is built into the bundled payment. The theoretical benefit of this system is that providers with lower complication rates will be able to provide care with lower warranty costs and lower overall costs. This may also result in referring riskier patients to tertiary or quaternary referral centers. Unless the payment model truly covers the higher cost of managing such referred cases, the economic risk may be unsustainable for these centers. We took the last seven patients that were referred by other surgeons as "too high risk" for colectomy at other centers. A contribution margin was calculated using standard Medicare reimbursement rates at our institution and cost of care based on our administrative database. We then recalculated a contribution margin assuming a 3 % reduction in payment for a higher than average readmission rate, like that which will take effect in 2014. Finally, we took into account the cost of any readmissions. Seven patients with diagnosis related group (DRG) 330 were reviewed with an average age of 66.8 ± 16 years, American Society of Anesthesiologists score 2.3 ± 1.0, body mass index 31.6 ± 9.8 kg/m(2) (range 22-51 kg/m(2)). There was a 57 % readmission rate, 29 % reoperation rate, 10.8 ± 7.7 day average initial length of stay with 14 ± 8.6 day average readmission length of stay. Forty-two percent were discharged to a location other than home. Seventy-one percent of these patients had Medicare insurance. The case mix index was 2.45. Average reimbursement for DRG 330 was $17,084 (based on Medicare data) for our facility in 2012, with the national average being $12,520. The total contribution margin among all cases collectively was -$19,122 ± 13,285 (average per patient -$2,731, range -$21,905-$12,029). Assuming a 3 % reimbursement reduction made the overall contribution margin -$22,122 ± 13,285 (average -$3,244). Including the cost of readmission in the variable cost made the contribution margin -$115,741 ± 16,023 (average -$16,534). Care of high-risk patients at tertiary and quaternary referral centers is a very expensive proposition and can lead to financial ruin under the current reimbursement system.

The effect of repair costs on the profitability of a ureteroscopy program.

PubMed

Tosoian, Jeffrey J; Ludwig, Wesley; Sopko, Nikolai; Mullins, Jeffrey K; Matlaga, Brian R

2015-04-01

Ureteroscopy (URS) is a common treatment for patients with stone disease. One of the disadvantages of this approach is the great capital expense associated with the purchase and repair of endoscopic equipment. In some cases, these costs can outpace revenues and lead to an unprofitable and unsustainable enterprise. We sought to characterize the profitability of our URS program when accounting for endoscope maintenance and repair costs. We identified all URS cases performed at a single hospital during fiscal year 2013 (FY2013). Charges, collection rates, and fixed and variable costs including annual equipment repair costs were obtained. The net margin and break-even point of URS were derived on a per-case basis. For 190 cases performed in FY2013, total endoscope repair costs totaled $115,000, resulting in an average repair cost of $605 per case. The vast majority of cases (94.2%) were conducted in the outpatient setting, which generated a net margin of $659 per case, while inpatient cases yielded a net loss of $455. URS was ultimately associated with a net positive margin approaching $600 per case. On break-even analysis, URS remained profitable until repair costs reached $1200 per case. Based on these findings, an established URS program can sustain profitability even with large equipment repair costs. Nonetheless, our findings serve to emphasize the importance of controlling costs, particularly in the current setting of decreasing reimbursement. A multifaceted approach, based on improving endoscope durability and exploring digital and disposable platforms, will be critical in maintaining the sustainability of URS.

Leveraging Global Maritime Partnerships to Increase Global Security in the Maritime Domain

DTIC Science & Technology

2008-04-04

global interdependency (ways to counter the threat), along with the agility and elusiveness of the maritime threat to utilize the vastness of the...is that all of these costs cut into their profit margins and are therefore passed along by way of increased prices for goods purchased by the...costs of security measures and initiatives without cutting into their profit margins . Because of this they are more apt to take on the added risk

Revenue Sufficiency and Reliability in a Zero Marginal Cost Future

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

Frew, Bethany A.

Features of existing wholesale electricity markets, such as administrative pricing rules and policy-based reliability standards, can distort market incentives from allowing generators sufficient opportunities to recover both fixed and variable costs. Moreover, these challenges can be amplified by other factors, including (1) inelastic demand resulting from a lack of price signal clarity, (2) low- or near-zero marginal cost generation, particularly arising from low natural gas fuel prices and variable generation (VG), such as wind and solar, and (3) the variability and uncertainty of this VG. As power systems begin to incorporate higher shares of VG, many questions arise about themore » suitability of the existing marginal-cost-based price formation, primarily within an energy-only market structure, to ensure the economic viability of resources that might be needed to provide system reliability. This article discusses these questions and provides a summary of completed and ongoing modelling-based work at the National Renewable Energy Laboratory to better understand the impacts of evolving power systems on reliability and revenue sufficiency.« less

Revenue Sufficiency and Reliability in a Zero Marginal Cost Future: Preprint

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

Frew, Bethany A.; Milligan, Michael; Brinkman, Greg

Features of existing wholesale electricity markets, such as administrative pricing rules and policy-based reliability standards, can distort market incentives from allowing generators sufficient opportunities to recover both fixed and variable costs. Moreover, these challenges can be amplified by other factors, including (1) inelastic demand resulting from a lack of price signal clarity, (2) low- or near-zero marginal cost generation, particularly arising from low natural gas fuel prices and variable generation (VG), such as wind and solar, and (3) the variability and uncertainty of this VG. As power systems begin to incorporate higher shares of VG, many questions arise about themore » suitability of the existing marginal-cost-based price formation, primarily within an energy-only market structure, to ensure the economic viability of resources that might be needed to provide system reliability. This article discusses these questions and provides a summary of completed and ongoing modelling-based work at the National Renewable Energy Laboratory to better understand the impacts of evolving power systems on reliability and revenue sufficiency.« less

The Balanced Budget Act of 1997 and the financial health of teaching hospitals.

PubMed

Phillips, Robert L; Fryer, George E; Chen, Frederick M; Morgan, Sarah E; Green, Larry A; Valente, Ernest; Miyoshi, Thomas J

2004-01-01

We wanted to evaluate the most recent, complete data related to the specific effects of the Balanced Budget Act of 1997 relative to the overall financial health of teaching hospitals. We also define cost report variables and calculations necessary for continued impact monitoring. We undertook a descriptive analysis of hospital cost report variables for 1996, 1998, and 1999, using simple calculations of total, Medicare, prospective payment system, graduate medical education (GME), and bad debt margins, as well as the proportion with negative total operating margins. Nearly 35% of teaching hospitals had negative operating margins in 1999. Teaching hospital total margins fell by nearly 50% between 1996 and 1999, while Medicare margins remained relatively stable. GME margins have fallen by nearly 24%, however, even as reported education costs have risen by nearly 12%. Medicare + Choice GME payments were less than 10% of those projected. Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. Medicare payments remain an important financial cushion for teaching hospitals, more than one third of which operated in the red. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. Medicare + Choice support of the medical education enterprise is 90% less than baseline projections and should be thoroughly investigated. The Medicare Payment Advisory Commission, which has a critical role in evaluating the effects of Medicare policy changes, should be more transparent in its methods.

Assessing the Utilization of Total Ankle Replacement in the United States.

PubMed

Reddy, Sudheer; Koenig, Lane; Demiralp, Berna; Nguyen, Jennifer T; Zhang, Qian

2017-06-01

Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals. Outcome variables of interest were the likelihood of a hospital performing TAR, the volume of TAR cases, TAR hospital costs, and hospital profit margins. Data from the 2010 Cost Report and Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based on the all payer cost-to-charge ratio for each hospital in the Cost Report. Nationwide Inpatient Sample data were used to generate descriptive statistics on all TAR patients across payers. Medicare participants accounted for 47.5% of the overall population of TAR patients. Average implant cost was $13 034, accounting for approximately 70% of the total all-payer cost. Approximately, one-third of hospitals were profitable with respect to primary TAR. Profitable hospitals had lower total costs and higher payments leading to a difference in profit of approximately $11 000 from TAR surgeries between profitable and nonprofitable hospitals. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. TAR surgeries were more likely to take place in large and major teaching hospitals. Among hospitals performing at least 1 TAR, the margin on TAR cases was positively associated with the total number of TARs performed by a hospital. There is an overall significant financial burden associated with performing TAR with many health systems failing to demonstrate profitability despite its increased utilization. While additional factors such as improved patient outcomes may be driving utilization of TAR, financial barriers may exist that can affect utilization of TAR across health systems. Level III, comparative study.

Applications of a damage tolerance analysis methodology in aircraft design and production

NASA Technical Reports Server (NTRS)

Woodward, M. R.; Owens, S. D.; Law, G. E.; Mignery, L. A.

1992-01-01

Objectives of customer mandated aircraft structural integrity initiatives in design are to guide material selection, to incorporate fracture resistant concepts in the design, to utilize damage tolerance based allowables and planned inspection procedures necessary to enhance the safety and reliability of manned flight vehicles. However, validated fracture analysis tools for composite structures are needed to accomplish these objectives in a timely and economical manner. This paper briefly describes the development, validation, and application of a damage tolerance methodology for composite airframe structures. A closed-form analysis code, entitled SUBLAM was developed to predict the critical biaxial strain state necessary to cause sublaminate buckling-induced delamination extension in an impact damaged composite laminate. An embedded elliptical delamination separating a thin sublaminate from a thick parent laminate is modelled. Predicted failure strains were correlated against a variety of experimental data that included results from compression after impact coupon and element tests. An integrated analysis package was developed to predict damage tolerance based margin-of-safety (MS) using NASTRAN generated loads and element information. Damage tolerance aspects of new concepts are quickly and cost-effectively determined without the need for excessive testing.

Addressing Theory and Performance Enhancements for the Independent Sustain and Address AC Plasma Display

NASA Astrophysics Data System (ADS)

Warren, Kevin Wilson

The Independent Sustain and Address (ISA) AC plasma panel is a flat, flicker-free, gas discharge type of display device. This display technology promises to reduce both the cost of manufacturing and operation of AC plasma displays. The ISA technology uses a vastly different mechanism to change the state of the display pixels than the standard AC plasma technology. This addressing mechanism is an exploitation of some of the natural characteristics associated with the plasma that can form during strong gas discharges. This thesis presents detailed data from experiments that were designed to evaluate and test the effectiveness of this mechanism. Through these experiments, the theory that the addressing methodology is based upon is developed and evaluated. These experiments show that the address margin windows for this technology are very large, minimally two to three times larger than the address margins for the standard XY AC plasma addressing techniques. New capabilities are also described, such as global brightness control for the ISA technology and a technique for increasing the addressing rate. These advances were designed into working prototypes and transferred to industry where there are currently commercial products available based upon these advances. A technique for implementing gray scale using some of these advances is also proposed.

Playing Hardball with Facilities Expenses.

ERIC Educational Resources Information Center

Fickes, Michael

1997-01-01

Describes one school district manager's tactics for successfully controlling district costs and increasing capital improvements while only marginally increasing the facilities maintenance budget. Highlights guidelines for controlling personnel requirements and cost-reduction methods. Discusses specific cost-control measures involving telephone…

Economic tools to promote transparency and comparability in the Paris Agreement

NASA Astrophysics Data System (ADS)

Aldy, Joseph; Pizer, William; Tavoni, Massimo; Reis, Lara Aleluia; Akimoto, Keigo; Blanford, Geoffrey; Carraro, Carlo; Clarke, Leon E.; Edmonds, James; Iyer, Gokul C.; McJeon, Haewon C.; Richels, Richard; Rose, Steven; Sano, Fuminori

2016-11-01

The Paris Agreement culminates a six-year transition towards an international climate policy architecture based on parties submitting national pledges every five years. An important policy task will be to assess and compare these contributions. We use four integrated assessment models to produce metrics of Paris Agreement pledges, and show differentiated effort across countries: wealthier countries pledge to undertake greater emission reductions with higher costs. The pledges fall in the lower end of the distributions of the social cost of carbon and the cost-minimizing path to limiting warming to 2 °C, suggesting insufficient global ambition in light of leaders’ climate goals. Countries’ marginal abatement costs vary by two orders of magnitude, illustrating that large efficiency gains are available through joint mitigation efforts and/or carbon price coordination. Marginal costs rise almost proportionally with income, but full policy costs reveal more complex regional patterns due to terms of trade effects.

Cost benefits of advanced software: A review of methodology used at Kennedy Space Center

NASA Technical Reports Server (NTRS)

Joglekar, Prafulla N.

1993-01-01

To assist rational investments in advanced software, a formal, explicit, and multi-perspective cost-benefit analysis methodology is proposed. The methodology can be implemented through a six-stage process which is described and explained. The current practice of cost-benefit analysis at KSC is reviewed in the light of this methodology. The review finds that there is a vicious circle operating. Unsound methods lead to unreliable cost-benefit estimates. Unreliable estimates convince management that cost-benefit studies should not be taken seriously. Then, given external demands for cost-benefit estimates, management encourages software enginees to somehow come up with the numbers for their projects. Lacking the expertise needed to do a proper study, courageous software engineers with vested interests use ad hoc and unsound methods to generate some estimates. In turn, these estimates are unreliable, and the cycle continues. The proposed methodology should help KSC to break out of this cycle.

Development of weight and cost estimates for lifting surfaces with active controls

NASA Technical Reports Server (NTRS)

Anderson, R. D.; Flora, C. C.; Nelson, R. M.; Raymond, E. T.; Vincent, J. H.

1976-01-01

Equations and methodology were developed for estimating the weight and cost incrementals due to active controls added to the wing and horizontal tail of a subsonic transport airplane. The methods are sufficiently generalized to be suitable for preliminary design. Supporting methodology and input specifications for the weight and cost equations are provided. The weight and cost equations are structured to be flexible in terms of the active control technology (ACT) flight control system specification. In order to present a self-contained package, methodology is also presented for generating ACT flight control system characteristics for the weight and cost equations. Use of the methodology is illustrated.

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Average System Cost methodology functionalization. 301.7 Section 301.7 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.7 Average System Cost methodology functionalization. (a) Functionalization of each Account...

Economic optimization of natural hazard protection - conceptual study of existing approaches

NASA Astrophysics Data System (ADS)

Spackova, Olga; Straub, Daniel

2013-04-01

Risk-based planning of protection measures against natural hazards has become a common practice in many countries. The selection procedure aims at identifying an economically efficient strategy with regard to the estimated costs and risk (i.e. expected damage). A correct setting of the evaluation methodology and decision criteria should ensure an optimal selection of the portfolio of risk protection measures under a limited state budget. To demonstrate the efficiency of investments, indicators such as Benefit-Cost Ratio (BCR), Marginal Costs (MC) or Net Present Value (NPV) are commonly used. However, the methodologies for efficiency evaluation differ amongst different countries and different hazard types (floods, earthquakes etc.). Additionally, several inconsistencies can be found in the applications of the indicators in practice. This is likely to lead to a suboptimal selection of the protection strategies. This study provides a general formulation for optimization of the natural hazard protection measures from a socio-economic perspective. It assumes that all costs and risks can be expressed in monetary values. The study regards the problem as a discrete hierarchical optimization, where the state level sets the criteria and constraints, while the actual optimization is made on the regional level (towns, catchments) when designing particular protection measures and selecting the optimal protection level. The study shows that in case of an unlimited budget, the task is quite trivial, as it is sufficient to optimize the protection measures in individual regions independently (by minimizing the sum of risk and cost). However, if the budget is limited, the need for an optimal allocation of resources amongst the regions arises. To ensure this, minimum values of BCR or MC can be required by the state, which must be achieved in each region. The study investigates the meaning of these indicators in the optimization task at the conceptual level and compares their suitability. To illustrate the theoretical findings, the indicators are tested on a hypothetical example of five regions with different risk levels. Last but not least, political and societal aspects and limitations in the use of the risk-based optimization framework are discussed.

Informing practice regarding marginalization: the application of the Koci Marginality Index.

PubMed

Koci, Anne Floyd; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2012-12-01

The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on women's functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused women's health are discussed. The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al., 2002 ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached $8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a woman's health immediately and in the long-term (Breiding, Black, & Ryan, 2008 ; Campbell, 2002 ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez, 2002 ) and those without documentation are at higher risk for marginalization (Montalvo-Liendo, Koci, McFarlane, Nava, Gilroy, & Maddoux, 2012). This paper explores marginality with reference to IPV and the development and application of an instrument to measure marginality.

Estimation of the full marginal costs of port related truck traffic.

PubMed

Berechman, Joseph

2009-11-01

NY region is expected to grow by additional 1 million people by 2020, which translates into roughly 70 million more tons of goods to be delivered annually. Due to lack of rail capacity, mainly trucks will haul this volume of freight, challenging an already much constrained highway network. What are the total costs associated with this additional traffic, in particular, congestion, safety and emission? Since a major source of this expected flow is the Port of New York-New Jersey, this paper focuses on the estimation of the full marginal costs of truck traffic resulting from the further expansion of the port's activities.

The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital.

PubMed

Sasikumar, M; Boyer, S; Remacle-Bonnet, A; Ventelou, B; Brouqui, P

2017-04-01

This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.

An Analysis of Cost Analysis Methods Used during Contract Evaluation and Source Selection in Government Contracting.

DTIC Science & Technology

1986-12-01

optimal value can be stated as, Marginal Productivity of Marginal Productivity of Good A Good B " Price of Good A Price of Good B This...contractor proposed production costs could be used. _11 i4 W Vi..:. II. CONTRACT PROPOSAL EVALUATION A. PRICE ANALYSIS Price analysis, in its broadest sense...enters the market with a supply function represented by line S2, then the new price will be reestablished at price OP2 and quantity OQ2. Price

Economic Analysis of a Basic Allowance for Health Care for Active Duty and Retired Members of the Armed Forces

DTIC Science & Technology

2014-12-01

the ability to alter consumer behavior and lower costs (Herzlinger, 2004; Feldstein, 1995). One of the possible drivers behind this behavioral...between $400–$2,400 may alter consumer behavior on the margin because those changes should lead them to think more carefully about the marginal costs...section. While the underlying system proposed by Heffley and Miceli does not mirror the proposed BAHC, it does offer insights into expected consumer

Regulatory Scientific Advice on Non-Inferiority Drug Trials

PubMed Central

Knol, Mirjam J.; Klungel, Olaf H.; Gispen-De Wied, Christine C.; de Boer, Antonius; Hoes, Arno W.; Leufkens, Hubert G.; Mantel-Teeuwisse, Aukje K.

2013-01-01

The active-controlled trial with a non-inferiority design has gained popularity in recent years. However, non-inferiority trials present some methodological challenges, especially in determining the non-inferiority margin. Regulatory guidelines provide some general statements on how a non-inferiority trial should be conducted. Moreover, in a scientific advice procedure, regulators give companies the opportunity to discuss critical trial issues prior to the start of the trial. The aim of this study was to identify potential issues that may benefit from more explicit guidance by regulators. To achieve this, we collected and analyzed questions about non-inferiority trials posed by applicants for scientific advice in Europe in 2008 and 2009, as well as the responses given by the European Medicines Agency (EMA). In our analysis we included 156 final letters of advice from 2008 and 2009, addressed to 94 different applicants (manufacturers). Our analysis yielded two major findings: (1) applicants frequently asked questions ‘whether’ and ‘how’ to conduct a non-inferiority trial, 26% and 74%, respectively, and (2) the EMA regulators seem mainly concerned about the choice of the non-inferiority margin in non-inferiority trials (36% of total regulatory answers). In 40% of the answers, the EMA recommended using a stricter margin, and in 10% of the answers regarding non-inferiority margins, the EMA questioned the justification of the proposed non-inferiority margin. We conclude that there are still difficulties in selecting the appropriate methodology for non-inferiority trials. Straightforward and harmonized guidance regarding non-inferiority trials is required, for example on whether it is necessary to conduct such a trial and how the non-inferiority margin is determined. It is unlikely that regulatory guidelines can cover all therapeutic areas; therefore, in some cases regulatory scientific advice may be used as an opportunity for tailored advice. PMID:24040346

18 CFR 301.5 - Changes in Average System Cost methodology.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Changes in Average System Cost methodology. 301.5 Section 301.5 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.5 Changes in Average System Cost methodology. (a) The Administrator, at his or her...

18 CFR 301.5 - Changes in Average System Cost methodology.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Changes in Average System Cost methodology. 301.5 Section 301.5 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.5 Changes in Average System Cost methodology. (a) The Administrator, at his or her...

18 CFR 301.5 - Changes in Average System Cost methodology.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Changes in Average System Cost methodology. 301.5 Section 301.5 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.5 Changes in Average System Cost methodology. (a) The Administrator, at his or her...

18 CFR 301.5 - Changes in Average System Cost methodology.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Changes in Average System Cost methodology. 301.5 Section 301.5 Conservation of Power and Water Resources FEDERAL ENERGY... ACT § 301.5 Changes in Average System Cost methodology. (a) The Administrator, at his or her...

Investigation of Statistical Inference Methodologies Through Scale Model Propagation Experiments

DTIC Science & Technology

2015-09-30

statistical inference methodologies for ocean- acoustic problems by investigating and applying statistical methods to data collected from scale-model...to begin planning experiments for statistical inference applications. APPROACH In the ocean acoustics community over the past two decades...solutions for waveguide parameters. With the introduction of statistical inference to the field of ocean acoustics came the desire to interpret marginal

Hepatic Resection for Colorectal Liver Metastases: A Cost-Effectiveness Analysis

PubMed Central

Beard, Stephen M.; Holmes, Michael; Price, Charles; Majeed, Ali W.

2000-01-01

Objective To analyze the cost-effectiveness of resection for liver metastases compared with standard nonsurgical cytotoxic treatment. Summary Background Data The efficacy of hepatic resection for metastases from colorectal cancer has been debated, despite reported 5-year survival rates of 20% to 40%. Resection is confined to specialized centers and is not widely available, perhaps because of lack of appropriate expertise, resources, or awareness of its efficacy. The cost-effectiveness of resection is important from the perspective of managed care in the United States and for the commissioning of health services in the United Kingdom. Methods A simple decision-based model was developed to evaluate the marginal costs and health benefits of hepatic resection. Estimates of resectability for liver metastases were taken from UK-reported case series data. The results of 100 hepatic resections conducted in Sheffield from 1997 to 1999 were used for the cost calculation of liver resection. Survival data from published series of resections were compiled to estimate the incremental cost per life-year gained (LYG) because of the short period of follow-up in the Sheffield series. Results Hepatic resection for colorectal liver metastases provides an estimated marginal benefit of 1.6 life-years (undiscounted) at a marginal cost of £6,742. If 17% of patients have only palliative resections, the overall cost per LYG is approximately £5,236 (£5,985 with discounted benefits). If potential benefits are extended to include 20-year survival rates, these figures fall to approximately £1,821 (£2,793 with discounted benefits). Further univariate sensitivity analysis of key model parameters showed the cost per LYG to be consistently less than £15,000. Conclusion In this model, hepatic resection appears highly cost-effective compared with nonsurgical treatments for colorectal-related liver metastases. PMID:11088071

Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

PubMed

Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

2014-06-01

In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

Focus of NASA's Spaceliner 100 Investment Area

NASA Technical Reports Server (NTRS)

Hueter, Uwe; Lyles, Garry (Technical Monitor)

2000-01-01

This presentation discuss the goals and objectives of the SL100 Technology Focus. Some of the Technology objectives were to: increase system performance margin; drive down operations costs; drive down manufacturing and production costs; and drive down development test and evaluation costs.

Advanced Control Considerations for Turbofan Engine Design

NASA Technical Reports Server (NTRS)

Connolly, Joseph W.; Csank, Jeffrey T.; Chicatelli, Amy

2016-01-01

This paper covers the application of a model-based engine control (MBEC) methodology featuring a self tuning on-board model for an aircraft turbofan engine simulation. The nonlinear engine model is capable of modeling realistic engine performance, allowing for a verification of the advanced control methodology over a wide range of operating points and life cycle conditions. The on-board model is a piece-wise linear model derived from the nonlinear engine model and updated using an optimal tuner Kalman Filter estimation routine, which enables the on-board model to self-tune to account for engine performance variations. MBEC is used here to show how advanced control architectures can improve efficiency during the design phase of a turbofan engine by reducing conservative operability margins. The operability margins that can be reduced, such as stall margin, can expand the engine design space and offer potential for efficiency improvements. Application of MBEC architecture to a nonlinear engine simulation is shown to reduce the thrust specific fuel consumption by approximately 1% over the baseline design, while maintaining safe operation of the engine across the flight envelope.

Co-benefits of mitigating global greenhouse gas emissions for future air quality and human health

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

West, Jason; Smith, Steven J.; Silva, Raquel

2013-10-01

Reducing greenhouse gas (GHG) emissions also influences air quality. We simulate the co-benefits of global GHG reductions on air quality and human health via two mechanisms: a) reducing co-emitted air pollutants, and b) slowing climate change and its effect on air quality. Relative to a reference scenario, global GHG mitigation in the RCP4.5 scenario avoids 0.5±0.2, 1.3±0.6, and 2.2±1.6 million premature deaths in 2030, 2050, and 2100, from changes in fine particulate matter and ozone. Global average marginal co-benefits of avoided mortality are $40-400 (ton CO2)-1, exceeding marginal abatement costs in 2030 and 2050, and within the low range ofmore » costs in 2100. East Asian co-benefits are 10-80 times the marginal cost in 2030. These results indicate that transitioning to a low-carbon future might be justified by air quality and health co-benefits.« less

Evolved dispersal strategies at range margins

PubMed Central

Dytham, Calvin

2009-01-01

Dispersal is a key component of a species's ecology and will be under different selection pressures in different parts of the range. For example, a long-distance dispersal strategy suitable for continuous habitat at the range core might not be favoured at the margin, where the habitat is sparse. Using a spatially explicit, individual-based, evolutionary simulation model, the dispersal strategies of an organism that has only one dispersal event in its lifetime, such as a plant or sessile animal, are considered. Within the model, removing habitat, increasing habitat turnover, increasing the cost of dispersal, reducing habitat quality or altering vital rates imposes range limits. In most cases, there is a clear change in the dispersal strategies across the range, although increasing death rate towards the margin has little impact on evolved dispersal strategy across the range. Habitat turnover, reduced birth rate and reduced habitat quality all increase evolved dispersal distances at the margin, while increased cost of dispersal and reduced habitat density lead to lower evolved dispersal distances at the margins. As climate change shifts suitable habitat poleward, species ranges will also start to shift, and it will be the dispersal capabilities of marginal populations, rather than core populations, that will influence the rate of range shifting. PMID:19324810

Facility cost analysis in outpatient plastic surgery: implications for the academic health center.

PubMed

Pacella, Salvatore J; Comstock, Matthew C; Kuzon, William M

2008-04-01

The authors examined the economic patterns of outpatient aesthetic and reconstructive plastic surgical procedures performed within an academic health center. For fiscal years 2003 and 2004, the University of Michigan Health System's accounting database was queried to identify all outpatient plastic surgery cases (aesthetic and reconstructive) from four surgical facilities. Total facility charges, cost, revenue, and margin were calculated for each case. Contribution margin (total revenue minus variable direct cost) was compared with total case time to determine average contribution margin per operating suite case minute for subsets of aesthetic and reconstructive procedures. A total of 3603 cases (3457 reconstructive and 146 aesthetic) were identified. Payer mix included Blue Cross (36.7 percent), health maintenance organization (28.7 percent), other commercial payers (17.4 percent), Medicare/Medicaid (13.5 percent), and self-pay (3.7 percent). The most profitable cases were reconstructive laser procedures ($66.20; n = 361), scar revision ($36.01; n = 25), and facial trauma ($32.17; n = 64). The least profitable were hand arthroplasty ($13.93; n = 35), arthroscopy ($17.25; n = 15), and breast reduction ($17.46; n = 210). Aesthetic procedures (n = 144) yielded a significantly higher contribution margin per case minute ($24.21) compared with reconstructive procedures ($22.28; n = 3093) (p = 0.01). Plastic surgical cases performed at dedicated ambulatory surgery centers ($28.60; n = 1477) yielded significantly higher contribution margin per case minute compared with those performed at hospital-based facilities ($25.58; n = 2123) (p < 0.01). Use of standardized accounting (contribution margin per case minute) can be a strategically effective method for determining the most profitable and appropriate case mix. Within academic health centers, aesthetic surgery can be a profitable enterprise; dedicated ambulatory surgery centers yield higher profitability.

Automatic detection and agronomic characterization of olive groves using high-resolution imagery and LIDAR data

NASA Astrophysics Data System (ADS)

Caruso, T.; Rühl, J.; Sciortino, R.; Marra, F. P.; La Scalia, G.

2014-10-01

The Common Agricultural Policy of the European Union grants subsidies for olive production. Areas of intensified olive farming will be of major importance for the increasing demand for oil production of the next decades, and countries with a high ratio of intensively and super-intensively managed olive groves will be more competitive than others, since they are able to reduce production costs. It can be estimated that about 25-40% of the Sicilian oliviculture must be defined as "marginal". Modern olive cultivation systems, which permit the mechanization of pruning and harvest operations, are limited. Agronomists, landscape planners, policy decision-makers and other professionals have a growing need for accurate and cost-effective information on land use in general and agronomic parameters in the particular. The availability of high spatial resolution imagery has enabled researchers to propose analysis tools on agricultural parcel and tree level. In our study, we test the performance of WorldView-2 imagery relative to the detection of olive groves and the delineation of olive tree crowns, using an object-oriented approach of image classification in combined use with LIDAR data. We selected two sites, which differ in their environmental conditions and in their agronomic parameters of olive grove cultivation. The main advantage of the proposed methodology is the low necessary quantity of data input and its automatibility. However, it should be applied in other study areas to test if the good results of accuracy assessment can be confirmed. Data extracted by the proposed methodology can be used as input data for decision-making support systems for olive grove management.

A cost evaluation methodology for surgical technologies.

PubMed

Ismail, Imad; Wolff, Sandrine; Gronfier, Agnes; Mutter, Didier; Swanström, Lee L; Swantröm, Lee L

2015-08-01

To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room's medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.

Probabilistic Design of a Mars Sample Return Earth Entry Vehicle Thermal Protection System

NASA Technical Reports Server (NTRS)

Dec, John A.; Mitcheltree, Robert A.

2002-01-01

The driving requirement for design of a Mars Sample Return mission is to assure containment of the returned samples. Designing to, and demonstrating compliance with, such a requirement requires physics based tools that establish the relationship between engineer's sizing margins and probabilities of failure. The traditional method of determining margins on ablative thermal protection systems, while conservative, provides little insight into the actual probability of an over-temperature during flight. The objective of this paper is to describe a new methodology for establishing margins on sizing the thermal protection system (TPS). Results of this Monte Carlo approach are compared with traditional methods.

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

A standard description and costing methodology for the balance-of-plant items of a solar thermal electric power plant. Report of a multi-institutional working group

NASA Technical Reports Server (NTRS)

1983-01-01

Standard descriptions for solar thermal power plants are established and uniform costing methodologies for nondevelopmental balance of plant (BOP) items are developed. The descriptions and methodologies developed are applicable to the major systems. These systems include the central receiver, parabolic dish, parabolic trough, hemispherical bowl, and solar pond. The standard plant is defined in terms of four categories comprising (1) solar energy collection, (2) power conversion, (3) energy storage, and (4) balance of plant. Each of these categories is described in terms of the type and function of components and/or subsystems within the category. A detailed description is given for the BOP category. BOP contains a number of nondevelopmental items that are common to all solar thermal systems. A standard methodology for determining the costs of these nondevelopmental BOP items is given. The methodology is presented in the form of cost equations involving cost factors such as unit costs. A set of baseline values for the normalized cost factors is also given.

The effects of safety practice, technology adoption, and firm characteristics on motor carrier safety

DOT National Transportation Integrated Search

2004-01-01

The theory of the firm suggests that firms should maximize profit by investing in safety until : marginal cost is equal to the marginal benefit. This paper addresses motor carrier safety from the : perspective of the firm, developing the theoretical ...

Decision analysis in formulary decision making.

PubMed

Schechter, C B

1993-06-01

Although decision making about what drugs to include in an institutional formulary appears to lend itself readily to quantitative techniques such as decision analysis and cost-benefit analysis, a review of the literature reveals that very little has been published in this area. Several of the published decision analyses use non-standard techniques that are, at best, of unproved validity, and may seriously distort the underlying issues through covert under-counting or double-counting of various drug attributes. Well executed decision analyses have contributed to establishing that drug acquisition costs are not an adequate measure of the total economic impact of formulary decisions and that costs of labour and materials associated with drug administration must be calculated on an institution-specific basis to reflect unique staffing patterns, bulk purchasing practices, and the availability of surplus capacity within the institution which might be mobilised at little marginal cost. Clinical studies of newly introduced drugs frequently fail to answer the questions that weigh most heavily on the structuring of a formal assessment of a proposed formulary acquisition. Studies comparing a full spectrum of therapeutically equivalent drugs are rarely done, and individual studies of particular pairs of drugs can rarely be used together because of differences in methodology or patient populations studied. Gathering of institution-specific economic and clinical data is a daunting, labour-intensive task. In many institutions, incentive and reward structures discourage behaviour that takes the broad institutional perspective that is intrinsic to a good decision analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Health economic evaluation: important principles and methodology.

PubMed

Rudmik, Luke; Drummond, Michael

2013-06-01

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

Three essays in energy economics

NASA Astrophysics Data System (ADS)

Kim, Dae-Wook

Deregulation in electricity and natural gas market in an attempt to alleviate market power of privately owned utilities is widespread throughout the United States. Beginning with Gollop and Roberts (1979), a number of empirical studies have allowed the data to identify industry competition and marginal cost levels by estimating the firms' first order condition within a conjectural variations framework. The first chapter of my dissertation uses direct measures of marginal cost for the California electricity market to measure the extent to which estimated mark-ups and marginal costs are biased. My results suggest that the New Empirical Industrial Organization technique poorly estimates the level of mark-ups and the sensitivity of marginal cost to cost shifters. The second chapter takes advantage of the market structure of electricity and natural gas varies in the United States. The goal of the chapter is to analyze whether combined-billed residential households of electricity and natural gas firms face information costs associated with determining the portion of their monthly energy bill attributed to natural gas consumption and the portion attributed to electricity consumption. However, if households are unable to determine whether an increase in their energy bill is the result of an increase in the price of electricity or an increase in the price of natural gas, they act as if electricity and natural gas were complements. I find that own-price elasticities are smaller in absolute terms in combined-billed markets, while cross-price elasticities are more positive, compared to separate-billed markets; both of these results are consistent with the presence of information costs. In chapter 3, I provide an empirical evidence of the impact of variations in ownership, regulation and market structure on the electric and natural gas markets in the United States. My results suggest that the private firms in electricity markets are associated with higher prices than public firms. I further find that dual-product firms in the natural gas industry tend to charge less than single product firms. Finally, my results suggest that merger activities in natural gas markets are associated with higher rates after controlling cost and demand.

Association between component costs, study methodologies, and foodborne illness-related factors with the cost of nontyphoidal Salmonella illness.

PubMed

McLinden, Taylor; Sargeant, Jan M; Thomas, M Kate; Papadopoulos, Andrew; Fazil, Aamir

2014-09-01

Nontyphoidal Salmonella spp. are one of the most common causes of bacterial foodborne illness. Variability in cost inventories and study methodologies limits the possibility of meaningfully interpreting and comparing cost-of-illness (COI) estimates, reducing their usefulness. However, little is known about the relative effect these factors have on a cost-of-illness estimate. This is important for comparing existing estimates and when designing new cost-of-illness studies. Cost-of-illness estimates, identified through a scoping review, were used to investigate the association between descriptive, component cost, methodological, and foodborne illness-related factors such as chronic sequelae and under-reporting with the cost of nontyphoidal Salmonella spp. illness. The standardized cost of nontyphoidal Salmonella spp. illness from 30 estimates reported in 29 studies ranged from $0.01568 to $41.22 United States dollars (USD)/person/year (2012). The mean cost of nontyphoidal Salmonella spp. illness was $10.37 USD/person/year (2012). The following factors were found to be significant in multiple linear regression (p≤0.05): the number of direct component cost categories included in an estimate (0-4, particularly long-term care costs) and chronic sequelae costs (inclusion/exclusion), which had positive associations with the cost of nontyphoidal Salmonella spp. illness. Factors related to study methodology were not significant. Our findings indicated that study methodology may not be as influential as other factors, such as the number of direct component cost categories included in an estimate and costs incurred due to chronic sequelae. Therefore, these may be the most important factors to consider when designing, interpreting, and comparing cost of foodborne illness studies.

A Practical Methodology for Disaggregating the Drivers of Drug Costs Using Administrative Data.

PubMed

Lungu, Elena R; Manti, Orlando J; Levine, Mitchell A H; Clark, Douglas A; Potashnik, Tanya M; McKinley, Carol I

2017-09-01

Prescription drug expenditures represent a significant component of health care costs in Canada, with estimates of $28.8 billion spent in 2014. Identifying the major cost drivers and the effect they have on prescription drug expenditures allows policy makers and researchers to interpret current cost pressures and anticipate future expenditure levels. To identify the major drivers of prescription drug costs and to develop a methodology to disaggregate the impact of each of the individual drivers. The methodology proposed in this study uses the Laspeyres approach for cost decomposition. This approach isolates the effect of the change in a specific factor (e.g., price) by holding the other factor(s) (e.g., quantity) constant at the base-period value. The Laspeyres approach is expanded to a multi-factorial framework to isolate and quantify several factors that drive prescription drug cost. Three broad categories of effects are considered: volume, price and drug-mix effects. For each category, important sub-effects are quantified. This study presents a new and comprehensive methodology for decomposing the change in prescription drug costs over time including step-by-step demonstrations of how the formulas were derived. This methodology has practical applications for health policy decision makers and can aid researchers in conducting cost driver analyses. The methodology can be adjusted depending on the purpose and analytical depth of the research and data availability. © 2017 Journal of Population Therapeutics and Clinical Pharmacology. All rights reserved.

Reactive Power Pricing Model Considering the Randomness of Wind Power Output

NASA Astrophysics Data System (ADS)

Dai, Zhong; Wu, Zhou

2018-01-01

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

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

PubMed

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

1993-03-01

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

A primer on marginal effects-part II: health services research applications.

PubMed

Onukwugha, E; Bergtold, J; Jain, R

2015-02-01

Marginal analysis evaluates changes in a regression function associated with a unit change in a relevant variable. The primary statistic of marginal analysis is the marginal effect (ME). The ME facilitates the examination of outcomes for defined patient profiles or individuals while measuring the change in original units (e.g., costs, probabilities). The ME has a long history in economics; however, it is not widely used in health services research despite its flexibility and ability to provide unique insights. This article, the second in a two-part series, discusses practical issues that arise in the estimation and interpretation of the ME for a variety of regression models often used in health services research. Part one provided an overview of prior studies discussing ME followed by derivation of ME formulas for various regression models relevant for health services research studies examining costs and utilization. The current article illustrates the calculation and interpretation of ME in practice and discusses practical issues that arise during the implementation, including: understanding differences between software packages in terms of functionality available for calculating the ME and its confidence interval, interpretation of average marginal effect versus marginal effect at the mean, and the difference between ME and relative effects (e.g., odds ratio). Programming code to calculate ME using SAS, STATA, LIMDEP, and MATLAB are also provided. The illustration, discussion, and application of ME in this two-part series support the conduct of future studies applying the concept of marginal analysis.

Methodology for Estimating Total Automotive Manufacturing Costs

DOT National Transportation Integrated Search

1983-04-01

A number of methodologies for estimating manufacturing costs have been developed. This report discusses the different approaches and shows that an approach to estimating manufacturing costs in the automobile industry based on surrogate plants is pref...

Methodology for Determining the Avoidable and Fully Allocated Costs of Amtrak Routes : Volume II, Appendix A

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

Methodology for Determining the Avoidable and Fully Allocated Costs of Amtrak Routes : Volume III, Appendix B-H

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

Methodology for determining the avoidable and fully allocated costs of Amtrak routes, volume 1 : main report

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology.

PubMed

Tan, Siok Swan; Bakker, Jan; Hoogendoorn, Marga E; Kapila, Atul; Martin, Joerg; Pezzi, Angelo; Pittoni, Giovanni; Spronk, Peter E; Welte, Robert; Hakkaart-van Roijen, Leona

2012-01-01

The objective of the present study was to measure and compare the direct costs of intensive care unit (ICU) days at seven ICU departments in Germany, Italy, the Netherlands, and the United Kingdom by means of a standardized costing methodology. A retrospective cost analysis of ICU patients was performed from the hospital's perspective. The standardized costing methodology was developed on the basis of the availability of data at the seven ICU departments. It entailed the application of the bottom-up approach for "hotel and nutrition" and the top-down approach for "diagnostics," "consumables," and "labor." Direct costs per ICU day ranged from €1168 to €2025. Even though the distribution of costs varied by cost component, labor was the most important cost driver at all departments. The costs for "labor" amounted to €1629 at department G but were fairly similar at the other departments (€711 ± 115). Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

76 FR 2029 - Small Business Investment Companies-Energy Saving Qualified Investments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-12

... Costs SBA anticipates that this rule will provide marginal benefit to small businesses seeking... debenture and the energy saving debenture suggest that this rule will have a similarly marginal impact. In... Venture Capital Association MoneyTree TM Report indicates that $1.9 billion in Cleantech investments were...

Notes on Distortions in the Market for Educational Services.

ERIC Educational Resources Information Center

Olson, Lawrence S.

The document analyzes economic factors that might cause the output of educational services to diverge from the theoretical optimum because of a divergence between marginal social valuation and marginal social cost. Education contains both investment and consumption aspects. The analysis shows that the only distortion resulting from uncertainty…

Modeling nonlinear preferences

Treesearch

Donald F. Dennis

2002-01-01

Economic theory, as well as intuition, supports the notion of increasing or decreasing marginal rates of substitution. That is, the marginal benefit derived from an increase in a desired good or service, or one's willingness to accept tradeoffs among various costs or' benefits, depends on the current mix or allocation. However, due to widespread availability...

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SYSTEM COST METHODOLOGY FOR SALES FROM UTILITIES TO BONNEVILLE POWER ADMINISTRATION UNDER NORTHWEST POWER... functionalization under its Direct Analysis assigns costs, revenues, debits or credits based upon the actual and/or...) Functionalization methods. (1) Direct analysis, if allowed or required by Table 1, assigns costs, revenues, debits...

ITS telecommunications : public or private? : a cost tradeoff methodology guide

DOT National Transportation Integrated Search

1996-12-16

This cost Tradeoff Assessment Methodology Report outlines generic steps and strategy for analyzing the costs of obtaining telecommunications capacity to meet the requirements of jurisdictional ITS programs. A special focus has been placed on analysis...

Determinants of Change in the Cost-effectiveness Threshold.

PubMed

Paulden, Mike; O'Mahony, James; McCabe, Christopher

2017-02-01

The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants. Where the health care system is technically efficient, an increase in the health care budget unambiguously raises the threshold, whereas an increase in the demand for existing, non-marginal health interventions unambiguously lowers the threshold. Improvements in the technical efficiency of existing interventions may raise or lower the threshold, depending on the cause of the improvement in efficiency, whether the intervention is already funded, and, if so, whether it is marginal. New technologies may also raise or lower the threshold, depending on whether the new technology is a substitute for an existing technology and, again, whether the existing technology is marginal. Our analysis permits health economists and decision makers to assess if and in what direction the threshold may change over time. This matters, as threshold changes impact the cost-effectiveness of interventions that require decisions now but have costs and effects that fall in future periods.

The cost of an emergency department visit and its relationship to emergency department volume.

PubMed

Bamezai, Anil; Melnick, Glenn; Nawathe, Amar

2005-05-01

This article addresses 2 questions: (1) to what extent do emergency departments (EDs) exhibit economies of scale; and (2) to what extent do publicly available accounting data understate the marginal cost of an outpatient ED visit? Understanding the appropriate role for EDs in the overall health care system is crucially dependent on answers to these questions. The literature on these issues is sparse and somewhat dated and fails to differentiate between trauma and nontrauma hospitals. We believe a careful review of these questions is necessary because several changes (greater managed care penetration, increased price competition, cost of compliance with Emergency Medical Treatment and Active Labor Act regulations, and so on) may have significantly altered ED economics in recent years. We use a 2-pronged approach, 1 based on descriptive analyses of publicly available accounting data and 1 based on statistical cost models estimated from a 9-year panel of hospital data, to address the above-mentioned questions. Neither the descriptive analyses nor the statistical models support the existence of significant scale economies. Furthermore, the marginal cost of outpatient ED visits, even without the emergency physician component, appear quite high--in 1998 dollars, US295 dollars and US412 dollars for nontrauma and trauma EDs, respectively. These statistical estimates exceed the accounting estimates of per-visit costs by a factor of roughly 2. Our findings suggest that the marginal cost of an outpatient ED visit is higher than is generally believed. Hospitals thus need to carefully review how EDs fit within their overall operations and cost structure and may need to pay special attention to policies and procedures that guide the delivery of nonurgent care through the ED.

Optimization of a GO2/GH2 Impinging Injector Element

NASA Technical Reports Server (NTRS)

Tucker, P. Kevin; Shyy, Wei; Vaidyanathan, Rajkumar

2001-01-01

An injector optimization methodology, method i, is used to investigate optimal design points for a gaseous oxygen/gaseous hydrogen (GO2/GH2) impinging injector element. The unlike impinging element, a fuel-oxidizer- fuel (F-O-F) triplet, is optimized in terms of design variables such as fuel pressure drop, (Delta)P(sub f), oxidizer pressure drop, (Delta)P(sub o), combustor length, L(sub comb), and impingement half-angle, alpha, for a given mixture ratio and chamber pressure. Dependent variables such as energy release efficiency, ERE, wall heat flux, Q(sub w), injector heat flux, Q(sub inj), relative combustor weight, W(sub rel), and relative injector cost, C(sub rel), are calculated and then correlated with the design variables. An empirical design methodology is used to generate these responses for 163 combinations of input variables. Method i is then used to generate response surfaces for each dependent variable. Desirability functions based on dependent variable constraints are created and used to facilitate development of composite response surfaces representing some, or all, of the five dependent variables in terms of the input variables. Three examples illustrating the utility and flexibility of method i are discussed in detail. First, joint response surfaces are constructed by sequentially adding dependent variables. Optimum designs are identified after addition of each variable and the effect each variable has on the design is shown. This stepwise demonstration also highlights the importance of including variables such as weight and cost early in the design process. Secondly, using the composite response surface which includes all five dependent variables, unequal weights are assigned to emphasize certain variables relative to others. Here, method i is used to enable objective trade studies on design issues such as component life and thrust to weight ratio. Finally, specific variable weights are further increased to illustrate the high marginal cost of realizing the last increment of injector performance and thruster weight.

Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

PubMed

Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

2011-07-01

Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Cost comparisons and methodological heterogeneity in cost-of-illness studies: the example of colorectal cancer.

PubMed

Ó Céilleachair, Alan J; Hanly, Paul; Skally, Máiréad; O'Neill, Ciaran; Fitzpatrick, Patricia; Kapur, Kanika; Staines, Anthony; Sharp, Linda

2013-04-01

Colorectal cancer (CRC) is the third most common cancer worldwide with over 1 million new cases diagnosed each year. Advances in treatment and survival are likely to have increased lifetime costs of managing the disease. Cost-of-illness (COI) studies are key building blocks in economic evaluations of interventions and comparative effectiveness research. We systematically reviewed and critiqued the COI literature on CRC. We searched several databases for CRC COI studies published in English, between January 2000 and February 2011. Information was abstracted on: setting, patient population, top-down/bottom-up costing, incident/prevalent approach, payer perspective, time horizon, costs included, cost source, and per-person costs. We developed a framework to compare study methodologies and assess homogeneity/heterogeneity. A total of 26 papers met the inclusion criteria. There was extensive methodological heterogeneity. Studies included case-control studies based on claims/reimbursement data (10), examinations of patient charts (5), and analysis of claims data (4). Epidemiological approaches varied (prevalent, 6; incident, 8; mixed, 10; unclear, 4). Time horizons ranged from 1 year postdiagnosis to lifetime. Seventeen studies used top-down costing. Twenty-five studies included healthcare-payer direct medical costs; 2 included indirect costs; 1 considered patient costs. There was broad agreement in how studies accounted for time, but few studies described costs in sufficient detail to allow replication. In general, costs were not comparable between studies. Methodological heterogeneity and lack of transparency made it almost impossible to compare CRC costs between studies or over time. For COI studies to be more useful and robust there is need for clear and rigorous guidelines around methodological and reporting "best practice."

Coal gasification systems engineering and analysis. Appendix E: Cost estimation and economic evaluation methodology

NASA Technical Reports Server (NTRS)

1980-01-01

The cost estimation and economic evaluation methodologies presented are consistent with industry practice for assessing capital investment requirements and operating costs of coal conversion systems. All values stated are based on January, 1980 dollars with appropriate recognition of the time value of money. Evaluation of project economic feasibility can be considered a two step process (subject to considerable refinement). First, the costs of the project must be quantified and second, the price at which the product can be manufacturd must be determined. These two major categories are discussed. The summary of methodology is divided into five parts: (1) systems costs, (2)instant plant costs, (3) annual operating costs, (4) escalation and discounting process, and (5) product pricing.

Titrating versus targeting home care services to frail elderly clients: an application of agency theory and cost-benefit analysis to home care policy.

PubMed

Weissert, William; Chernew, Michael; Hirth, Richard

2003-02-01

The article summarizes the shortcomings of current home care targeting policy, provides a conceptual framework for understanding the sources of its problems, and proposes an alternative resource allocation method. Methods required for different aspects of the study included synthesis of the published literature, regression analysis of risk predictors, and comparison of actual resource allocations with simulated budgets. Problems of imperfect agency ranging from unclear goals and inappropriate incentives to lack of information about the marginal effectiveness of home care could be mitigated with an improved budgeting method that combines client selection and resource allocation. No program can produce its best outcome performance when its goals are unclear and its technology is unstandardized. Titration of care would reallocate resources to maximize marginal benefit for marginal cost.

Highway User Benefit Analysis System Research Project #128

DOT National Transportation Integrated Search

2000-10-01

In this research, a methodology for estimating road user costs of various competing alternatives was developed. Also, software was developed to calculate the road user cost, perform economic analysis and update cost tables. The methodology is based o...

Financial Impacts of Priority Swine Diseases to Pig Farmers in Red River and Mekong River Delta, Vietnam.

PubMed

Pham, H T T; Antoine-Moussiaux, N; Grosbois, V; Moula, N; Truong, B D; Phan, T D; Vu, T D; Trinh, T Q; Vu, C C; Rukkwamsuk, T; Peyre, M

2017-08-01

A study was conducted between May 2013 and August 2014 in three provinces of Vietnam to investigate financial impacts of swine diseases in pig holdings in 2010-2013. The aim of the study was to quantify the costs of swine diseases at producer level in order to understand swine disease priority for monitoring at local level. Financial impacts of porcine reproductive and respiratory syndrome (PRRS), foot and mouth disease (FMD), and epidemic diarrhoea were assessed for 162 pig holders in two Red River Delta provinces and in one Mekong River Delta province, using data on pig production and swine disease outbreaks at farms. Losses incurred by swine diseases were estimated, including direct losses due to mortality (100% market value of pig before disease onset) and morbidity (abortion, delay of finishing stage), and indirect losses due to control costs (treatment, improving biosecurity and emergency vaccination) and revenue foregone (lower price in case of emergency selling). Financial impacts of swine diseases were expressed as percentage of gross margin of pig holding. The gross margin varied between pig farming groups (P < 0.0001) in the following order: large farm (USD 18 846), fattening farm (USD 7014) and smallholder (USD 2350). The losses per pig holding due to PRRS were the highest: 41% of gross margin for large farm, 38% for fattening farm and 63% for smallholder. Cost incurred by FMD was lower with 19%, 25% and 32% of gross margin of pig holding in large farm, fattening farm and smallholder, respectively. The cost of epidemic diarrhoea was the lowest compared to losses due to PRRS and FMD and accounted for around 10% of gross margin of pig holding in the three pig farming groups. These estimates provided critical elements on swine disease priorities to better inform surveillance and control at both national and local level. © 2016 Blackwell Verlag GmbH.

A method for identifying EMI critical circuits during development of a large C3

NASA Astrophysics Data System (ADS)

Barr, Douglas H.

The circuit analysis methods and process Boeing Aerospace used on a large, ground-based military command, control, and communications (C3) system are described. This analysis was designed to help identify electromagnetic interference (EMI) critical circuits. The methodology used the MIL-E-6051 equipment criticality categories as the basis for defining critical circuits, relational database technology to help sort through and account for all of the approximately 5000 system signal cables, and Macintosh Plus personal computers to predict critical circuits based on safety margin analysis. The EMI circuit analysis process systematically examined all system circuits to identify which ones were likely to be EMI critical. The process used two separate, sequential safety margin analyses to identify critical circuits (conservative safety margin analysis, and detailed safety margin analysis). These analyses used field-to-wire and wire-to-wire coupling models using both worst-case and detailed circuit parameters (physical and electrical) to predict circuit safety margins. This process identified the predicted critical circuits that could then be verified by test.

Cost-effectiveness analyses of hepatitis A vaccine: a systematic review to explore the effect of methodological quality on the economic attractiveness of vaccination strategies.

PubMed

Anonychuk, Andrea M; Tricco, Andrea C; Bauch, Chris T; Pham, Ba'; Gilca, Vladimir; Duval, Bernard; John-Baptiste, Ava; Woo, Gloria; Krahn, Murray

2008-01-01

Hepatitis A vaccines have been available for more than a decade. Because the burden of hepatitis A virus has fallen in developed countries, the appropriate role of vaccination programmes, especially universal vaccination strategies, remains unclear. Cost-effectiveness analysis is a useful method of relating the costs of vaccination to its benefits, and may inform policy. This article systematically reviews the evidence on the cost effectiveness of hepatitis A vaccination in varying populations, and explores the effects of methodological quality and key modelling issues on the cost-effectiveness ratios.Cost-effectiveness/cost-utility studies of hepatitis A vaccine were identified via a series of literature searches (MEDLINE, EMBASE, HSTAR and SSCI). Citations and full-text articles were reviewed independently by two reviewers. Reference searching, author searches and expert consultation ensured literature saturation. Incremental cost-effectiveness ratios (ICERs) were abstracted for base-case analyses, converted to $US, year 2005 values, and categorised to reflect various levels of cost effectiveness. Quality of reporting, methodological issues and key modelling issues were assessed using frameworks published in the literature.Thirty-one cost-effectiveness studies (including 12 cost-utility analyses) were included from full-text article review (n = 58) and citation screening (n = 570). These studies evaluated universal mass vaccination (n = 14), targeted vaccination (n = 17) and vaccination of susceptibles (i.e. individuals initially screened for antibody and, if susceptible, vaccinated) [n = 13]. For universal vaccination, 50% of the ICERs were <$US20 000 per QALY or life-year gained. Analyses evaluating vaccination in children, particularly in high incidence areas, produced the most attractive ICERs. For targeted vaccination, cost effectiveness was highly dependent on the risk of infection.Incidence, vaccine cost and discount rate were the most influential parameters in sensitivity analyses. Overall, analyses that evaluated the combined hepatitis A/hepatitis B vaccine, adjusted incidence for under-reporting, included societal costs and that came from studies of higher methodological quality tended to have more attractive cost-effectiveness ratios. Methodological quality varied across studies. Major methodological flaws included inappropriate model type, comparator, incidence estimate and inclusion/exclusion of costs.

Machine cost analysis using the traditional machine-rate method and ChargeOut!

Treesearch

E. M. (Ted) Bilek

2009-01-01

Forestry operations require ever more use of expensive capital equipment. Mechanization is frequently necessary to perform cost-effective and safe operations. Increased capital should mean more sophisticated capital costing methodologies. However the machine rate method, which is the costing methodology most frequently used, dates back to 1942. CHARGEOUT!, a recently...

Reconciling quality and cost: A case study in interventional radiology.

PubMed

Zhang, Li; Domröse, Sascha; Mahnken, Andreas

2015-10-01

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

Tunnel and Station Cost Methodology : Mined Tunnels

DOT National Transportation Integrated Search

1983-01-01

The main objective of this study was to develop a model for estimating the cost of subway station and tunnel construction. This report describes a cost estimating methodology for subway tunnels that can be used by planners, designers, owners, and gov...

Tunnel and Station Cost Methodology Volume II: Stations

DOT National Transportation Integrated Search

1981-01-01

The main objective of this study was to develop a model for estimating the cost of subway station and tunnel construction. This report describes a cost estimating methodology for subway tunnels that can be used by planners, designers, owners, and gov...

Costs of Addressing Heroin Addiction in Malaysia and 32 Comparable Countries Worldwide

PubMed Central

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Luekens, Craig; Ng, Nora; Schottenfeld, Richard

2012-01-01

Objective Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Data Sources/Study Setting Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003–May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Study Design Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Principal Findings Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29–53 percent) and buprenorphine (33–72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Conclusions Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. PMID:22091732

Costs of addressing heroin addiction in Malaysia and 32 comparable countries worldwide.

PubMed

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Luekens, Craig; Ng, Nora; Schottenfeld, Richard

2012-04-01

Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003-May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29-53 percent) and buprenorphine (33-72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. © Health Research and Educational Trust.

Predictors of Payer Mix and Financial Performance Among Safety Net Hospitals Prior to the Affordable Care Act.

PubMed

Sommers, Benjamin D; Stone, Juliana; Kane, Nancy

2016-01-01

The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. We analyzed the 2010 financial statements of 98 large, urban safety net hospital systems in 34 states, supplemented with data on population demographics, hospital features, and state policies. We used multivariate regression to identify independent predictors of three outcomes: 1) Medicaid-reliant payer mix (hospitals for which at least 25% of hospital days are paid for by Medicaid); 2) safety net revenue-to-cost ratio (Medicaid and Medicare Disproportionate Share Hospital payments and local government transfers, divided by charity care costs and Medicaid payment shortfall); and 3) operating margin. Medicaid-reliant payer mix was positively associated with more inclusive state Medicaid eligibility criteria and more minority patients. More inclusive Medicaid eligibility and higher Medicaid reimbursement rates positively predicted safety net revenue-to-cost ratio. University governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs. Institutional and state policies may outweigh patient demographics in the financial health of safety net hospitals. © The Author(s) 2015.

Literacy in the Work Force. Report Number 947.

ERIC Educational Resources Information Center

Lund, Leonard; McGuire, E. Patrick

Up to 10 percent of U.S. workers are either functionally illiterate or marginally literate. These workers increase the operational costs of their employers and restrain companies' flexibility. The high school graduates of the 1990s will exacerbate the problem by entering the work force with marginal literacy skills. A survey of 1,600 manufacturing…

76 FR 23732 - Margin Requirements for Uncleared Swaps for Swap Dealers and Major Swap Participants

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... these statutory bounds the Commission has endeavored to limit costs appropriately. For example, as... Commission anticipates that the prudential regulators will publicly post their proposed rules on their Web... containing a threshold below which the CSE was not required to post initial margin, i.e., zero thresholds...

A Sports Franchise Simulation Game

ERIC Educational Resources Information Center

Surdam, David G.

2009-01-01

Students in sports economics courses might better learn the basic concepts by running their own franchise. A simple game, based on the card game War, is easy and inexpensive to implement. Students quickly grasp the importance of weighing marginal benefits, both in terms of team record and marginal revenue, against the costs of improving their…

Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa

PubMed Central

Kasteng, Frida; Settumba, Stella; Källander, Karin; Vassall, Anna

2016-01-01

Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs’ workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5–57), was valued at USD 6.9 (range 0.9–20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4–169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes. PMID:26001813

Health Systems and Sustainability: Doctors and Consumers Differ on Threats and Solutions

PubMed Central

Robertson, Jane; Walkom, Emily J.; Henry, David A.

2011-01-01

Background Healthcare systems face the problem of insufficient resources to meet the needs of ageing populations and increasing demands for access to new treatments. It is unclear whether doctors and consumers agree on the main challenges to health system sustainability. Methodology We conducted a mail survey of Australian doctors (specialists and general practitioners) and a computer assisted telephone interview (CATI) of consumers to determine their views on contributors to increasing health care costs, rationing of services and involvement in health resource allocation decisions. Differences in responses are reported as odds ratios (OR) and 99% confidence intervals (CI). Results Of 2948 doctors, 1139 (38.6%) responded; 533 of 826 consumers responded (64.5% response). Doctors were more concerned than consumers with the effects of an ageing population (OR 3.0; 99% CI 1.7, 5.4), and costs of new drugs and technologies (OR 5.1; CI 3.3, 8.0), but less likely to consider pharmaceutical promotional activities as a cost driver (OR 0.29, CI 0.22, 0.39). Doctors were more likely than consumers to view ‘community demand’ for new technologies as a major cost driver, (OR 1.6; 1.2, 2.2), but less likely to attribute increased costs to patients failing to take responsibility for their own health (OR 0.35; 0.24, 0.49). Like doctors, the majority of consumers saw a need for public consultation in decisions about funding for new treatments. Conclusions Australian doctors and consumers hold different views on the sustainability of the healthcare system, and a number of key issues relating to costs, cost drivers, roles and responsibilities. Doctors recognise their dual responsibility to patients and society, see an important role for physicians in influencing resource allocation, and acknowledge their lack of skills in assessing treatments of marginal value. Consumers recognise cost pressures on the health system, but express willingness to be involved in health care decision making. PMID:21556357

Economic concepts to address future water supply-demand imbalances in Iran, Morocco and Saudi Arabia

NASA Astrophysics Data System (ADS)

Hellegers, Petra; Immerzeel, Walter; Droogers, Peter

2013-10-01

In Middle East and North Africa (MENA) countries, renewable groundwater and surface water supply are limited while demand for water is growing rapidly. Climate change is expected to increase water demand even further. The main aim of this paper is to evaluate the water supply-demand imbalances in Iran, Morocco and Saudi Arabia in 2040-2050 under dry, average and wet climate change projections and to show on the basis of the marginal cost and marginal value of water the optimum mix of supply-side and demand-side adjustments to address the imbalance. A hydrological model has been used to estimate the water supply-demand imbalance. Water supply and demand curves have been used to explore for which (marginal value of) water usage the marginal cost of supply-enhancement becomes too expensive. The results indicate that in the future in all cases, except in Iran under the wet climate projection, the quantity of water demanded has to be reduced considerably to address the imbalance, which is indeed what is currently happening already.

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

PubMed

Thompson, M S

1983-01-01

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

[Incentives and disincentives for research and development of new drugs by the pharmaceutical industry].

PubMed

Curcio, Pasqualina Curcio

2008-10-01

The authors present a model with factors that influence research and development decisions by the pharmaceutical industry: risk of disease transmission and possibility of control; case-fatality and the presence of cure or treatments; income; number of persons who demand the medicine; and opportunity costs for the company. Companies tend to invest in markets with inelastic demand (highly contagious diseases with no possibility of controlling transmission and/or very lethal diseases without treatment) and/or where there is a large population or high per capita income. Companies tend not to invest in markets where marginal costs exceed marginal income, particularly when costs increase permanently as a consequence of rising opportunity costs generated by foregoing profit in other markets. In such cases, policies to subsidize R&D are not effective, and policies must be orientated towards strengthening basic and applied research by public institutions.

Funding pharmaceutical innovation through direct tax credits.

PubMed

Lybecker, Kristina M; Freeman, Robert A

2007-07-01

Rising pharmaceutical prices, increasing demand for more effective innovative drugs and growing public outrage have heightened criticism of the pharmaceutical industry. The public debate has focused on drug prices and access. As a consequence, the patent system is being reexamined as an efficient mechanism for encouraging pharmaceutical innovation and drug development. We propose an alternative to the existing patent system, instead rewarding the innovating firm with direct tax credits in exchange for marginal cost pricing. This concept is based on the fundamental assumption that innovation that benefits society at large may be financed publicly. As an industry which produces a social good characterized by high fixed costs, high information and regulatory costs, and relatively low marginal costs of production, pharmaceuticals are well-suited to such a mechanism. Under this proposal, drug prices fall, consumer surplus increases, access is enhanced, and the incentives to innovate are preserved.

Modeling and Analysis of Wholesale Electricity Market Design. Understanding the Missing Money Problem. December 2013 - January 2015

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

Papalexopoulos, A.; Hansen, C.; Perrino, D.

This project examined the impact of renewable energy sources, which have zero incremental energy costs, on the sustainability of conventional generation. This “missing money” problem refers to market outcomes in which infra-marginal energy revenues in excess of operations and maintenance (O&M) costs are systematically lower than the amortized costs of new entry for a marginal generator. The problem is caused by two related factors: (1) conventional generation is dispatched less, and (2) the price that conventional generation receives for its energy is lower. This lower revenue stream may not be sufficient to cover both the variable and fixed costs ofmore » conventional generation. In fact, this study showed that higher wind penetrations in the Electric Reliability Council of Texas (ERCOT) system could cause many conventional generators to become uneconomic.« less

Systems cost/performance analysis (study 2.3). Volume 2: Systems cost/performance model. [unmanned automated payload programs and program planning

NASA Technical Reports Server (NTRS)

Campbell, B. H.

1974-01-01

A methodology which was developed for balanced designing of spacecraft subsystems and interrelates cost, performance, safety, and schedule considerations was refined. The methodology consists of a two-step process: the first step is one of selecting all hardware designs which satisfy the given performance and safety requirements, the second step is one of estimating the cost and schedule required to design, build, and operate each spacecraft design. Using this methodology to develop a systems cost/performance model allows the user of such a model to establish specific designs and the related costs and schedule. The user is able to determine the sensitivity of design, costs, and schedules to changes in requirements. The resulting systems cost performance model is described and implemented as a digital computer program.

Scale Issues in Modeling the Water Resources Sector in National Economic Models: A Case study of China

NASA Astrophysics Data System (ADS)

Strzepek, K. M.; Kirshen, P.; Yohe, G.

2001-05-01

The fundamental theme of this research was to investigate tradeoffs in model resolution for modeling water resources in the context of national economic development and capital investment decisions.. Based on a case study of China, the research team has developed water resource models at relatively fine scales, then investigated how they can be aggregated to regional or national scales and for use in national level planning decisions or global scale integrated assessment models of food and/or environmental change issues. The team has developed regional water supply and water demand functions.. Simplifying and aggregating the supply and demand functions will allow reduced form functions of the water sector for inclusion in large scale national economic models. Water Supply Cost functions were developed looking at both surface and groundwater supplies. Surface Water: Long time series of flows at the mouths of the 36 major river sub-basins in China are used in conjunction with different basin reservoir storage quantities to obtain storage-yield curves. These are then combined with reservoir and transmission cost data to obtain yield-cost or surface water demand curves. The methodology to obtain the long time series of flows for each basin is to fit a simple abcd water balance model to each basin. The costs of reservoir storage have been estimated by using a methodology developed in the USA that relates marginal storage costs to existing storage, slope and geological conditions. USA costs functions have then been adjusted to Chinese costs. The costs of some actual dams in China were used to "ground-truth" the methodology. Groundwater: The purpose of the groundwater work is to estimate the recharge in each basin, and the depths and quality of water of aquifers. A byproduct of the application of the abcd water balance model is the recharge. Depths and quality of aquifers are being taken from many separate reports on groundwater in different parts of China; we have been unable to find any global or regional datasets of groundwater.. Combining Surface and Groundwater Supply Functions Water Demand Curves. Water Use data is reported on political regions. Water Supply is reported and modeled on river basin regions. It is necessary to allocate water demands to river basins. To accomplish this China's 9 major river basins were divided into 36 hydroeconomic regions. The counties were then allocated to one of the 36-hydroeconomic zones. The county-level water use data was aggregated to 5 major water use sectors: 1)industry; 2)urban municipal and vegetable gardens: 3) major irrigation; 4) Energy and 5)Other agriculture (forestry, pasture; fishery). Sectoral Demand functions that include price and income elasticity were developed for the 5 sectors for each of the 9 major river basin. The supply and demand curves were aggregated at a variety of geographical scales as well as levels of economic sectoral aggregation. Implications for investment and sustainable development policies were examined for the various aggregation using partial and general equilibrium modeling of the Chinese economy. These results and policy implications for China as well as insights and recommendation for other developing countries will be presented.

Methodological Considerations in Social Cost Studies of Addictive Substances: A Systematic Literature Review.

PubMed

Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

2016-01-01

Alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals' use is associated with a higher likelihood of developing several diseases and injuries and, as a consequence, considerable health-care expenditures. There is yet a lack of consistent methodologies to estimate the economic impact of addictive substances to society. The aim was to assess the methodological approaches applied in social cost studies estimating the economic impact of alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals. A systematic literature review through the electronic databases, Medline (PubMed) and Web of Science, was performed. Studies in English published from 1997 examining the social costs of the addictive substances alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals were eligible for inclusion. Twelve social cost studies met the inclusion criteria. In all studies, the direct and indirect costs were measured, but the intangible costs were seldom taken into account. A wide variety in cost items included across studies was observed. Sensitivity analyses to address the uncertainty around certain cost estimates were conducted in eight studies considered in the review. Differences in cost items included in cost-of-illness studies limit the comparison across studies. It is clear that it is difficult to deal with all consequences of substance use in cost-of-illness studies. Future social cost studies should be based on sound methodological principles in order to result in more reliable cost estimates of the economic burden of substance use.

Maternal cfDNA screening for Down syndrome--a cost sensitivity analysis.

PubMed

Cuckle, Howard; Benn, Peter; Pergament, Eugene

2013-07-01

This study aimed to determine the principal factors contributing to the cost of avoiding a birth with Down syndrome by using cell-free DNA (cfDNA) to replace conventional screening. A range of unit costs were assigned to each item in the screening process. Detection rates were estimated by meta-analysis and modeling. The marginal cost associated with the detection of additional cases using cfDNA was estimated from the difference in average costs divided by the difference in detection. The main factor was the unit cost of cfDNA testing. For example, replacing a combined test costing $150 with 3% false-positive rate and invasive testing at $1000, by cfDNA tests at $2000, $1500, $1000, and $500, the marginal cost is $8.0, $5.8, $3.6, and $1.4m, respectively. Costs were lower when replacing a quadruple test and higher for a 5% false-positive rate, but the relative importance of cfDNA unit cost was unchanged. A contingent policy whereby 10% to 20% women were selected for cfDNA testing by conventional screening was considerably more cost-efficient. Costs were sensitive to cfDNA uptake. Universal cfDNA screening for Down syndrome will only become affordable by public health purchasers if costs fall substantially. Until this happens, the contingent use of cfDNA is recommended. © 2013 John Wiley & Sons, Ltd.

75 FR 39663 - Stainless Steel Bar From Brazil: Final Results of Antidumping Duty Administrative Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-12

... a post-preliminary analysis in which we altered the cost-of- production methodology from that which... scope of the order is dispositive. Alternative Cost Methodology In our Preliminary Results we relied on... Results, 75 FR at 12516), and we compared the home-market prices to POR costs for the cost-of-production...

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

NASA Technical Reports Server (NTRS)

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

1978-01-01

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

Cost-of-illness studies of atrial fibrillation: methodological considerations.

PubMed

Becker, Christian

2014-10-01

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies' methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies' relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

Life-Cycle Cost/Benefit Assessment of Expedite Departure Path (EDP)

NASA Technical Reports Server (NTRS)

Wang, Jianzhong Jay; Chang, Paul; Datta, Koushik

2005-01-01

This report presents a life-cycle cost/benefit assessment (LCCBA) of Expedite Departure Path (EDP), an air traffic control Decision Support Tool (DST) currently under development at NASA. This assessment is an update of a previous study performed by bd Systems, Inc. (bd) during FY01, with the following revisions: The life-cycle cost assessment methodology developed by bd for the previous study was refined and calibrated using Free Flight Phase 1 (FFP1) cost information for Traffic Management Advisor (TMA, or TMA-SC in the FAA's terminology). Adjustments were also made to the site selection and deployment scheduling methodology to include airspace complexity as a factor. This technique was also applied to the benefit extrapolation methodology to better estimate potential benefits for other years, and at other sites. This study employed a new benefit estimating methodology because bd s previous single year potential benefit assessment of EDP used unrealistic assumptions that resulted in optimistic estimates. This methodology uses an air traffic simulation approach to reasonably predict the impacts from the implementation of EDP. The results of the costs and benefits analyses were then integrated into a life-cycle cost/benefit assessment.

77 FR 30411 - Connect America Fund; High-Cost Universal Service Support

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... ``benchmarks'' for high cost loop support (HCLS). The methodology the Bureau adopts, builds on the analysis... to support continued broadband investment. The methodology the Bureau adopts today is described in... methodology, HCLS will be recalculated to account for the additional support available under the overall cap...

10 CFR Appendix B to Part 436 - Goal Setting Methodology

Code of Federal Regulations, 2013 CFR

2013-01-01

... investment program, (using where appropriate, the life cycle costing factors and methodology in subpart A of... subpart A, the dollars saved can be projected against the dollars invested. Life cycle costing methodology..., maintenance, and equipment acquisition; and phase-out schedule (of older equipment or plants which may be...

10 CFR Appendix B to Part 436 - Goal Setting Methodology

Code of Federal Regulations, 2012 CFR

2012-01-01

... investment program, (using where appropriate, the life cycle costing factors and methodology in subpart A of... subpart A, the dollars saved can be projected against the dollars invested. Life cycle costing methodology..., maintenance, and equipment acquisition; and phase-out schedule (of older equipment or plants which may be...

10 CFR Appendix B to Part 436 - Goal Setting Methodology

Code of Federal Regulations, 2011 CFR

2011-01-01

... investment program, (using where appropriate, the life cycle costing factors and methodology in subpart A of... Subpart A, the dollars saved can be projected against the dollars invested. Life cycle costing methodology..., maintenance, and equipment acquisition; and phase-out schedule (of older equipment or plants which may be...

10 CFR Appendix B to Part 436 - Goal Setting Methodology

Code of Federal Regulations, 2014 CFR

2014-01-01

... investment program, (using where appropriate, the life cycle costing factors and methodology in subpart A of... subpart A, the dollars saved can be projected against the dollars invested. Life cycle costing methodology..., maintenance, and equipment acquisition; and phase-out schedule (of older equipment or plants which may be...

Real Options as a Strategic Management Framework: A Case Study of the Operationally Responsive Space Initiative

DTIC Science & Technology

2007-03-01

of the project, and the Weighted Average Cost of Capital ( WACC ). WACC is defined as the after-tax marginal cost of capital (Copeland & Antikarov...Initial Investment t = Life Expectancy of Project (Start =1, to Finish=N) E(FCF) = Expected Free-Cash Flow WACC = Weighted Average Cost of

A comparison of pay-as-bid and marginal pricing in electricity markets

NASA Astrophysics Data System (ADS)

Ren, Yongjun

This thesis investigates the behaviour of electricity markets under marginal and pay-as-bid pricing. Marginal pricing is believed to yield the maximum social welfare and is currently implemented by most electricity markets. However, in view of recent electricity market failures, pay-as-bid has been extensively discussed as a possible alternative to marginal pricing. In this research, marginal and pay-as-bid pricing have been analyzed in electricity markets with both perfect and imperfect competition. The perfect competition case is studied under both exact and uncertain system marginal cost prediction. The comparison of the two pricing methods is conducted through two steps: (i) identify the best offer strategy of the generating companies (gencos); (ii) analyze the market performance under these optimum genco strategies. The analysis results together with numerical simulations show that pay-as-bid and marginal pricing are equivalent in a perfect market with exact system marginal cost prediction. In perfect markets with uncertain demand prediction, the two pricing methods are also equivalent but in an expected value sense. If we compare from the perspective of second order statistics, all market performance measures exhibit much lower values under pay-as-bid than under marginal pricing. The risk of deviating from the mean is therefore much higher under marginal pricing than under pay-as-bid. In an imperfect competition market with exact demand prediction, the research shows that pay-as-bid pricing yields lower consumer payments and lower genco profits. This research provides quantitative evidence that challenges some common claims about pay-as-bid pricing. One is that under pay-as-bid, participants would soon learn how to offer so as to obtain the same or higher profits than what they would have obtained under marginal pricing. This research however shows that, under pay-as-bid, participants can at best earn the same profit or expected profit as under marginal pricing. A second common claim refuted by this research is that pay-as-bid does not provide correct price signals if there is a scarcity of generation resources. We show that pay-as-bid does provide a price signal with such characteristics and furthermore argue that the price signal under marginal pricing with gaming may not necessarily be correct since it would then not reflect a lack of generation capacity but a desire to increase profit.

Instances selection algorithm by ensemble margin

NASA Astrophysics Data System (ADS)

Saidi, Meryem; Bechar, Mohammed El Amine; Settouti, Nesma; Chikh, Mohamed Amine

2018-05-01

The main limit of data mining algorithms is their inability to deal with the huge amount of available data in a reasonable processing time. A solution of producing fast and accurate results is instances and features selection. This process eliminates noisy or redundant data in order to reduce the storage and computational cost without performances degradation. In this paper, a new instance selection approach called Ensemble Margin Instance Selection (EMIS) algorithm is proposed. This approach is based on the ensemble margin. To evaluate our approach, we have conducted several experiments on different real-world classification problems from UCI Machine learning repository. The pixel-based image segmentation is a field where the storage requirement and computational cost of applied model become higher. To solve these limitations we conduct a study based on the application of EMIS and other instance selection techniques for the segmentation and automatic recognition of white blood cells WBC (nucleus and cytoplasm) in cytological images.

Ramsey waits: allocating public health service resources when there is rationing by waiting.

PubMed

Gravelle, Hugh; Siciliani, Luigi

2008-09-01

The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

Cost of Milk and Marketing Margins in Dairy Farms of Turkey

NASA Astrophysics Data System (ADS)

Uzunoz, Meral; Altintas, Gulcin; Akcay, Yasar

The study is based on the cost of milk and marketing margins in dairy farms in Tokat-Turkey with the help of primary data collected randomly from 62 farmers. In the study it was determined that milk production in dairy farms was relatively profitable in domestic (1.34), cross-bred (1.29) and culture (1.58) dairy cattle. It was found that marketing margins of milk were 183.33% for domestic, cross-breed and culture dairy cattle. As a result, although there were some structural problems for dairy farms such as high input prices, lack of cooperation among producers and long marketing chains between producers and retailers, it can be still perceived that the dairy farming can be one of the most important income sources for the farmers of rural provinces of Tokat-Turkey. Furthermore it should be stated that current livestock policy need to be regulated.

Budgeting in health care systems.

PubMed

Maynard, A

1984-01-01

During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economise in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence.

Cost modeling to justify technology acquisitions.

PubMed

Vanden Brink, J; Gray, S

1997-06-01

In an era of diminishing resources, healthcare providers must justify new technology acquisitions. Cost modeling is one method of evaluating the financial impact a technology acquisition will have on a healthcare facility or integrated delivery system. This methodology requires careful data collection and a thorough analysis of both current costs and future cost savings resulting from the new technology. By using a cost modeling methodology, providers will be able to achieve competitive and economic advantages by analyzing both cost and value.

Socio-economic analysis of the risk management of hexabromocyclododecane (HBCD) in China in the context of the Stockholm Convention.

PubMed

Zhu, Jing; Liu, Jian-Guo; Hu, Jian-Xin; Yi, Shan

2016-05-01

Socio-economic analysis (SEA) plays an important role in decision-making on risk management actions for certain chemicals under Multilateral Environmental Agreements (MEAs) in developing countries. This paper showed the first holistic and quantitative SEA case study on that by developing a country-specific SEA framwork and methodologies and applying the case of HBCD phase-out in China under the Stockholm Convention on Persistent Organic Pollutants (POPs). The study indicates that, under the possible scenarios of 10 years and 5 years , the economic costs of HBCD phase-out in China would be between 9.032 and 19.021 billion RMB. Although the total economic costs seems to be significant, it would only have a marginal impact on the house building industry with a likely cost increase by about 0.07‰-0.14‰. Meanwhile, the HBCD phase-out may render significant environmental and health benefits, including about 23-29 tons of HBCD release prevented to the environment, 1.142-1.469 million tons of potentially HBCD contained hazardous wastes avoided, along with significant reduction from 58% up to almost 100% in local environmental concentrations of HBCD, and about 0.0996-0.128 million workers at risk avoided and at least 3.067-4.033 billion RMB of the health care savings. While the scenario of phasing out HBCD over 10 years would be less costly than the scenario of that over 5 years, the later scenario suggested much greater environmental and health benefits for China. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patents and profits: A disparity of manufacturing margins in the tenofovir value chain.

PubMed

Walwyn, David

2013-03-01

Registered in 2001, tenofovir disoproxil fumarate (TDF) has quickly become a mainstay of first line regimens for the treatment of HIV. Initially only available in developed countries at a cost of US$5 000 per person per year (ppy), Gilead's Access Programme (GAP) has extended the use of the product to 2.4 million patients in low and middle income countries. The programme has two components: distribution of the branded product at reduced prices and licensing partnerships with generic manufacturers. The licensing partnerships now supply 75% of the market by volume, at a treatment cost of US$57 ppy (1% of the branded cost). From Gilead's perspective, GAP must be considered a huge success. It has enabled the company to maintain high prices in developed countries whilst reducing its input costs and deflecting criticism of its failure to provide essential medicines for the poor, hence risking the possibility of compulsory licensing. Over the period 2001 to 2011, TDF in its various forms has generated for Gilead more than US$31 billion revenue at a gross margin of 80%, equivalent to a gross profit of US$25 billion. Analysis of the TDF value chain, from preparation of the active pharmaceutical ingredient (API) to sale of the formulated product, shows that manufacturing margins are highly skewed in favour of the originator, with the latter's profit being US$3.2 billion vs. US$4 million for API manufacturers and US$39 million for formulators (2011). The data argues for a more rational approach to drug pricing including possible regulation in developed countries and more sustainable margins for the generic producers.

A new methodology for modeling of direct landslide costs for transportation infrastructures

NASA Astrophysics Data System (ADS)

Klose, Martin; Terhorst, Birgit

2014-05-01

The world's transportation infrastructure is at risk of landslides in many areas across the globe. A safe and affordable operation of traffic routes are the two main criteria for transportation planning in landslide-prone areas. The right balancing of these often conflicting priorities requires, amongst others, profound knowledge of the direct costs of landslide damage. These costs include capital investments for landslide repair and mitigation as well as operational expenditures for first response and maintenance works. This contribution presents a new methodology for ex post assessment of direct landslide costs for transportation infrastructures. The methodology includes tools to compile, model, and extrapolate landslide losses on different spatial scales over time. A landslide susceptibility model enables regional cost extrapolation by means of a cost figure obtained from local cost compilation for representative case study areas. On local level, cost survey is closely linked with cost modeling, a toolset for cost estimation based on landslide databases. Cost modeling uses Landslide Disaster Management Process Models (LDMMs) and cost modules to simulate and monetize cost factors for certain types of landslide damage. The landslide susceptibility model provides a regional exposure index and updates the cost figure to a cost index which describes the costs per km of traffic route at risk of landslides. Both indexes enable the regionalization of local landslide losses. The methodology is applied and tested in a cost assessment for highways in the Lower Saxon Uplands, NW Germany, in the period 1980 to 2010. The basis of this research is a regional subset of a landslide database for the Federal Republic of Germany. In the 7,000 km² large Lower Saxon Uplands, 77 km of highway are located in potential landslide hazard area. Annual average costs of 52k per km of highway at risk of landslides are identified as cost index for a local case study area in this region. The cost extrapolation for the Lower Saxon Uplands results in annual average costs for highways of 4.02mn. This test application as well as a validation of selected modeling tools verifies the functionality of this methodology.

Handling Uncertain Gross Margin and Water Demand in Agricultural Water Resources Management using Robust Optimization

NASA Astrophysics Data System (ADS)

Chaerani, D.; Lesmana, E.; Tressiana, N.

2018-03-01

In this paper, an application of Robust Optimization in agricultural water resource management problem under gross margin and water demand uncertainty is presented. Water resource management is a series of activities that includes planning, developing, distributing and managing the use of water resource optimally. Water resource management for agriculture can be one of the efforts to optimize the benefits of agricultural output. The objective function of agricultural water resource management problem is to maximizing total benefits by water allocation to agricultural areas covered by the irrigation network in planning horizon. Due to gross margin and water demand uncertainty, we assume that the uncertain data lies within ellipsoidal uncertainty set. We employ robust counterpart methodology to get the robust optimal solution.

A Bayesian model averaging approach with non-informative priors for cost-effectiveness analyses.

PubMed

Conigliani, Caterina

2010-07-20

We consider the problem of assessing new and existing technologies for their cost-effectiveness in the case where data on both costs and effects are available from a clinical trial, and we address it by means of the cost-effectiveness acceptability curve. The main difficulty in these analyses is that cost data usually exhibit highly skew and heavy-tailed distributions, so that it can be extremely difficult to produce realistic probabilistic models for the underlying population distribution. Here, in order to integrate the uncertainty about the model into the analysis of cost data and into cost-effectiveness analyses, we consider an approach based on Bayesian model averaging (BMA) in the particular case of weak prior informations about the unknown parameters of the different models involved in the procedure. The main consequence of this assumption is that the marginal densities required by BMA are undetermined. However, in accordance with the theory of partial Bayes factors and in particular of fractional Bayes factors, we suggest replacing each marginal density with a ratio of integrals that can be efficiently computed via path sampling. Copyright (c) 2010 John Wiley & Sons, Ltd.

Marginal Pipeline Costs of Enlisted Personnel.

DTIC Science & Technology

1979-12-03

printing, cleaning supplies , organizational equipment for train- ing support, barracks furnishings, motor pools and various other items. (USMC: MC... cleaning , supplies , and related items. 11-26 C. ARMY MISSION/SUPPORT COSTS The Army accepted 124,000 active NPS accessions in FY1978. These

42 CFR 493.649 - Methodology for determining fee amount.

Code of Federal Regulations, 2010 CFR

2010-10-01

... fringe benefit costs to support the required number of State inspectors, management and direct support... full time equivalent employee. Included in this cost are salary and fringe benefit costs, necessary... 42 Public Health 5 2010-10-01 2010-10-01 false Methodology for determining fee amount. 493.649...

The costs of nurse turnover, part 2: application of the Nursing Turnover Cost Calculation Methodology.

PubMed

Jones, Cheryl Bland

2005-01-01

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention.

Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study.

PubMed

Ly, Dan P; Cutler, David M

2018-02-14

Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers. The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013. There are 2824 hospitals as subjects of this study. The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013. Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year. Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.

Seismic margin assessment of the Edwin I. Hatch Nuclear Plant, Unit 1

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

Barr, W.T.; Moore, D.P.; Smith, J.E.

1991-06-01

This summary presents the results and lessons learned from the seismic margin assessment (SMA) of Unit 1 of the Hatch Nuclear Plant. The primary purpose of this SMA was to assess the practicality of the EPRI SMA methodology on a BWR on a soil site such as Hatch. The major findings from the Hatch SMA are briefly described along with the lessons learned during the project implementation. The experience gained on the Hatch SMA is expected to benefit others in the performance of future SMAs. 12 refs.

Loss of Coolant Accident (LOCA) / Emergency Core Coolant System (ECCS Evaluation of Risk-Informed Margins Management Strategies for a Representative Pressurized Water Reactor (PWR)

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

Szilard, Ronaldo Henriques

A Risk Informed Safety Margin Characterization (RISMC) toolkit and methodology are proposed for investigating nuclear power plant core, fuels design and safety analysis, including postulated Loss-of-Coolant Accident (LOCA) analysis. This toolkit, under an integrated evaluation model framework, is name LOCA toolkit for the US (LOTUS). This demonstration includes coupled analysis of core design, fuel design, thermal hydraulics and systems analysis, using advanced risk analysis tools and methods to investigate a wide range of results.

American business ethics and health care costs.

PubMed

Garrett, T M; Klonoski, R J; Baillie, H W

1993-01-01

The health care industry operates in the margin between market competition and social welfare programs. Violations of business ethics on the market side add considerably to costs. When the inefficient use of resources and market distortions due to power and ignorance as well as legal and subsidized monopolies are added, increased costs can approach $100 billion. Modest remedies are suggested.

Entropy Filtered Density Function for Large Eddy Simulation of Turbulent Reacting Flows

NASA Astrophysics Data System (ADS)

Safari, Mehdi

Analysis of local entropy generation is an effective means to optimize the performance of energy and combustion systems by minimizing the irreversibilities in transport processes. Large eddy simulation (LES) is employed to describe entropy transport and generation in turbulent reacting flows. The entropy transport equation in LES contains several unclosed terms. These are the subgrid scale (SGS) entropy flux and entropy generation caused by irreversible processes: heat conduction, mass diffusion, chemical reaction and viscous dissipation. The SGS effects are taken into account using a novel methodology based on the filtered density function (FDF). This methodology, entitled entropy FDF (En-FDF), is developed and utilized in the form of joint entropy-velocity-scalar-turbulent frequency FDF and the marginal scalar-entropy FDF, both of which contain the chemical reaction effects in a closed form. The former constitutes the most comprehensive form of the En-FDF and provides closure for all the unclosed filtered moments. This methodology is applied for LES of a turbulent shear layer involving transport of passive scalars. Predictions show favor- able agreements with the data generated by direct numerical simulation (DNS) of the same layer. The marginal En-FDF accounts for entropy generation effects as well as scalar and entropy statistics. This methodology is applied to a turbulent nonpremixed jet flame (Sandia Flame D) and predictions are validated against experimental data. In both flows, sources of irreversibility are predicted and analyzed.

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Arizona. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Hawaii. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Connecticut. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

ECONOMICS OF INDIVIDUALIZATION IN COMPARATIVE EFFECTIVENESS RESEARCH AND A BASIS FOR A PATIENT-CENTERED HEALTH CARE

PubMed Central

Basu, Anirban

2011-01-01

The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset. PMID:21601299

Economics of individualization in comparative effectiveness research and a basis for a patient-centered health care.

PubMed

Basu, Anirban

2011-05-01

The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset. Copyright © 2011 Elsevier B.V. All rights reserved.

Assessing Air Pollutant-Induced, Health-Related External Costs in the Context of Nonmarginal System Changes: A Review.

PubMed

Bachmann, Till M

2015-08-18

Marginal analysis is the usual approach to environmental economic assessment, for instance, of health-related external costs due to energy-associated air pollutant emissions. However, nonlinearity exists in all steps of their assessment, i.e., atmospheric dispersion, impact assessment, and monetary valuation. Dedicated assessments thus appear necessary when evaluating large systems or their changes such as in green accounting or the implications of economy-wide energy transitions. Corresponding approaches are reviewed. Tools already exist that allow assessing a marginal change (e.g., one power plant's emissions) for different background emission scenarios that merely need to be defined and implemented. When assessing nonmarginal changes, the top-down approach is considered obsolete, and four variants of the bottom-up approach with different application domains were identified. Variants 1 and 2 use precalculated external cost factors with different levels of sophistication, suitable for energy systems modeling, optimizing for social (i.e., private and external) costs. Providing more reliable results due to more detailed modeling, emission sources are assessed individually or jointly in variants 3 and 4, respectively. Aiming at considering nonlinearity more fully and simultaneously following marginal analysis principles, I propose a variant 3-based approach, subdividing an aggregate (i.e., a nonmarginal change) into several smaller changes. Its strengths and drawbacks, notably the associated effort, are discussed.

Bayesian analysis of the flutter margin method in aeroelasticity

DOE PAGES

Khalil, Mohammad; Poirel, Dominique; Sarkar, Abhijit

2016-08-27

A Bayesian statistical framework is presented for Zimmerman and Weissenburger flutter margin method which considers the uncertainties in aeroelastic modal parameters. The proposed methodology overcomes the limitations of the previously developed least-square based estimation technique which relies on the Gaussian approximation of the flutter margin probability density function (pdf). Using the measured free-decay responses at subcritical (preflutter) airspeeds, the joint non-Gaussain posterior pdf of the modal parameters is sampled using the Metropolis–Hastings (MH) Markov chain Monte Carlo (MCMC) algorithm. The posterior MCMC samples of the modal parameters are then used to obtain the flutter margin pdfs and finally the fluttermore » speed pdf. The usefulness of the Bayesian flutter margin method is demonstrated using synthetic data generated from a two-degree-of-freedom pitch-plunge aeroelastic model. The robustness of the statistical framework is demonstrated using different sets of measurement data. In conclusion, it will be shown that the probabilistic (Bayesian) approach reduces the number of test points required in providing a flutter speed estimate for a given accuracy and precision.« less

Cost allocation methodology applicable to the temporary assistance for needy families program. Final rule.

PubMed

2008-07-23

This final rule applies to the Temporary Assistance for Needy Families (TANF) program and requires States, the District of Columbia and the Territories (hereinafter referred to as the "States") to use the "benefiting program" cost allocation methodology in U.S. Office of Management and Budget (OMB) Circular A-87 (2 CFR part 225). It is the judgment and determination of HHS/ACF that the "benefiting program" cost allocation methodology is the appropriate methodology for the proper use of Federal TANF funds. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave federally-recognized Tribes the opportunity to operate their own Tribal TANF programs. Federally-recognized Indian tribes operating approved Tribal TANF programs have always followed the "benefiting program" cost allocation methodology in accordance with OMB Circular A-87 (2 CFR part 225) and the applicable regulatory provisions at 45 CFR 286.45(c) and (d). This final rule contains no substantive changes to the proposed rule published on September 27, 2006.

Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology.

PubMed

Falls, Christopher Edward

2008-01-01

American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.

An uncertainty analysis of air pollution externalities from road transport in Belgium in 2010.

PubMed

Int Panis, L; De Nocker, L; Cornelis, E; Torfs, R

2004-12-01

Although stricter standards for vehicles will reduce emissions to air significantly by 2010, a number of problems will remain, especially related to particulate concentrations in cities, ground-level ozone, and CO(2). To evaluate the impacts of new policy measures, tools need to be available that assess the potential benefits of these measures in terms of the vehicle fleet, fuel choice, modal choice, kilometers driven, emissions, and the impacts on public health and related external costs. The ExternE accounting framework offers the most up to date and comprehensive methodology to assess marginal external costs of energy-related pollutants. It combines emission models, air dispersion models at local and regional scales with dose-response functions and valuation rules. Vito has extended this accounting framework with data and models related to the future composition of the vehicle fleet and transportation demand to evaluate the impact of new policy proposals on air quality and aggregated (total) external costs by 2010. Special attention was given to uncertainty analysis. The uncertainty for more than 100 different parameters was combined in Monte Carlo simulations to assess the range of possible outcomes and the main drivers of these results. Although the impacts from emission standards and total fleet mileage look dominant at first, a number of other factors were found to be important as well. This includes the number of diesel vehicles, inspection and maintenance (high-emitter cars), use of air conditioning, and heavy duty transit traffic.

The economic burden of patient safety targets in acute care: a systematic review

PubMed Central

Mittmann, Nicole; Koo, Marika; Daneman, Nick; McDonald, Andrew; Baker, Michael; Matlow, Anne; Krahn, Murray; Shojania, Kaveh G; Etchells, Edward

2012-01-01

Background Our objective was to determine the quality of literature in costing of the economic burden of patient safety. Methods We selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: “costs and cost analysis,” “cost-effectiveness,” “cost,” and “financial management, hospital.” We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated. Results We screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414. Conclusion There are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed. PMID:23097615

Evaluating Oilseed Biofuel Production Feasibility in California’s San Joaquin Valley Using Geophysical and Remote Sensing Techniques

PubMed Central

Corwin, Dennis L.; Yemoto, Kevin; Clary, Wes; Banuelos, Gary; Skaggs, Todd H.; Lesch, Scott M.

2017-01-01

Though more costly than petroleum-based fuels and a minor component of overall military fuel sources, biofuels are nonetheless strategically valuable to the military because of intentional reliance on multiple, reliable, secure fuel sources. Significant reduction in oilseed biofuel cost occurs when grown on marginally productive saline-sodic soils plentiful in California’s San Joaquin Valley (SJV). The objective is to evaluate the feasibility of oilseed production on marginal soils in the SJV to support a 115 ML yr−1 biofuel conversion facility. The feasibility evaluation involves: (1) development of an Ida Gold mustard oilseed yield model for marginal soils; (2) identification of marginally productive soils; (3) development of a spatial database of edaphic factors influencing oilseed yield and (4) performance of Monte Carlo simulations showing potential biofuel production on marginally productive SJV soils. The model indicates oilseed yield is related to boron, salinity, leaching fraction, and water content at field capacity. Monte Carlo simulations for the entire SJV fit a shifted gamma probability density function: Q = 68.986 + gamma (6.134,5.285), where Q is biofuel production in ML yr−1. The shifted gamma cumulative density function indicates a 0.15–0.17 probability of meeting the target biofuel-production level of 115 ML yr−1, making adequate biofuel production unlikely. PMID:29036925

Facing the Recession: How Did Safety-Net Hospitals Fare Financially Compared with Their Peers?

PubMed Central

Reiter, Kristin L; Jiang, H Joanna; Wang, Jia

2014-01-01

Objective To examine the effect of the recession on the financial performance of safety-net versus non-safety-net hospitals. Data Sources/Study Setting Agency for Healthcare Research and Quality Hospital Cost and Utilization Project State Inpatient Databases, Medicare Cost Reports, American Hospital Association Annual Survey, InterStudy, and Area Health Resource File. Study Design Retrospective, longitudinal panel of hospitals, 2007–2011. Safety-net hospitals were identified using percentage of patients who were Medicaid or uninsured. Generalized estimating equations were used to estimate average effects of the recession on hospital operating and total margins, revenues and expenses in each year, 2008–2011, comparing safety-net with non-safety-net hospitals. Data Collection/Extraction Methods 1,453 urban, nonfederal, general acute hospitals in 32 states with complete data. Principal Findings Safety-net hospitals, as identified in 2007, had lower operating and total margins. The gap in operating margin between safety-net and non-safety-net hospitals was sustained throughout the recession; however, total margin was more negatively affected for non-safety-net hospitals in 2008. Higher percentages of Medicaid and uninsured patients were associated with lower revenue in private hospitals in all years, and lower revenue and expenses in public hospitals in 2011. Conclusions Safety-net hospitals may not be disproportionately vulnerable to macro-economic fluctuations, but their significantly lower margins leave less financial cushion to weather sustained financial pressure. PMID:25220012

Preliminary Multi-Variable Parametric Cost Model for Space Telescopes

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Hendrichs, Todd

2010-01-01

This slide presentation reviews creating a preliminary multi-variable cost model for the contract costs of making a space telescope. There is discussion of the methodology for collecting the data, definition of the statistical analysis methodology, single variable model results, testing of historical models and an introduction of the multi variable models.

Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture.

PubMed

Fojo, Tito; Mailankody, Sham; Lo, Andrew

2014-12-01

Cancer is expected to continue as a major health and economic problem worldwide. Several factors are contributing to the increasing economic burden imposed by cancer, with the cost of cancer drugs an undeniably important variable. The use of expensive therapies with marginal benefits for their approved indications and for unproven indications is contributing to the rising cost of cancer care. We believe that expensive therapies are stifling progress by (1) encouraging enormous expenditures of time, money, and resources on marginal therapeutic indications and (2) promoting a me-too mentality that is stifling innovation and creativity. The modest gains of Food and Drug Administration-approved therapies and the limited progress against major cancers is evidence of a lowering of the efficacy bar that, together with high drug prices, has inadvertently incentivized the pursuit of marginal outcomes and a me-too mentality evidenced by the duplication of effort and redundant pharmaceutical pipelines. We discuss the economic realities that are driving this process and provide suggestions for radical changes to reengineer our collective cancer ecosystem to achieve better outcomes for society.

Marginal regression models for clustered count data based on zero-inflated Conway-Maxwell-Poisson distribution with applications.

PubMed

Choo-Wosoba, Hyoyoung; Levy, Steven M; Datta, Somnath

2016-06-01

Community water fluoridation is an important public health measure to prevent dental caries, but it continues to be somewhat controversial. The Iowa Fluoride Study (IFS) is a longitudinal study on a cohort of Iowa children that began in 1991. The main purposes of this study (http://www.dentistry.uiowa.edu/preventive-fluoride-study) were to quantify fluoride exposures from both dietary and nondietary sources and to associate longitudinal fluoride exposures with dental fluorosis (spots on teeth) and dental caries (cavities). We analyze a subset of the IFS data by a marginal regression model with a zero-inflated version of the Conway-Maxwell-Poisson distribution for count data exhibiting excessive zeros and a wide range of dispersion patterns. In general, we introduce two estimation methods for fitting a ZICMP marginal regression model. Finite sample behaviors of the estimators and the resulting confidence intervals are studied using extensive simulation studies. We apply our methodologies to the dental caries data. Our novel modeling incorporating zero inflation, clustering, and overdispersion sheds some new light on the effect of community water fluoridation and other factors. We also include a second application of our methodology to a genomic (next-generation sequencing) dataset that exhibits underdispersion. © 2015, The International Biometric Society.

Need for a marginal methodology in assessing natural gas system methane emissions in response to incremental consumption.

PubMed

Mac Kinnon, Michael; Heydarzadeh, Zahra; Doan, Quy; Ngo, Cuong; Reed, Jeff; Brouwer, Jacob

2018-05-17

Accurate quantification of methane emissions from the natural gas system is important for establishing greenhouse gas inventories and understanding cause and effect for reducing emissions. Current carbon intensity methods generally assume methane emissions are proportional to gas throughput so that increases in gas consumption yield linear increases in emitted methane. However, emissions sources are diverse and many are not proportional to throughput. Insights into the causal drivers of system methane emissions, and how system-wide changes affect such drivers are required. The development of a novel cause-based methodology to assess marginal methane emissions per unit of fuel consumed is introduced. The carbon intensities of technologies consuming natural gas are critical metrics currently used in policy decisions for reaching environmental goals. For example, the low-carbon fuel standard in California uses carbon intensity to determine incentives provided. Current methods generally assume methane emissions from the natural gas system are completely proportional to throughput. The proposed cause-based marginal emissions method will provide a better understanding of the actual drivers of emissions to support development of more effective mitigation measures. Additionally, increasing the accuracy of carbon intensity calculations supports the development of policies that can maximize the environmental benefits of alternative fuels, including reducing greenhouse gas emissions.

Assessing the value of storage services in large-scale multireservoir systems

NASA Astrophysics Data System (ADS)

Tilmant, A.; Arjoon, D.; Guilherme, G. F.

2012-12-01

Following three decades of rather low investment in dams, many regions throughout the world are now seeking to further develop new storage capacity in order to meet exploding demands for water and to hedge against the risk posed by climate change. Storage capacity is indee perceived as a key element of climate change adaptation strategies, while at the same time contributing to socioeconomic development through irrigation, energy generation, fish production, and municipal and industrial water supply. The benefits provided by dams must be balanced with the associated environmental and social costs, which can take various forms such as the degradation of ecosystems due to altered flow regimes, the relocation of people from the impoundment area, etc. The benefits of storage essentially come from the ability to move water in time, making it available during the low flow season when it becomes more valuable. As river basins develop and new dams are constructed, it may be important for planning and operational purposes to assess the individual contribution of each reservoir to the benefits of storage. We present a methodology to determine the economic value of storage in multireservoir systems based on the marginal net benefit functions of storage. In economics, the marginal net benefit function for water represents the user's willingness to pay for various quantities of water, i.e. the demand for water. Here, we will concentrate on the marginal net benefit of storing raw water in a particular reservoir for later use by different users/sectors. Based on this function, one can determine the economic value associated with changes in storage from the reservoir operating policies and the marginal value of water stored in the reservoirs. This information can nowadays be obtained from multireservoir optimization models. A cascade of reservoirs in the upper reaches of the Euphrates river basin (Turkey/Syria) is used to illustrate the methodology. To water resources planners in both countries, the highly contrasted hydrologic regime of the Euphrates river could only be dealt with through storage. However, due to political tensions, those projects were carried out without much cooperation and coordination among riparian countries. The development started in the late 1960s with the construction of the head reservoir in Turkey (Keban dam) and the most downstream reservoir in Syria (Tabqa dam). Thirty years later, five other dams in both countries had been commissioned, changing the economy of this region through the export of hydroelectric power (7812 MW) and agricultural products (cotton and cereals). The operating policies and marginal water values of this multipurpose multiresevoir system are determined using Stochastic Dual Dynamic Programming, an optimization algorithm that can handle large-scale reservoir operation problems while keeping an individual representation of the hydraulic infrastructure and the demand sites. The analysis of the simulation results reveal that the average value of storage for the entire cascade of reservoirs is around 420 million US/a, which is 18% of the annual short-run benefits of the system (2.26 billion US/a).

Critical care medicine beds, use, occupancy and costs in the United States: a methodological review

PubMed Central

Halpern, Neil A; Pastores, Stephen M.

2017-01-01

This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the intensive care unit (ICU) bed supply, occupancy rates, and costs in the United States (US). Data for total ICU beds, use and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System (HCRIS) maintained by the federal Centers for Medicare and Medicaid Services (CMS) and the proprietary Hospital Statistics of the American Hospital Association (AHA). Two costing methodologies can be used to calculate ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of US ICU beds, use and cost helps provide clarity to the width and scope of the critical care medicine (CCM) enterprise within the US healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to CCM and be better prepared to participate in their own local hospital organizations or regional CCM programs. PMID:26308432

Marginal revenue and length of stay in inpatient psychiatry.

PubMed

Pletscher, Mark

2016-09-01

This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated to assess variations in policy effects over length of stay. Among patients whose costs are fully reimbursed by the mixed scheme, the model demonstrates a significant effect of marginal revenue on length of stay. No significant policy effects are found among patients for whom only health insurance rates are delivered as mixed tariffs and government contributions are made retrospectively. The results indicate that marginal revenue can affect length of stay in inpatient psychiatry facilities, but that the reduction in marginal revenue must be sufficiently large.

Cost-Utility Analysis: Current Methodological Issues and Future Perspectives

PubMed Central

Nuijten, Mark J. C.; Dubois, Dominique J.

2011-01-01

The use of cost–effectiveness as final criterion in the reimbursement process for listing of new pharmaceuticals can be questioned from a scientific and policy point of view. There is a lack of consensus on main methodological issues and consequently we may question the appropriateness of the use of cost–effectiveness data in health care decision-making. Another concern is the appropriateness of the selection and use of an incremental cost–effectiveness threshold (Cost/QALY). In this review, we focus mainly on only some key methodological concerns relating to discounting, the utility concept, cost assessment, and modeling methodologies. Finally we will consider the relevance of some other important decision criteria, like social values and equity. PMID:21713127

Intermountain Health Care, Inc.: Standard Costing System Methodology and Implementation

PubMed Central

Rosqvist, W.V.

1984-01-01

Intermountain Health Care, Inc. (IHC) a notfor-profit hospital chain with 22 hospitals in the intermountain area and corporate offices located in Salt Lake City, Utah, has developed a Standard Costing System to provide hospital management with a tool for confronting increased cost pressures in the health care environment. This document serves as a description of methodology used in developing the standard costing system and outlines the implementation process.

Costing of physical activity programmes in primary prevention: a review of the literature

PubMed Central

2011-01-01

This literature review aims to analyse the costing methodology in economic analyses of primary preventive physical activity programmes. It demonstrates the usability of a recently published theoretical framework in practice, and may serve as a guide for future economic evaluation studies and for decision making. A comprehensive literature search was conducted to identify all relevant studies published before December 2009. All studies were analysed regarding their key economic findings and their costing methodology. In summary, 18 international economic analyses of primary preventive physical activity programmes were identified. Many of these studies conclude that the investigated intervention provides good value for money compared with alternatives (no intervention, usual care or different programme) or is even cost-saving. Although most studies did provide a description of the cost of the intervention programme, methodological details were often not displayed, and savings resulting from the health effects of the intervention were not always included sufficiently. This review shows the different costing methodologies used in the current health economic literature and compares them with a theoretical framework. The high variability regarding the costs assessment and the lack of transparency concerning the methods limits the comparability of the results, which points out the need for a handy minimal dataset of cost assessment. PMID:22827967

First Clean Air Act Benefits and Costs Prospective Study - Press Release November 16, 1999

EPA Pesticide Factsheets

The economic value of the public health and environmental benefits that Americans enjoy from the Clean Air Act Amendments of 1990 exceed their costs by a margin of four to one, according to this EPA study released in 1999.

The Basic Economics of CD-ROM Pricing.

ERIC Educational Resources Information Center

Erkkila, John E.

1991-01-01

This explanation of how the basic economic model of pricing applies to the CD-ROM industry considers the supply and demand sides of the market and compares three distinct pricing strategies: (1) pricing to maximize profits; (2) average cost pricing; and (3) marginal cost pricing. (EAM)

Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs.

PubMed Central

Poulsen, K. B.; Bremmelgaard, A.; Sørensen, A. I.; Raahave, D.; Petersen, J. V.

1994-01-01

A cohort of 4515 surgical patients in ten selected intervention groups was followed. Three hundred and seventeen developed postoperative wound infections, and 291 of these cases were matched 1:1 to controls by operation, sex and age. In comparison to the controls the cases stayed longer in hospital after the intervention and had more contact after discharge with the social security system. Using data from a national sentinel reference database of the incidence of postoperative wound infections, and using national activity data, we established an empirical cost model based on the estimated marginal costs of hospital resources and social sick pay. It showed that the hospital resources spent on the ten groups, which represent half of the postoperative wound infections in Denmark, amounted to approximately 0.5% of the annual national hospital budget. This stratified model creates a better basis for selecting groups of operations which need priority in terms of preventive measures. PMID:7925666

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Texas

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Texas. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Minnesota

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Minnesota. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Indiana

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Indiana. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Florida

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Florida. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Maine

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Maine. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Vermont

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Vermont. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Michigan

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Michigan. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Alabama

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Alabama. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of New Hampshire

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of New Hampshire. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology usedmore » in the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of New Mexico

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of New Mexico. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology usedmore » in the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Colorado

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Colorado. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Washington

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Washington. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Montana

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Montana. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the District of Columbia

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the District of Columbia. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Massachusetts

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Massachusetts. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Oregon

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Oregon. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Wisconsin

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Wisconsin. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Ohio

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Ohio. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of South Carolina

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of South Carolina. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology usedmore » in the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of North Carolina

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of North Carolina. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology usedmore » in the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Cost Effectiveness of ASHRAE Standard 90.1-2013 for the State of Iowa

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

Hart, Philip R.; Athalye, Rahul A.; Xie, YuLong

2015-12-01

Moving to the ASHRAE Standard 90.1-2013 (ASHRAE 2013) edition from Standard 90.1-2010 (ASHRAE 2010) is cost-effective for the State of Iowa. The table below shows the state-wide economic impact of upgrading to Standard 90.1-2013 in terms of the annual energy cost savings in dollars per square foot, additional construction cost per square foot required by the upgrade, and life-cycle cost (LCC) per square foot. These results are weighted averages for all building types in all climate zones in the state, based on weightings shown in Table 4. The methodology used for this analysis is consistent with the methodology used inmore » the national cost-effectiveness analysis. Additional results and details on the methodology are presented in the following sections. The report provides analysis of two LCC scenarios: Scenario 1, representing publicly-owned buildings, considers initial costs, energy costs, maintenance costs, and replacement costs—without borrowing or taxes. Scenario 2, representing privately-owned buildings, adds borrowing costs and tax impacts.« less

Measuring the costs of outreach motivational interviewing for smoking cessation and relapse prevention among low-income pregnant women

PubMed Central

Ruger, Jennifer Prah; Emmons, Karen M; Kearney, Margaret H; Weinstein, Milton C

2009-01-01

Background Economic theory provides the philosophical foundation for valuing costs in judging medical and public health interventions. When evaluating smoking cessation interventions, accurate data on costs are essential for understanding resource consumption. Smoking cessation interventions, for which prior data on resource costs are typically not available, present special challenges. We develop a micro-costing methodology for estimating the real resource costs of outreach motivational interviewing (MI) for smoking cessation and relapse prevention among low-income pregnant women and report results from a randomized controlled trial (RCT) employing the methodology. Methodological standards in cost analysis are necessary for comparison and uniformity in analysis across interventions. Estimating the costs of outreach programs is critical for understanding the economics of reaching underserved and hard-to-reach populations. Methods Randomized controlled trial (1997-2000) collecting primary cost data for intervention. A sample of 302 low-income pregnant women was recruited from multiple obstetrical sites in the Boston metropolitan area. MI delivered by outreach health nurses vs. usual care (UC), with economic costs as the main outcome measures. Results The total cost of the MI intervention for 156 participants was $48,672 or $312 per participant. The total cost of $311.8 per participant for the MI intervention compared with a cost of $4.82 per participant for usual care, a difference of $307 ([CI], $289.2 to $322.8). The total fixed costs of the MI were $3,930 and the total variable costs of the MI were $44,710. The total expected program costs for delivering MI to 500 participants would be 147,430, assuming no economies of scale in program delivery. The main cost components of outreach MI were intervention delivery, travel time, scheduling, and training. Conclusion Grounded in economic theory, this methodology systematically identifies and measures resource utilization, using a process tracking system and calculates both component-specific and total costs of outreach MI. The methodology could help improve collection of accurate data on costs and estimates of the real resource costs of interventions alongside clinical trials and improve the validity and reliability of estimates of resource costs for interventions targeted at underserved and hard-to-reach populations. PMID:19775455

Top Level Space Cost Methodology (TLSCM)

DTIC Science & Technology

1997-12-02

Software 7 6. ACEIT . 7 C. Ground Rules and Assumptions 7 D. Typical Life Cycle Cost Distribution 7 E. Methodologies 7 1. Cost/budget Threshold 9 2. Analogy...which is based on real-time Air Force and space programs. Ref.(25:2- 8, 2-9) 6. ACEIT : Automated Cost Estimating Integrated Tools( ACEIT ), Tecolote...Research, Inc. There is a way to use the ACEIT cost program to get a print-out of an expanded WBS. Therefore, find someone that has ACEIT experience and

Egypt`s first remotely controlled subsea completion -- A Gulf of Suez case history

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

El Hawary, A.; Hoffman, J.G.

1995-11-01

A case history of the Gulf of Suez Petroleum Company`s (GUPCO) first remotely controlled subsea completion is provided. The first completion was for well GS 373-2, a previously drilled and tested exploration well located in the south portion of the Gulf of Suez. Subsea technology was utilized to economically justify development of this one well marginal field which was discovered in 1978. Traditional methods proved to be too costly for development, therefore application of a low cost subsea tree was utilized to capture the resources. In the Gulf of Suez many fields have been discovered by have not been developedmore » due to low reserves. These marginal projects can have a profound impact on the revenue and shareholder value if any economic method is used to exploit these opportunities. Platform installation was not feasible due to reserve size, hence the well has remained abandoned until recently. Capturing the experience of Amoco in the Gulf of Mexico and in the Dutch North Sea, GUPCO was able to build a low cost subsea system which would allow for the economic development of the marginal fields discovered in the past. This paper presents a summarized look at subsea completion technology. The cost comparison of traditional development methods will be made, given the local cost structure in Egypt. The application of this technology has some limitations and constraints which will be discussed in the paper. Furthermore the actual field installation of Egypt`s first remotely controlled subsea tree will be summarized. Also included is a discussion on simple remote controls,and offshore installation operations.« less

Potential cost to Western Australia of proposed patient co-payments according to healthcare organisational structure: A preliminary analysis.

PubMed

Millar, J Alasdair; Millar, Robyn C

2014-01-01

The Australian federal government has proposed an AUD $7 patient co-payment for a general practitioner (GP) consultation. One effect of the co-payment may be that patients will seek assistance at public hospital emergency departments (EDs), where currently there is no user charge. We studied the possible financial impact of patient diversion on the Western Australia (WA) health budget. We constructed a spreadsheet model of changes in annual cash flows including the co-payment, GP fees for service, and rates of diversion to emergency departments with additional marginal costs for ED attendance. Changes in WA cash flows are the aggregate of marginal ED costs of treating diverted patients and added expenditure in fees paid to rural doctors who also man local emergency centres. The estimated costs to WA are AUD $6.3 million, $35.9 million and $87.4 million at 1, 5, and 10 per cent diversion, respectively. Commonwealth receipts increase and expenditure on Medicare benefits declines. A diversion of patients from GP surgeries to ED in WA caused by the co-payment will result in increased costs to the state, which may be substantial, and will reduce net costs to the Commonwealth.

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

PubMed Central

2010-01-01

Introduction In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. Methods This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. Results From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. Conclusions The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process. PMID:20579341

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

PubMed

Tyrrell, Amanda K; Russo, Giuliano; Dussault, Gilles; Ferrinho, Paulo

2010-06-25

In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

Anticipating and controlling mask costs within EDA physical design

NASA Astrophysics Data System (ADS)

Rieger, Michael L.; Mayhew, Jeffrey P.; Melvin, Lawrence S.; Lugg, Robert M.; Beale, Daniel F.

2003-08-01

For low k1 lithography, more aggressive OPC is being applied to critical layers, and the number of mask layers with OPC treatments is growing rapidly. The 130 nm, process node required, on average, 8 layers containing rules- or model-based OPC. The 90 nm node will have 16 OPC layers, of which 14 layers contain aggressive model-based OPC. This escalation of mask pattern complexity, coupled with the predominant use of vector-scan e-beam (VSB) mask writers contributes to the rising costs of advanced mask sets. Writing times for OPC layouts are several times longer than for traditional layouts, making mask exposure the single largest cost component for OPC masks. Lower mask yields, another key factor in higher mask costs, is also aggravated by OPC. Historical mask set costs are plotted below. The initial cost of a 90 nm-node mask set will exceed one million dollars. The relative impact of mask cost on chip depends on how many total wafers are printed with each mask set. For many foundry chips, where unit production is often well below 1000 wafers, mask costs are larger than wafer processing costs. Further increases in NRE may begin to discourage these suppliers' adoption to 90 nm and smaller nodes. In this paper we will outline several alternatives for reducing mask costs by strategically leveraging dimensional margins. Dimensional specifications for a particular masking layer usually are applied uniformly to all features on that layer. As a practical matter, accuracy requirements on different features in the design may vary widely. Take a polysilicon layer, for example: global tolerance specifications for that layer are driven by the transistor-gate requirements; but these parameters over-specify interconnect feature requirements. By identifying features where dimensional accuracy requirements can be reduced, additional margin can be leveraged to reduce OPC complexity. Mask writing time on VSB tools will drop in nearly direct proportion to reduce shot count. By inspecting masks with reference to feature-dependent margins, instead of uniform specifications, mask yield can be effectively increased further reducing delivered mask expense.

Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources

PubMed Central

2013-01-01

Background Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients’ condition, the necessity of the treatment, and the patients’ preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient’s recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. Methods The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach serves to compare these optimization strategies with a simple model of the status quo. All the approaches are evaluated by a realistic discrete event simulation: the outcomes are the ratio of successful assignments and dismissals, the computation time, and the model’s cost factors. Results A discrete event simulation of 226,000 cases shows a reduction of the dismissal rate compared to the baseline by more than 30 percentage points (from a mean dismissal ratio of 74.7% to 40.06% comparing the status quo with the optimization strategies). Each of the optimization strategies leads to an improved assignment. The exact approach has only a marginal advantage over the heuristic strategies in the model’s cost factors (≤3%). Moreover,this marginal advantage was only achieved at the price of a computational time fifty times that of the heuristic models (an average computing time of 141 s using the exact method, vs. 2.6 s for the heuristic strategy). Conclusions In terms of its performance and the quality of its solution, the heuristic strategy RAND is the preferred method for bed assignment in the case of shared resources. Future research is needed to investigate whether an equally marked improvement can be achieved in a large scale clinical application study, ideally one comprising all the departments involved in admission and assignment planning. PMID:23289448

Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources.

PubMed

Schmidt, Robert; Geisler, Sandra; Spreckelsen, Cord

2013-01-07

Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients' condition, the necessity of the treatment, and the patients' preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient's recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach serves to compare these optimization strategies with a simple model of the status quo. All the approaches are evaluated by a realistic discrete event simulation: the outcomes are the ratio of successful assignments and dismissals, the computation time, and the model's cost factors. A discrete event simulation of 226,000 cases shows a reduction of the dismissal rate compared to the baseline by more than 30 percentage points (from a mean dismissal ratio of 74.7% to 40.06% comparing the status quo with the optimization strategies). Each of the optimization strategies leads to an improved assignment. The exact approach has only a marginal advantage over the heuristic strategies in the model's cost factors (≤3%). Moreover,this marginal advantage was only achieved at the price of a computational time fifty times that of the heuristic models (an average computing time of 141 s using the exact method, vs. 2.6 s for the heuristic strategy). In terms of its performance and the quality of its solution, the heuristic strategy RAND is the preferred method for bed assignment in the case of shared resources. Future research is needed to investigate whether an equally marked improvement can be achieved in a large scale clinical application study, ideally one comprising all the departments involved in admission and assignment planning.

A Post-Intentional Exploration of Agnostic College Students' Experiences

ERIC Educational Resources Information Center

Armstrong, Amanda

2017-01-01

Scholars have adapted college student identity development models to examine and highlight the unique, laborious, and varied experiences of marginalized populations. However, researchers have minimally explored the perspectives of nontheistic and nonreligious college students using poststructural methodologies. I followed a post-intentional…

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.

Comparison between low-cost marker-less and high-end marker-based motion capture systems for the computer-aided assessment of working ergonomics.

PubMed

Patrizi, Alfredo; Pennestrì, Ettore; Valentini, Pier Paolo

2016-01-01

The paper deals with the comparison between a high-end marker-based acquisition system and a low-cost marker-less methodology for the assessment of the human posture during working tasks. The low-cost methodology is based on the use of a single Microsoft Kinect V1 device. The high-end acquisition system is the BTS SMART that requires the use of reflective markers to be placed on the subject's body. Three practical working activities involving object lifting and displacement have been investigated. The operational risk has been evaluated according to the lifting equation proposed by the American National Institute for Occupational Safety and Health. The results of the study show that the risk multipliers computed from the two acquisition methodologies are very close for all the analysed activities. In agreement to this outcome, the marker-less methodology based on the Microsoft Kinect V1 device seems very promising to promote the dissemination of computer-aided assessment of ergonomics while maintaining good accuracy and affordable costs. PRACTITIONER’S SUMMARY: The study is motivated by the increasing interest for on-site working ergonomics assessment. We compared a low-cost marker-less methodology with a high-end marker-based system. We tested them on three different working tasks, assessing the working risk of lifting loads. The two methodologies showed comparable precision in all the investigations.

Development of regional stump-to-mill logging cost estimators

Treesearch

Chris B. LeDoux; John E. Baumgras

1989-01-01

Planning logging operations requires estimating the logging costs for the sale or tract being harvested. Decisions need to be made on equipment selection and its application to terrain. In this paper a methodology is described that has been developed and implemented to solve the problem of accurately estimating logging costs by region. The methodology blends field time...

A Mathematical Model for Allocation of School Resources to Optimize a Selected Output.

ERIC Educational Resources Information Center

McAfee, Jackson K.

The methodology of costing an education program by identifying the resources it utilizes places all costs within the framework of staff, equipment, materials, facilities, and services. This paper suggests that this methodology is much stronger than the more traditional budgetary and cost per pupil approach. The techniques of data collection are…

Cost-effectiveness methodology for computer systems selection

NASA Technical Reports Server (NTRS)

Vallone, A.; Bajaj, K. S.

1980-01-01

A new approach to the problem of selecting a computer system design has been developed. The purpose of this methodology is to identify a system design that is capable of fulfilling system objectives in the most economical way. The methodology characterizes each system design by the cost of the system life cycle and by the system's effectiveness in reaching objectives. Cost is measured by a 'system cost index' derived from an analysis of all expenditures and possible revenues over the system life cycle. Effectiveness is measured by a 'system utility index' obtained by combining the impact that each selection factor has on the system objectives and it is assessed through a 'utility curve'. A preestablished algorithm combines cost and utility and provides a ranking of the alternative system designs from which the 'best' design is selected.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 6. Technical Appendices.

DOT National Transportation Integrated Search

1979-09-01

This last volume, includes five technical appendices which document the methodologies used in the benefit-cost analysis. They are the following: Scenario analysis methodology; Impact estimation; Example of impact estimation; Sensitivity analysis; Agg...

Defense Department Profit and Contract Finance Policies and Their Effects on Contract and Contractor Performance

DTIC Science & Technology

2008-02-01

liabilities (e.g., accounts payable). This ratio can be compared to the firm’s weighted average cost of capital ( WACC ). WACC is the cost of debt plus the cost...RatioCost of Debt Marginal Tax Rate Risk-Free Rate Cost of Equity Risk Premium Industry Beta WACC Technical Risk CPFF/CPAF …. FFP/ MYP - Contract Choice...estimates the levered WACC as the discount rate, and finally calculates the NPV of the contract. Specific model input includes profit policy levers

Evaluation of Enhanced Risk Monitors for Use on Advanced Reactors

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

Ramuhalli, Pradeep; Veeramany, Arun; Bonebrake, Christopher A.

This study provides an overview of the methodology for integrating time-dependent failure probabilities into nuclear power reactor risk monitors. This prototypic enhanced risk monitor (ERM) methodology was evaluated using a hypothetical probabilistic risk assessment (PRA) model, generated using a simplified design of a liquid-metal-cooled advanced reactor (AR). Component failure data from industry compilation of failures of components similar to those in the simplified AR model were used to initialize the PRA model. Core damage frequency (CDF) over time were computed and analyzed. In addition, a study on alternative risk metrics for ARs was conducted. Risk metrics that quantify the normalizedmore » cost of repairs, replacements, or other operations and management (O&M) actions were defined and used, along with an economic model, to compute the likely economic risk of future actions such as deferred maintenance based on the anticipated change in CDF due to current component condition and future anticipated degradation. Such integration of conventional-risk metrics with alternate-risk metrics provides a convenient mechanism for assessing the impact of O&M decisions on safety and economics of the plant. It is expected that, when integrated with supervisory control algorithms, such integrated-risk monitors will provide a mechanism for real-time control decision-making that ensure safety margins are maintained while operating the plant in an economically viable manner.« less

Two-part models with stochastic processes for modelling longitudinal semicontinuous data: Computationally efficient inference and modelling the overall marginal mean.

PubMed

Yiu, Sean; Tom, Brian Dm

2017-01-01

Several researchers have described two-part models with patient-specific stochastic processes for analysing longitudinal semicontinuous data. In theory, such models can offer greater flexibility than the standard two-part model with patient-specific random effects. However, in practice, the high dimensional integrations involved in the marginal likelihood (i.e. integrated over the stochastic processes) significantly complicates model fitting. Thus, non-standard computationally intensive procedures based on simulating the marginal likelihood have so far only been proposed. In this paper, we describe an efficient method of implementation by demonstrating how the high dimensional integrations involved in the marginal likelihood can be computed efficiently. Specifically, by using a property of the multivariate normal distribution and the standard marginal cumulative distribution function identity, we transform the marginal likelihood so that the high dimensional integrations are contained in the cumulative distribution function of a multivariate normal distribution, which can then be efficiently evaluated. Hence, maximum likelihood estimation can be used to obtain parameter estimates and asymptotic standard errors (from the observed information matrix) of model parameters. We describe our proposed efficient implementation procedure for the standard two-part model parameterisation and when it is of interest to directly model the overall marginal mean. The methodology is applied on a psoriatic arthritis data set concerning functional disability.

Profitability analysis in the hospital industry.

PubMed Central

Cleverley, W O

1978-01-01

Measures of marginal profit are derived for the two payment classes--cost payers and charge payers--that the hospital industry must consider in profitability analysis, i.e., prediction of the excess of revenue over expenses. Two indexes of profitability, use when payment mix is constant and when it is nonconstant, respectively, are derived from the two marginal profit measures, and one of them is shown to be a modification of the contribution margin, the conventional measure of profitability used in general industry. All three measures--the contribution margin and the two new indexes of profitability--are used to estimate changes in net income resulting from changes in patient volume with and without accompanying changes in payment mix. The conventional measure yields large overestimates of expected excess revenue. PMID:632101

A Pareto analysis approach to assess relevant marginal CO{sub 2} footprint for petroleum products

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

Tehrani, Nejad M. Alireza, E-mail: alireza.tehraninejad@gmail.com

2015-07-15

Recently, linear programing (LP) models have been extended to track the marginal CO{sub 2} intensity of automotive fuels at the refinery gate. The obtained CO{sub 2} data are recommended for policy making because they capture the economic and environmental tensions as well as the processing effects related to oil products. However, they are proven to be extremely sensitive to small perturbations and therefore useless in practice. In this paper, we first investigate the theoretical reasons of this drawback. Then, we develop a multiple objective LP framework to assess relevant marginal CO{sub 2} footprints that preserve both defensibility and stability atmore » a satisfactory level of acceptance. A case study illustrates this new methodology. - Highlights: • Refining LP models have limitations to provide useful marginal CO{sub 2} footprints. • A multi objective optimization framework is developed to assess relevant CO{sub 2} data. • Within a European Refinig industry, diesel is more CO{sub 2} intensive than gasoline.« less

Pitfalls, Potentials, and Ethics of Online Survey Research: LGBTQ and Other Marginalized and Hard-to-Access Youths.

PubMed

McInroy, Lauren B

2016-06-01

Online research methodologies may serve as an important mechanism for population-focused data collection in social work research. Online surveys have become increasingly prevalent in research inquiries with young people and have been acknowledged for their potential in investigating understudied and marginalized populations and subpopulations, permitting increased access to communities that tend to be less visible-and thus often less studied-in offline contexts. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people are a socially stigmatized, yet digitally active, youth population whose participation in online surveys has been previously addressed in the literature. Many of the opportunities and challenges of online survey research identified with LGBTQ youths may be highly relevant to other populations of marginalized and hard-to-access young people, who are likely present in significant numbers in the online environment (for example, ethnoracialized youths and low-income youths). In this article, the utility of online survey methods with marginalized young people is discussed, and recommendations for social work research are provided.

Economics of plant production on marginal sites in the state Mecklenburg-Vorpommern

NASA Astrophysics Data System (ADS)

Ziesemer, Andrea; Andreas, Gurgel; Ines, Bull

2017-04-01

Marginal sites are defined by economics. It is not possible to produce any profit there under given conditions of markets and policy even when management is optimized. In the state Mecklenburg-Vorpommern, a portion of nearly 20 % of arable land is characterized by such conditions. There are often to find sandy sites below 28 soil points with low storage capacity and irregular water supply. Animal husbandry as a type of agricultural upgrading has a more important role in the south and southwest of the state than in the regions with better soil quality. The percentage of Maize was already in 2003 twice as high in the regions with more marginal sites. After implementation of the Renewable Energy Act many enterprises started built biogas plants. In 2010, the portion of maize was raised to 20 %. The increase of Maize was combined with a reduction of growing other fodder crops, rye and also by reducing set-aside areas. The scale of the cash crops Rape (16%), Wheat (15 %) and barley (9 %) stayed the same. The yields and production processes of several selected farms in Mecklenburg-Vorpommern were analyzed for the years 2011 to 2016. The farms reached 6.6 tons per hectare of wheat and 6.1 tons per hectare of barley on soils below 28 soil points. Hybrid rye achieved 5.4 tons per hectare and rape 3.0. Maize was especially dependent on water supply and made between 30 and 35 tons per hectare. The big problem in these regions is caused by high production costs in cropping. More than a half of the costs is required for seeds, fertilization and crop protection. However, the remaining revenues are not adequate for paying work and fix costs as an evaluation of farms in Mecklenburg-Vorpommern shows. It is not a valid option to set more land that is arable aside in regions with much marginal sites because cropping is a strategic investment there. Therefore, it is important to make effort on crop rotations and optimization of production intensities to decrease costs per unit and to save a certain level of yields. A calculation of crop rotations shows that the contribution margin of three-year crop rotations and four-year rotations containing maize is lower by 20 to 25 percent compared with crop rotations on sites with better soil quality. Besides the four-year rotations demonstrate that maize is able to increase the profit for farms. These rotations with maize obtain better contribution margins than cash crop rotations on the margin sites. Furthermore, maize will be a good instrument to come up to requirements on nitrogen balances in future.

Estimating the Effect of Health Insurance on Personal Prescription Drug Importation

PubMed Central

Zullo, Andrew R.; Howe, Chanelle J.; Galárraga, Omar

2016-01-01

Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. Importation carries a risk of exposure to counterfeit (i.e., falsified, fraudulent), adulterated, and substandard drugs. Inadequate health insurance may increase the risk of importation. We use inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations. The marginal prevalence difference [95% confidence limits] for those without (prevalence = 0.031) versus those with health insurance was 0.016 [0.011, 0.021]. The prevalence difference was higher among persons who were Hispanic, born in Latin America, Russia, or Europe, traveled to developing countries, and did not use the Internet to fill prescriptions or to find health information. Health insurance coverage may effectively reduce importation, especially among particular subpopulations. PMID:26837427

Intraoperative monitoring of marginal mandibular nerve during neck dissection.

PubMed

Tirelli, Giancarlo; Bergamini, Pier Riccardo; Scardoni, Alessandro; Gatto, Annalisa; Boscolo Nata, Francesca; Marcuzzo, Alberto Vito

2018-05-01

The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection. This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor. The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy. In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection. © 2018 Wiley Periodicals, Inc.

Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

PubMed

Robinson, Luke Steven; Sarkies, Mitchell; Brown, Ted; O'Brien, Lisa

2016-12-01

Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relationship between occurrence of surgical complications and hospital finances.

PubMed

Eappen, Sunil; Lane, Bennett H; Rosenberg, Barry; Lipsitz, Stuart A; Sadoff, David; Matheson, Dave; Berry, William R; Lester, Mark; Gawande, Atul A

2013-04-17

The effect of surgical complications on hospital finances is unclear. To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type. Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type. Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type. Of 34,256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39,017 (95% CI, $20,069-$50,394; P < .001) higher contribution margin per patient with private insurance ($55,953 vs $16,936) and a $1749 (95% CI, $976-$3287; P < .001) higher contribution margin per patient with Medicare ($3629 vs $1880). For this hospital system in which private insurers covered 40% of patients (13,544), Medicare covered 45% (15,406), Medicaid covered 4% (1336), and self-payment covered 6% (2202), occurrence of complications was associated with an $8084 (95% CI, $4903-$9740; P < .001) higher contribution margin per patient ($15,726 vs $7642) and with a $7435 lower per-patient total margin (95% CI, $5103-$10,507; P < .001) ($1013 vs -$6422). In this hospital system, the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance but a lower one for patients covered by Medicaid and who self-paid. Depending on payer mix, many hospitals have the potential for adverse near-term financial consequences for decreasing postsurgical complications.

[Methodologies for estimating the indirect costs of traffic accidents].

PubMed

Carozzi, Soledad; Elorza, María Eugenia; Moscoso, Nebel Silvana; Ripari, Nadia Vanina

2017-01-01

Traffic accidents generate multiple costs to society, including those associated with the loss of productivity. However, there is no consensus about the most appropriate methodology for estimating those costs. The aim of this study was to review methods for estimating indirect costs applied in crash cost studies. A thematic review of the literature was carried out between 1995 and 2012 in PubMed with the terms cost of illness, indirect cost, road traffic injuries, productivity loss. For the assessment of costs we used the the human capital method, on the basis of the wage-income lost during the time of treatment and recovery of patients and caregivers. In the case of premature death or total disability, the discount rate was applied to obtain the present value of lost future earnings. The computed years arose by subtracting to life expectancy at birth the average age of those affected who are not incorporated into the economically active life. The interest in minimizing the problem is reflected in the evolution of the implemented methodologies. We expect that this review is useful to estimate efficiently the real indirect costs of traffic accidents.

Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-03-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Efficient management of marine resources in conflict: an empirical study of marine sand mining, Korea.

PubMed

Kim, Tae-Goun

2009-10-01

This article develops a dynamic model of efficient use of exhaustible marine sand resources in the context of marine mining externalities. The classical Hotelling extraction model is applied to sand mining in Ongjin, Korea and extended to include the estimated marginal external costs that mining imposes on marine fisheries. The socially efficient sand extraction plan is compared with the extraction paths suggested by scientific research. If marginal environmental costs are correctly estimated, the developed efficient extraction plan considering the resource rent may increase the social welfare and reduce the conflicts among the marine sand resource users. The empirical results are interpreted with an emphasis on guidelines for coastal resource management policy.

Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-01-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018

Comparative Evaluation of Marginal Adaptation of BiodentineTM and Other Commonly Used Root End Filling Materials-An Invitro Study

PubMed Central

P.V., Ravichandra; Vemisetty, Harikumar; K., Deepthi; Reddy S, Jayaprada; D., Ramkiran; Krishna M., Jaya Nagendra; Malathi, Gita

2014-01-01

Aim: The purpose of this investigation was to evaluate the marginal adaptation of three root-end filling materials Glass ionomer cement, Mineral trioxide aggregate and BiodentineTM. Methodology: Thirty human single-rooted teeth were resected 3 mm from the apex. Root-end cavities were then prepared using an ultrasonic tip and filled with one of the following materials Glass ionomer cement (GIC), Mineral trioxide aggregate (MTA) and a bioactive cement BiodentineTM. The apical portions of the roots were then sectioned to obtain three 1 mm thick transversal sections. Confocal laser scanning microscopy (CLSM) was used to determine area of gaps and adaptation of the root-end filling materials with the dentin. The Post hoc test, a multiple comparison test was used for statistical data analysis. Results: Statistical analysis showed lowest marginal gaps (11143.42±967.753m2) and good marginal adaptation with BiodentineTM followed by MTA (22300.97±3068.883m2) and highest marginal gaps with GIC (33388.17±12155.903m2) which were statistically significant (p<0.0001). Conclusion: A new root end filling material BiodentineTM showed better marginal adaptation than commonly used root end filling materials PMID:24783148

Dialogical Grammar: Varieties of Dialogue in Wittgenstein's Methodology

ERIC Educational Resources Information Center

Lemberger, Dorit

2015-01-01

The dialogical character of Wittgenstein's "Philosophical Investigations" has received scant attention in the literature, given the work's status in his total oeuvre, and is dismissed as a marginal as compared to the other differences between the "Tractatus" and the "Investigations." The main lines of interpretation…

Conceptual and Preliminary Design of a Low-Cost Precision Aerial Delivery System

DTIC Science & Technology

2016-06-01

test results. It includes an analysis of the failure modes encountered during flight experimentation , methodology used for conducting coordinate...and experimentation . Additionally, the current and desired end state of the research is addressed. Finally, this chapter outlines the methodology ...preliminary design phases are utilized to investigate and develop a potentially low-cost alternative to existing systems. Using an Agile methodology

49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A... methodology must engage in non-binding mediation of its dispute with the railroad upon filing a formal...

Participatory Investigation of the Great East Japan Disaster: PhotoVoice from Women Affected by the Calamity.

PubMed

Yoshihama, Mieko; Yunomae, Tomoko

2018-05-02

Disasters exacerbate predisaster inequities and intensify the vulnerability of women and other marginalized and disempowered groups. Thus, disaster policies and responses should incorporate the experiences and perspectives of those who are marginalized. The authors sought to conduct a participatory research project to help develop more inclusive, gender-informed disaster responses and policies in Japan. In June 2011, following three months of planning and preparation, they initiated a participatory examination of the impact of the Great East Japan Disaster using PhotoVoice methodology. Engaging the very women affected by the calamity, the authors first implemented the project in three localities in the hardest-hit areas of northern Japan-the prefectures of Fukushima, Miyagi, and Iwate. The authors have since expanded the project to other locations, and the project is ongoing. Focused on the planning, implementation, and outcomes of the initial phase, this article examines the role and potential of participatory action research using the PhotoVoice methodology in the aftermath of a major disaster.

Analysis of longitudinal marginal structural models.

PubMed

Bryan, Jenny; Yu, Zhuo; Van Der Laan, Mark J

2004-07-01

In this article we construct and study estimators of the causal effect of a time-dependent treatment on survival in longitudinal studies. We employ a particular marginal structural model (MSM), proposed by Robins (2000), and follow a general methodology for constructing estimating functions in censored data models. The inverse probability of treatment weighted (IPTW) estimator of Robins et al. (2000) is used as an initial estimator and forms the basis for an improved, one-step estimator that is consistent and asymptotically linear when the treatment mechanism is consistently estimated. We extend these methods to handle informative censoring. The proposed methodology is employed to estimate the causal effect of exercise on mortality in a longitudinal study of seniors in Sonoma County. A simulation study demonstrates the bias of naive estimators in the presence of time-dependent confounders and also shows the efficiency gain of the IPTW estimator, even in the absence such confounding. The efficiency gain of the improved, one-step estimator is demonstrated through simulation.

Sharing Regional Cooperative Gains From Reusing Effluent for Irrigation

NASA Astrophysics Data System (ADS)

Dinar, Ariel; Yaron, Dan; Kannai, Yakar

1986-03-01

This paper is concerned with the allocation of cost and benefits from regional cooperation, with respect to reuse of municipal effluent for irrigation at the Ramla region of Israel. An efficient regional solution provides the maximal regional income which has to be redistributed among the town and several farms. Different allocations based on marginal cost pricing and schemes from cooperative game theory like the core, Shapley value, generalized Shapley value, and nucleolus are applied. The town and farm A have the main additional gains according to all allocation schemes presented. Advantages and disadvantages of these allocation schemes are examined in order to suggest a fair and acceptable allocation of the regional cooperative gains. Although no method has been preferred, the marginal cost pricing was found to be unacceptable by the participants. The conclusion is that the theory of cooperative games may provide guidelines while comparing the different solutions.

Estimating the cost-effectiveness of 54 weeks of infliximab for rheumatoid arthritis.

PubMed

Wong, John B; Singh, Gurkirpal; Kavanaugh, Arthur

2002-10-01

To estimate the cost-effectiveness of infliximab plus methotrexate for active, refractory rheumatoid arthritis. We projected the 54-week results from a randomized controlled trial of infliximab into lifetime economic and clinical outcomes using a Markov computer simulation model. Direct and indirect costs, quality of life, and disability estimates were based on trial results; Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) database outcomes; and published data. Results were discounted using the standard 3% rate. Because most well-accepted medical therapies have cost-effectiveness ratios below $50,000 to $100,000 per quality-adjusted life-year (QALY) gained, results below this range were considered to be "cost-effective." At 3 mg/kg, each infliximab infusion would cost $1393. When compared with methotrexate alone, 54 weeks of infliximab plus methotrexate decreased the likelihood of having advanced disability from 23% to 11% at the end of 54 weeks, which projected to a lifetime marginal cost-effectiveness ratio of $30,500 per discounted QALY gained, considering only direct medical costs. When applying a societal perspective and including indirect or productivity costs, the marginal cost-effectiveness ratio for infliximab was $9100 per discounted QALY gained. The results remained relatively unchanged with variation of model estimates over a broad range of values. Infliximab plus methotrexate for 54 weeks for rheumatoid arthritis should be cost-effective with its clinical benefit providing good value for the drug cost, especially when including productivity losses. Although infliximab beyond 54 weeks will likely be cost-effective, the economic and clinical benefit remains uncertain and will depend on long-term results of clinical trials.

Benefit-cost methodology study with example application of the use of wind generators

NASA Technical Reports Server (NTRS)

Zimmer, R. P.; Justus, C. G.; Mason, R. M.; Robinette, S. L.; Sassone, P. G.; Schaffer, W. A.

1975-01-01

An example application for cost-benefit methodology is presented for the use of wind generators. The approach adopted for the example application consisted of the following activities: (1) surveying of the available wind data and wind power system information, (2) developing models which quantitatively described wind distributions, wind power systems, and cost-benefit differences between conventional systems and wind power systems, and (3) applying the cost-benefit methodology to compare a conventional electrical energy generation system with systems which included wind power generators. Wind speed distribution data were obtained from sites throughout the contiguous United States and were used to compute plant factor contours shown on an annual and seasonal basis. Plant factor values (ratio of average output power to rated power) are found to be as high as 0.6 (on an annual average basis) in portions of the central U. S. and in sections of the New England coastal area. Two types of wind power systems were selected for the application of the cost-benefit methodology. A cost-benefit model was designed and implemented on a computer to establish a practical tool for studying the relative costs and benefits of wind power systems under a variety of conditions and to efficiently and effectively perform associated sensitivity analyses.

The marginal cost of carbon abatement from planting street trees in New York City

Treesearch

Kent F. Kovacs; Robert G. Haight; Suhyun Jung; Dexter H. Locke; Jarlath O' Neil-Dunne

2013-01-01

Urban trees can store carbon through the growth process and reduce fossil fuel use by lowering cooling and heating energy consumption of buildings through the process of transpiration, shading, and the blocking of wind. However, the planting and maintenance of urban trees come at a cost. We estimate the discounted cost of net carbon reductions associated with planting...

40 CFR 1042.850 - Exemptions and hardship relief.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regulations in this chapter to avoid the impending violation. (2) Send the Designated Compliance Officer a... without significant modification of your vessel, you may ask us to determine that a remanufacturing system is not considered available for your vessel because the cost would exceed the total marginal cost...

Health Economic Analysis of Antiplatelet Therapy for Acute Coronary Syndromes in the Context of Five Eastern Asian Countries.

PubMed

Wu, Bin; Tobe, Ruoyan Gai; Liu, Yuchen; He, Ben

2018-04-30

The economic outcomes of dual antiplatelet therapy in East Asian patients are still unclear. We aimed to evaluate the economic outcomes of ticagrelor versus clopidogrel for patients with acute coronary syndrome (ACS) in China, Japan, Korea, Taiwan and Hong Kong. A two-phase model consisting of a 1-year decision tree and a lifetime Markov model was used to estimate the economic outcomes. The data from the East Asian subgroup of Platelet Inhibition and Patient Outcomes (PLATO) and PHILO studies were used for the calculation of the events rate for ticagrelor and clopidogrel in the first 12 months, whereas the costs were obtained from East Asian sources and utility from the published literature. Sensitivity analyses were conducted to test model robustness. Ticagrelor showed the marginal lifetime quality-adjusted life-year (QALY) of 0.0050, 0.0091, 0.0107, 0.0050, and 0.0050 in China, Japan, Korea, Taiwan, and Hong Kong compared with clopidogrel, with marginal healthcare costs of (all values in US dollars) $562, $595, $975, $611, and $672, respectively. The marginal cost per QALY gained with ticagrelor was $112,051, $65,692, $91,207, $121,838, and $133,953 from a public healthcare system perspective of China, Japan, Korea, Taiwan, and Hong Kong, respectively. The sensitivity analysis showed consistent results. Treatment of ACS for 12 months with ticagrelor is not a cost-effective option for the prevention of thrombotic events in East Asia.

Management of busbar costs and spending tradeoffs for the transition to competitive markets in electricity

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

Corio, M.R.; Boyd, G.

Competition is changing the fundamental basis for doing business in the electricity generation market. As the market moves toward competitive market conditions, electricity will be viewed increasingly as a commodity--not only supplied to customers within a utility`s service area, but brokered and marketed outside its area as well. With movement toward retail wheeling being considered in California, Michigan, and New York, it may soon become a reality as well. This means that a utility can no longer feel secure as the monopoly supplier of electricity within its own franchise area. To remain the main supplier in its current service areamore » and compete for customers in other service areas, utilities will need to understand and examine all the components of ``busbar costs`` at its generating units. As competition drives the market to marginal costs, generating units with costs exceeding the market clearing price for electricity may soon have a limited role in the generation market. As the industry evolves, competition in the marketplace will force uneconomic plants to reduce costs or go out of business. This paper discusses results of studies addressing the evaluation of cost effectiveness, benchmarking of cost-efficiency, and development of marginal cost curves for busbar costs based on the development and aggregation of the three key measures which determine the cost and level of output (generation): (1) reliability; (2) heat rate; and (3) planned outage factor.« less

Health economic assessment: a methodological primer.

PubMed

Simoens, Steven

2009-12-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments.

Health Economic Assessment: A Methodological Primer

PubMed Central

Simoens, Steven

2009-01-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments. PMID:20049237

Constructing Cost-Effective and Targetable ICS Honeypots Suited for Production Networks

DTIC Science & Technology

2015-03-26

introducing Honeyd+ has a marginal impact on performance. Notable findings are that the Raspberry Pi is the preferred hosting platform for the EtherNet/IP... Raspberry Pi or Gumstix, which is a low-cost approach to replicating multiple decoys. One hidden drawback to low- interaction honeypots is the extensive time...EtherNet/IP industrial protocol. Honeyd+ is hosted on a low-cost computing platform ( Raspberry Pi running Raspbian, approximately $50) and a high-cost

Essays on microgrids, asymmetric pricing and market power in electricity markets

NASA Astrophysics Data System (ADS)

Lo Prete, Chiara

This dissertation presents four studies of the electricity industry. The first and second essays use economic-engineering models to assess different aspects of microgrid penetration in regional electricity markets, while the last two studies contain empirical analyses aimed at evaluating the performance of wholesale electricity markets. Chapter 2 develops a framework to quantify economic, environmental, efficiency and reliability impacts of different power production scenarios in a regional system, focusing on the interaction of microgrids with the existing transmission and distribution grid. The setting is the regional network formed by Belgium, France, Germany and the Netherlands. The study presents simulations of power market outcomes under various policies and levels of microgrid penetration, and evaluates them using a diverse set of metrics. Chapter 3 studies the interaction between a microgrid and a regulated electric utility in a regional electricity market. I consider the interaction among the utility, the microgrid developer and consumers in the framework of cooperative game theory (assuming exchangeable utility), and use regional market models to simulate scenarios in which microgrid introduction may or may not be socially beneficial. Under the assumptions of this chapter, customer participation is essential to the development of socially beneficial microgrids, while the utility has little or no gain from it. Discussed incentives to avoid that utilities block microgrid entry include additional revenue drivers related to microgrid connection, decoupling and performance-based mechanisms targeted at service quality. When prices are below marginal costs of utility provided power, microgrid development may be socially beneficial, but unprofitable for microgrid customers and its developer. By imposing lower charges and higher remuneration for its services, the regulator could ensure that microgrid value is positive, without adversely impacting the utility. Chapter 4 examines the possibility of asymmetric transmission of CO 2 and fuel prices to electricity futures prices in the second phase of the European Emission Trading Scheme. The goal is to assess whether output prices tend to respond more quickly to input price increases than decreases: this phenomenon is known as "rockets and feathers" in the literature. Results do not provide empirical evidence of statistically significant differences in the response of power prices to positive and negative shocks in CO 2 allowance and fuel markets. Chapter 5 re-examines the issue of the potential exercise of market power in California after liberalization, with a focus on its day-ahead energy market (the former PX) and its five largest thermal generators. The analysis focuses on a peak hour of operation (hour 18) and disregards hours in which congestion occurred. First, I define a direct measure of unilateral market power for each firm, equal to the hourly inverse elasticity of its residual demand function. The second part of the analysis aims at assessing whether the necessary conditions for the unilateral exercise of market power were satisfied in practice, based on a comparison of PX market-clearing prices, estimated marginal revenues and estimated bounds for the marginal costs of generation of each supplier. By conservatively assuming that the estimated upper bound is close to each firm's actual marginal cost of generation, the analysis suggests that in a large fraction of hours the thermal generators were acting less competitively that what implied by unilateral profit maximization. If instead I explicitly account for uncertainty in the marginal cost estimates with the introduction of a +/-10% margin on the estimated bounds, thermal generators are equally likely to bid close to their marginal costs or above them. Among the hours characterized by market-clearing prices above marginal costs, 64% present, on average, evidence of less competitive than Nash behavior. Two possible explanations for the observed restrained quantities, relative to the Nash level, include firms' coordinating efforts to raise prices on the day-ahead market and a Cournot game among the thermal generators, since the Cournot equilibrium represents an upper bound on supply function equilibria. (Abstract shortened by UMI.)

Hospital profitability for a surgeon's common procedures predicts the surgeon's overall profitability for the hospital.

PubMed

Dexter, F; Macario, A; Cerone, S M

1998-09-01

To evaluate whether a hospital's profitability for a surgeon's common procedures predicts the surgeon's overall profitability for the hospital. Observational study. Community and university-affiliated tertiary hospital with 21,903 surgical procedures performed per year. 7,520 patients having surgery performed by one of 46 surgeons. None. Financial data were obtained for all patients cared for by all the surgeons who performed at least ten cases of one of the hospital's six most common procedures. A surgeon's overall profitability for the hospital was measured using his or her contribution margin ratio (i.e., total revenue for all of the surgeon's patients divided by total variable cost for the patients). Contribution margin was calculated twice: once with all of a surgeon's patients, and second, limiting consideration to those patients who underwent one of the six common procedures. The common procedures accounted for 22 +/- 15% of the 46 surgeons' overall caseload, 29 +/- 10% of their patients' hospital costs, and 30 +/- 12% of the hospital revenue generated by the surgeons. Hospital contribution margin ratios ranged from 1.4 to 4.2. Contribution margin ratios for common procedures and contribution margin ratios for all patients were correlated (tau = 0.58, n = 46, p < 0.0001). Even though most surgical cases were for uncommon procedures, a surgeon's hospital profitability on common procedures predicted the surgeon's overall financial performance. Perioperative incentive programs based on common surgical procedures (clinical pathways) are likely to accurately reflect a surgeon's financial performance on their other surgeries.

Application of low-cost methodologies for mobile phone app development.

PubMed

Zhang, Melvyn; Cheow, Enquan; Ho, Cyrus Sh; Ng, Beng Yeong; Ho, Roger; Cheok, Christopher Cheng Soon

2014-12-09

The usage of mobile phones and mobile phone apps in the recent decade has indeed become more prevalent. Previous research has highlighted a method of using just the Internet browser and a text editor to create an app, but this does not eliminate the challenges faced by clinicians. More recently, two methodologies of app development have been shared, but there has not been any disclosures pertaining to the costs involved. In addition, limitations such as the distribution and dissemination of the apps have not been addressed. The aims of this research article are to: (1) highlight a low-cost methodology that clinicians without technical knowledge could use to develop educational apps; (2) clarify the respective costs involved in the process of development; (3) illustrate how limitations pertaining to dissemination could be addressed; and (4) to report initial utilization data of the apps and to share initial users' self-rated perception of the apps. In this study, we will present two techniques of how to create a mobile app using two of the well-established online mobile app building websites. The costs of development are specified and the methodology of dissemination of the apps will be shared. The application of the low-cost methodologies in the creation of the "Mastering Psychiatry" app for undergraduates and "Déjà vu" app for postgraduates will be discussed. A questionnaire survey has been administered to undergraduate students collating their perceptions towards the app. For the Mastering Psychiatry app, a cumulative total of 722 users have used the mobile app since inception, based on our analytics. For the Déjà vu app, there has been a cumulative total of 154 downloads since inception. The utilization data demonstrated the receptiveness towards these apps, and this is reinforced by the positive perceptions undergraduate students (n=185) had towards the low-cost self-developed apps. This is one of the few studies that have demonstrated the low-cost methodologies of app development; as well as student and trainee receptivity toward self-created Web-based mobile phone apps. The results obtained have demonstrated that these Web-based low-cost apps are applicable in the real life, and suggest that the methodologies shared in this research paper might be of benefit for other specialities and disciplines.

Application of Low-Cost Methodologies for Mobile Phone App Development

PubMed Central

Ng, Beng Yeong; Ho, Roger; Cheok, Christopher Cheng Soon

2014-01-01

Background The usage of mobile phones and mobile phone apps in the recent decade has indeed become more prevalent. Previous research has highlighted a method of using just the Internet browser and a text editor to create an app, but this does not eliminate the challenges faced by clinicians. More recently, two methodologies of app development have been shared, but there has not been any disclosures pertaining to the costs involved. In addition, limitations such as the distribution and dissemination of the apps have not been addressed. Objective The aims of this research article are to: (1) highlight a low-cost methodology that clinicians without technical knowledge could use to develop educational apps; (2) clarify the respective costs involved in the process of development; (3) illustrate how limitations pertaining to dissemination could be addressed; and (4) to report initial utilization data of the apps and to share initial users’ self-rated perception of the apps. Methods In this study, we will present two techniques of how to create a mobile app using two of the well-established online mobile app building websites. The costs of development are specified and the methodology of dissemination of the apps will be shared. The application of the low-cost methodologies in the creation of the “Mastering Psychiatry” app for undergraduates and “Déjà vu” app for postgraduates will be discussed. A questionnaire survey has been administered to undergraduate students collating their perceptions towards the app. Results For the Mastering Psychiatry app, a cumulative total of 722 users have used the mobile app since inception, based on our analytics. For the Déjà vu app, there has been a cumulative total of 154 downloads since inception. The utilization data demonstrated the receptiveness towards these apps, and this is reinforced by the positive perceptions undergraduate students (n=185) had towards the low-cost self-developed apps. Conclusions This is one of the few studies that have demonstrated the low-cost methodologies of app development; as well as student and trainee receptivity toward self-created Web-based mobile phone apps. The results obtained have demonstrated that these Web-based low-cost apps are applicable in the real life, and suggest that the methodologies shared in this research paper might be of benefit for other specialities and disciplines. PMID:25491323

Benefit-cost analysis of addiction treatment: methodological guidelines and empirical application using the DATCAP and ASI.

PubMed

French, Michael T; Salomé, Helena J; Sindelar, Jody L; McLellan, A Thomas

2002-04-01

To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment. A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines. Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates. The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission. The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se. This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment.

Effects of aerodynamic heating and TPS thermal performance uncertainties on the Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Goodrich, W. D.; Derry, S. M.; Maraia, R. J.

1980-01-01

A procedure for estimating uncertainties in the aerodynamic-heating and thermal protection system (TPS) thermal-performance methodologies developed for the Shuttle Orbiter is presented. This procedure is used in predicting uncertainty bands around expected or nominal TPS thermal responses for the Orbiter during entry. Individual flowfield and TPS parameters that make major contributions to these uncertainty bands are identified and, by statistical considerations, combined in a manner suitable for making engineering estimates of the TPS thermal confidence intervals and temperature margins relative to design limits. Thus, for a fixed TPS design, entry trajectories for future Orbiter missions can be shaped subject to both the thermal-margin and confidence-interval requirements. This procedure is illustrated by assessing the thermal margins offered by selected areas of the existing Orbiter TPS design for an entry trajectory typifying early flight test missions.

Do Medicare Advantage Plans Select Enrollees in Higher Margin Clinical Categories?

PubMed Central

Newhouse, Joseph P.; McWilliams, J. Michael; Price, Mary; Huang, Jie; Fireman, Bruce; Hsu, John

2013-01-01

The CMS-HCC risk adjustment system for Medicare Advantage (MA) plans calculates weights, which are effectively relative prices, for beneficiaries with different observable characteristics. To do so it uses the relative amounts spent per beneficiary with those characteristics in Traditional Medicare (TM). For multiple reasons one might expect relative amounts in MA to differ from TM, thereby making some beneficiaries more profitable to treat than others. Much of the difference comes from differences in how TM and MA treat different diseases or diagnoses. Using data on actual medical spending from two MA-HMO plans, we show that the weights calculated from MA costs do indeed differ from those calculated using TM spending. One of the two plans (Plan 1) is more typical of MA-HMO plans in that it contracts with independent community providers, while the other (Plan 2) is vertically integrated with care delivery. We calculate margins, or Average Revenue/Average Cost, for Medicare beneficiaries in the two plans who have one of 48 different combinations of medical conditions. The two plans’ margins for these 48 conditions are correlated (r=0.39, p<0.01). Both plans have margins that are more positive for persons with conditions that are managed by primary care physicians and where medical management can be effective. Conversely they have lower margins for persons with conditions that tend to be treated by specialists with greater market power than primary care physicians and for acute conditions where little medical management is possible. The two plan’s margins among beneficiaries with different observable characteristics vary over a range of 160 and 98 percentage points, respectively, and thus would appear to offer substantial incentive for selection by HCC. Nonetheless, we find no evidence of overrepresentation of beneficiaries in high margin HCC’s in either plan. Nor, using the margins from Plan 1, the more typical plan, do we find evidence of overrepresentation of high margin HCC’s in Medicare more generally. These results do not permit a conclusion on overall social efficiency, but we note that selection according to margin could be socially efficient. In addition, our findings suggest there are omitted interaction terms in the risk adjustment model that Medicare currently uses. PMID:24308879

Adapting Traditional Text Materials to Individualized Methodology

ERIC Educational Resources Information Center

Wood, Merle W.

1977-01-01

A consultant in business education presents his system for developing strategies of individualized instruction in using commercial materials designed for group instruction. To illustrate the process he includes seven figures of pages from an accounting text, with marginal notes to direct the student to an individualized supplement. (MF)

School Health Promotion and Teacher Professional Identity

ERIC Educational Resources Information Center

Jourdan, Didier; Simar, Carine; Deasy, Christine; Carvalho, Graça S.; McNamara, Patricia Mannix

2016-01-01

Purpose: Health and education are inextricably linked. Health promotion sits somewhat uncomfortably within schools, often remaining a marginal aspect of teachers' work. The purpose of this paper is to examine the compatibility of an HP-initiative with teacher professional identity. Design/methodology/approach: A qualitative research design was…

Contributing Meaning to Research in Developmental Disabilities: Integrating Participatory Action and Methodological Rigor

ERIC Educational Resources Information Center

Powers, Laurie E.

2017-01-01

Action research approaches reflecting power sharing by academic and community researchers, full engagement of community partners across all study phases, and ongoing commitment to partnership and capacity building have been increasingly embraced, particularly in research affecting marginalized populations. Findings suggest action research…

Sex Work Research: Methodological and Ethical Challenges

ERIC Educational Resources Information Center

Shaver, Frances M.

2005-01-01

The challenges involved in the design of ethical, nonexploitative research projects with sex workers or any other marginalized population are significant. First, the size and boundaries of the population are unknown, making it extremely difficult to get a representative sample. Second, because membership in hidden populations often involves…

Social Costs of Gambling in the Czech Republic 2012.

PubMed

Winkler, Petr; Bejdová, Markéta; Csémy, Ladislav; Weissová, Aneta

2017-12-01

Evidence about social costs of gambling is scarce and the methodology for their calculation has been a subject to strong criticism. We aimed to estimate social costs of gambling in the Czech Republic 2012. This retrospective, prevalence based cost of illness study builds on the revised methodology of Australian Productivity Commission. Social costs of gambling were estimated by combining epidemiological and economic data. Prevalence data on negative consequences of gambling were taken from existing national epidemiological studies. Economic data were taken from various national and international sources. Consequences of problem and pathological gambling only were taken into account. In 2012, the social costs of gambling in the Czech Republic were estimated to range between 541,619 and 619,608 thousands EUR. While personal and family costs accounted for 63% of all social costs, direct medical costs were estimated to range from 0.25 to 0.28% of all social costs only. This is the first study which estimates social costs of gambling in any of the Central and East European countries. It builds upon the solid evidence about prevalence of gambling related problems in the Czech Republic and satisfactorily reliable economic data. However, there is a number of limitations stemming from assumptions that were made, which suggest that the methodology for the calculation of the social costs of gambling needs further development.

Assessment of a stochastic downscaling methodology in generating an ensemble of hourly future climate time series

NASA Astrophysics Data System (ADS)

Fatichi, S.; Ivanov, V. Y.; Caporali, E.

2013-04-01

This study extends a stochastic downscaling methodology to generation of an ensemble of hourly time series of meteorological variables that express possible future climate conditions at a point-scale. The stochastic downscaling uses general circulation model (GCM) realizations and an hourly weather generator, the Advanced WEather GENerator (AWE-GEN). Marginal distributions of factors of change are computed for several climate statistics using a Bayesian methodology that can weight GCM realizations based on the model relative performance with respect to a historical climate and a degree of disagreement in projecting future conditions. A Monte Carlo technique is used to sample the factors of change from their respective marginal distributions. As a comparison with traditional approaches, factors of change are also estimated by averaging GCM realizations. With either approach, the derived factors of change are applied to the climate statistics inferred from historical observations to re-evaluate parameters of the weather generator. The re-parameterized generator yields hourly time series of meteorological variables that can be considered to be representative of future climate conditions. In this study, the time series are generated in an ensemble mode to fully reflect the uncertainty of GCM projections, climate stochasticity, as well as uncertainties of the downscaling procedure. Applications of the methodology in reproducing future climate conditions for the periods of 2000-2009, 2046-2065 and 2081-2100, using the period of 1962-1992 as the historical baseline are discussed for the location of Firenze (Italy). The inferences of the methodology for the period of 2000-2009 are tested against observations to assess reliability of the stochastic downscaling procedure in reproducing statistics of meteorological variables at different time scales.

Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa.

PubMed

Kasteng, Frida; Settumba, Stella; Källander, Karin; Vassall, Anna

2016-03-01

Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs' workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5-57), was valued at USD 6.9 (range 0.9-20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4-169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Creation and implementation of an effective physician compensation methodology for a nonprofit medical foundation.

PubMed

Ferch, A W

2000-01-01

The foundation has determined that the adjusted gross billing methodology is a viable method to be considered for a nonprofit medical foundation in compensating physicians. The foundation continues to experiment with the margin formula and is exploring other potential formulas, but believes with certain modifications the percentage of adjusted gross billing methodology can be effective and useful because of its simplicity, ease of administration, and motivational effect on the physicians. The primary improvement to the model needed would be the ability to adjust the formula on a frequent basis for individual practice variations. Modifications will continue to be made as circumstances change, but the basic principles will remain constant.

Costing for the Future: Exploring Cost Estimation With Unmanned Autonomous Systems

DTIC Science & Technology

2016-04-30

account for how cost estimating for autonomy is different than current methodologies and to suggest ways it can be addressed through the integration and...The Development stage involves refining the system requirements, creating a solution description , and building a system. 3. The Operational Test...parameter describes the extent to which efficient fabrication methodologies and processes are used, and the automation of labor-intensive operations

How Much Does Medical Education Cost? A Review. Health Manpower Policy Discussion Paper Series No. A3.

ERIC Educational Resources Information Center

MacBride, Owen

This survey of studies of medical school costs was made in order to evaluate and compare the methodologies and findings of those studies. The survey covered studies of one or more medical schools that either produced figures for average annual per-student cost of education and/or discussed the methodologies and problems involved in producing such…

Evaluation of Methodology for Estimating the Cost of Air Force On-The-Job Training. Final Report.

ERIC Educational Resources Information Center

Samers, Bernard N.; And Others

Described is the final phase of a study directed at the development of an on-the-job training (OJT) costing methodology. Utilizing a modification of survey techniques tested and evaluated during the previous phase, estimates were obtained for the cost of OJT for airman training from the l-level (unskilled to the 3-level (semiskilled) in five…

Role of specimen US for predicting resection margin status in breast conserving therapy.

PubMed

Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

2015-01-01

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

Confidence in outcome estimates from systematic reviews used in informed consent.

PubMed

Fritz, Robert; Bauer, Janet G; Spackman, Sue S; Bains, Amanjyot K; Jetton-Rangel, Jeanette

2016-12-01

Evidence-based dentistry now guides informed consent in which clinicians are obliged to provide patients with the most current, best evidence, or best estimates of outcomes, of regimens, therapies, treatments, procedures, materials, and equipment or devices when developing personal oral health care, treatment plans. Yet, clinicians require that the estimates provided from systematic reviews be verified to their validity, reliability, and contextualized as to performance competency so that clinicians may have confidence in explaining outcomes to patients in clinical practice. The purpose of this paper was to describe types of informed estimates from which clinicians may have confidence in their capacity to assist patients in competent decision-making, one of the most important concepts of informed consent. Using systematic review methodology, researchers provide clinicians with valid best estimates of outcomes regarding a subject of interest from best evidence. Best evidence is verified through critical appraisals using acceptable sampling methodology either by scoring instruments (Timmer analysis) or checklist (grade), a Cochrane Collaboration standard that allows transparency in open reviews. These valid best estimates are then tested for reliability using large databases. Finally, valid and reliable best estimates are assessed for meaning using quantification of margins and uncertainties. Through manufacturer and researcher specifications, quantification of margins and uncertainties develops a performance competency continuum by which valid, reliable best estimates may be contextualized for their performance competency: at a lowest margin performance competency (structural failure), high margin performance competency (estimated true value of success), or clinically determined critical values (clinical failure). Informed consent may be achieved when clinicians are confident of their ability to provide useful and accurate best estimates of outcomes regarding regimens, therapies, treatments, and equipment or devices to patients in their clinical practices and when developing personal, oral health care, treatment plans. Copyright © 2016 Elsevier Inc. All rights reserved.

Manned Mars mission cost estimate

NASA Technical Reports Server (NTRS)

Hamaker, Joseph; Smith, Keith

1986-01-01

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

Financial performance of health plans in Medicaid managed care.

PubMed

McCue, Mike

2012-01-01

This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization.

Abatement vs. treatment for efficient diffuse source water pollution management in terrestrial-marine systems.

PubMed

Roebeling, P C; Cunha, M C; Arroja, L; van Grieken, M E

2015-01-01

Marine ecosystems are affected by water pollution originating from coastal catchments. The delivery of water pollutants can be reduced through water pollution abatement as well as water pollution treatment. Hence, sustainable economic development of coastal regions requires balancing of the marginal costs from water pollution abatement and/or treatment and the associated marginal benefits from marine resource appreciation. Water pollution delivery reduction costs are, however, not equal across abatement and treatment options. In this paper, an optimal control approach is developed and applied to explore welfare maximizing rates of water pollution abatement and/or treatment for efficient diffuse source water pollution management in terrestrial-marine systems. For the case of diffuse source dissolved inorganic nitrogen water pollution in the Tully-Murray region, Queensland, Australia, (agricultural) water pollution abatement cost, (wetland) water pollution treatment cost and marine benefit functions are determined to explore welfare maximizing rates of water pollution abatement and/or treatment. Considering partial (wetland) treatment costs and positive water quality improvement benefits, results show that welfare gains can be obtained, primarily, through diffuse source water pollution abatement (improved agricultural management practices) and, to a minor extent, through diffuse source water pollution treatment (wetland restoration).

Cost effectiveness of total knee arthroplasty from a health care providers' perspective before and after introduction of an interdisciplinary clinical pathway--is investment always improvement?

PubMed

Krummenauer, Frank; Guenther, Klaus-Peter; Kirschner, Stephan

2011-12-14

Total knee arthroplasty (TKA) is an effective, but also cost-intensive health care intervention for end stage osteoarthritis. This investigation was designed to evaluate the cost-effectiveness of TKA before versus after introduction of an interdisciplinary clinical pathway from a University Orthopedic Surgery Department's cost perspective as an interdisciplinary full service health care provider. A prospective trial recruited two sequential cohorts of 132 and 128 consecutive patients, who were interviewed by means of the WOMAC questionnaire. Direct process costs from the health care providers' perspective were estimated according to the German DRG calculation framework. The health economic evaluation was based on margiual cost-effectveness ratios (MCERs); an individual marginal cost effectiveness relation≤100 € per % WOMAC index increase was considered as primary endpoint of the confirmatory cohort comparison. The interdisciplinary clinical pathway under consideration primarily consisted of a voluntary preoperative personal briefing of patients concerning postoperatively expectable progess in health status and optimum use of walking aids after surgery. All patients were supplied with written information on these topics, attendance of the personal briefing also included preoperative training for postoperative mobilisation by the Department's physiotherapeutic staff. An individual marginal cost effectiveness relation≤100 €/% WOMAC index increase was found in 38% of the patients in the pre pathway implementation cohort versus in 30% of the post pathway implementation cohort (Fisher p=0.278). Both cohorts showed substantial improvement in WOMAC scores (39 versus 35% in median), whereas the cohort did not differ significantly in the median WOMAC score before surgery (41% for the pre pathway cohort versus 44% for the post pathway cohort). Despite a locally significant decrease in costs (4303 versus 4194 € in median), the individual cost/benefit relation became worse after introduction of the pathway: for the first cohort the MCER was estimated 108 € per gained % WOMAC index increase (86-150 €/%) versus 118 €/% WOMAC gain (93-173 €/%) in the second cohort after pathway implementation. In summary, the proposed critical pathway for TKA could be shown to be significantly cost efficient, but not cost effective concerning functional outcome, when the above individual marginal cost effectiveness criterion was concentrated on. The introduction of an interdisciplinary clinical pathway does not necessarily improve patient related outcomes. On the contrary, cost effectiveness from the health care providers' perspective may even turn out remarkably reduced in the setting considered here (functional outcome assessment after treatment by a full service health care provider).

Cost effectiveness of total knee arthroplasty from a health care providers' perspective before and after introduction of an interdisciplinary clinical pathway - is investment always improvement?

PubMed Central

2011-01-01

Background Total knee arthroplasty (TKA) is an effective, but also cost-intensive health care intervention for end stage osteoarthritis. This investigation was designed to evaluate the cost-effectiveness of TKA before versus after introduction of an interdisciplinary clinical pathway from a University Orthopedic Surgery Department's cost perspective as an interdisciplinary full service health care provider. Methods A prospective trial recruited two sequential cohorts of 132 and 128 consecutive patients, who were interviewed by means of the WOMAC questionnaire. Direct process costs from the health care providers' perspective were estimated according to the German DRG calculation framework. The health economic evaluation was based on margiual cost-effectveness ratios (MCERs); an individual marginal cost effectiveness relation ≤ 100 € per % WOMAC index increase was considered as primary endpoint of the confirmatory cohort comparison. The interdisciplinary clinical pathway under consideration primarily consisted of a voluntary preoperative personal briefing of patients concerning postoperatively expectable progess in health status and optimum use of walking aids after surgery. All patients were supplied with written information on these topics, attendance of the personal briefing also included preoperative training for postoperative mobilisation by the Department's physiotherapeutic staff. Results An individual marginal cost effectiveness relation ≤ 100 €/% WOMAC index increase was found in 38% of the patients in the pre pathway implementation cohort versus in 30% of the post pathway implementation cohort (Fisher p = 0.278). Both cohorts showed substantial improvement in WOMAC scores (39 versus 35% in median), whereas the cohort did not differ significantly in the median WOMAC score before surgery (41% for the pre pathway cohort versus 44% for the post pathway cohort). Despite a locally significant decrease in costs (4303 versus 4194 € in median), the individual cost/benefit relation became worse after introduction of the pathway: for the first cohort the MCER was estimated 108 € per gained % WOMAC index increase (86 - 150 €/%) versus 118 €/% WOMAC gain (93 - 173 €/%) in the second cohort after pathway implementation. In summary, the proposed critical pathway for TKA could be shown to be significantly cost efficient, but not cost effective concerning functional outcome, when the above individual marginal cost effectiveness criterion was concentrated on. Conclusions The introduction of an interdisciplinary clinical pathway does not necessarily improve patient related outcomes. On the contrary, cost effectiveness from the health care providers' perspective may even turn out remarkably reduced in the setting considered here (functional outcome assessment after treatment by a full service health care provider). PMID:22168149

Financial implications of ventral hernia repair: a hospital cost analysis.

PubMed

Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

2013-01-01

Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p < 0.001) and net losses (3,430 vs. 1,700, p < 0.025) were significantly greater for those who underwent hernia repair as a secondary procedure. Among inpatients undergoing ventral hernia repair as the primary procedure, 46 were repaired without mesh; 79 were repaired with synthetic mesh and 48 with biologic mesh. Median direct costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p < .01). Median net losses for repairs without mesh were $500. Median net profit of $60 was observed for synthetic mesh-based repairs. The median contribution margin for cases utilizing biologic mesh was -$4,560, and the median net financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost-effective strategies for managing ventral hernias in a tertiary care environment need to be developed in light of the financial implications of this patient population.

Why are hospital-based nursing homes so costly? Relative importance of acuity and treatment setting.

PubMed

Pizer, Steven D; White, Alan J; White, Chapin

2002-05-01

To determine the extent to which higher costs in hospital-based skilled nursing facilities (HBSNF) can be explained by observable resident characteristics and unobservable selection effects, implying a design shortcoming of the skilled nursing facility prospective payment system (SNF PPS) implemented for Medicare-covered stays by the Balanced Budget Act of 1997 (BBA 1997). Data on resident characteristics from the Minimum Data Set (MDS) are combined with staff time costs from the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) 1995 and 1997 SNF Staff Time Measurement (STM) studies and nontherapy ancillary claim costs extracted from CMS SNF claim records. An endogenous switching model was estimated to measure the effect on costs of the relatively high acuity of HBSNF residents, net of differences purely attributable to the treatment setting. It was found that virtually the entire HBSNF differential is attributable to setting effects with resident characteristics and selection effects playing a negligible role. In addition, it was found that marginal costs associated with particular services and conditions are often lower in hospital-based than in freestanding facilities. HBSNFs incur high costs regardless of the characteristics of their residents. Their high fixed costs accompany relatively low marginal costs associated with admitting high-acuity residents. Consequently, a PPS casemix system that depends on resident characteristics and excludes consideration of facility characteristics (as mandated by BBA 1997) need not unfairly penalize HBSNFs, provided a powerful casemix system is used and HBSNFs specialize in the care of high-acuity residents.

Financial Analysis of Pediatric Resident Physician Primary Care Longitudinal Outpatient Experience.

PubMed

Stipelman, Carole H; Poss, Brad; Stetson, Laura Anne; Boi, Luca; Rogers, Michael; Puzey, Caleb; Koduri, Sri; Kaplan, Robert; Lee, Vivian S; Clark, Edward B

2018-05-16

To determine whether residency training represents a net positive or negative cost to academic medical centers, we analyzed the cost of a residency program and clinical productivity of residents and faculty in outpatient primary care practice with or without residents. Patient volume and revenue data (Current Procedural Terminology codes) from an academic primary care general pediatric clinic were evaluated for faculty clinics (faculty only) and resident teaching clinics (Longitudinal Outpatient Experience [LOE]) with 1-4 residents/faculty. Detailed cost per resident was determined using a departmental financial model that included salary, benefits, faculty and administrative staff effort, non-personnel costs, and institutional GME support. The LOE clinics had greater mean number of patient visits (11.6 vs 6.8) than faculty clinics per faculty member. In the LOE clinic, the number of patient visits per clinic was directly proportional to the number of residents per faculty. The cost for each resident was $250 per clinic ($112 per resident, $88 per medical assistant per resident, and $50 per room per resident). When factoring in clinic costs and faculty supervision time, the LOE clinic (average 3.5 residents with one supervising faculty) had greater average cost (+$687.00) and revenue (+$319.45) and lower operating margin (revenue minus cost, -$367.55) than faculty clinic (one faculty member). Pediatric resident LOE clinic had a greater average number of patient visits and revenue per faculty member but higher costs and lower operating margin than faculty clinic. Copyright © 2018. Published by Elsevier Inc.

The cost-effectiveness of a child nutrition education programme in Peru.

PubMed

Waters, Hugh R; Penny, Mary E; Creed-Kanashiro, Hilary M; Robert, Rebecca C; Narro, Rocío; Willis, Jeff; Caulfield, Laura E; Black, Robert E

2006-07-01

This article reports impact and cost results from a health facility-based nutrition education programme targeting children less than 2 years of age in Trujillo, Peru. Key elements of the programme included participative complementary feeding demonstrations, growth monitoring sessions and an accreditation process. Data were collected from six intervention and six control health facilities to measure utilization and costs associated with the intervention. To calculate the unit costs of services, these costs are allocated using activity-based costing. To measure the effects of the intervention, 338 children were followed through household surveys at regular intervals from birth until the age of 18 months. The intervention had a clear positive impact both on the use of nutrition-related services and on children's growth outcomes. Children in the intervention areas made 17.6 visits to health facilities in the first 18 months of life, compared with 14.1 visits for children in the control areas (P < 0.001). This pattern holds true for all socioeconomic groups. The intervention prevented 11.1 cases of stunting per 100 children. In multivariate logistic regression analysis, children in the intervention were 0.33 times as likely to be stunted as the controls (P = 0.002). The marginal cost of the intervention - including external costs, training, health education materials and extra travel and equipment - is 6.12 US dollars per child reached and 55.16 US dollars per case of stunting prevented. The estimated marginal cost of the intervention per death averted is 1952 US dollars.

The path to cost transformation.

PubMed

Hill-Mischel, Jody; Morrissey, Walter W; Neese, Kimberly; Shoger, Timothy R

2016-06-01

A healthcare organization's efforts to strategically transform its cost structure in preparation for value-based payment invariably must begin with a systemwide assessment of cost and quality. Such an assessment should focus on three categories of performance improvement activities: margin improvement, business restructuring, and clinical transformation. A work-team approach is recommended, where teams with multidisciplinary representation assume responsibility for assessing specific areas (e.g., acute care enterprise, physician enterprise, business restructuring).

Hardwood sawmill downtime costs

Treesearch

Jan Wiedenbeck; Kyle Blackwell

2003-01-01

How time flies when you don't pay attention to it. With hardwood sawmill operating costs ranging from $4 to $25 per operating minute ($95/MBF to $335/MBF) and gross profit margins ranging from $0.10/BF to $0.35/BF, five extra minutes of downtime per day will cost a sawmill that produces an average of 20,000 BF per day (5 MMBF annually) between $21 and $73 per day...

The financial performance of labor and delivery units.

PubMed

von Gruenigen, Vivian E; Powell, Diane M; Sorboro, Susan; McCarroll, Michelle L; Kim, Unhee

2013-07-01

Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physician-centric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality cost-effective care for sustainability, especially in obstetrics. Copyright © 2013 Mosby, Inc. All rights reserved.

Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis.

PubMed

Peersman, Geert; Jak, Wouter; Vandenlangenbergh, Tom; Jans, Christophe; Cartier, Philippe; Fennema, Peter

2014-01-01

Unicondylar knee arthroplasty (UKA) is believed to lead to less morbidity and enhanced functional outcomes when compared with total knee arthroplasty (TKA). Conversely, UKA is also associated with a higher revision risk than TKA. In order to further clarify the key differences between these separate procedures, the current study assessing the cost-effectiveness of UKA versus TKA was undertaken. A state-transition Markov model was developed to compare the cost-effectiveness of UKA versus TKA for unicondylar osteoarthritis using a Belgian payer's perspective. The model was designed to include the possibility of two revision procedures. Model estimates were obtained through literature review and revision rates were based on registry data. Threshold analysis and probabilistic sensitivity analysis were performed to assess the model's robustness. UKA was associated with a cost reduction of €2,807 and a utility gain of 0.04 quality-adjusted life years in comparison with TKA. Analysis determined that the model is sensitive to clinical effectiveness, and that a marginal reduction in the clinical performance of UKA would lead to TKA being the more cost-effective solution. UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA. © 2014 Elsevier B.V. All rights reserved.

Bureaucracy Versus Environment: The Environmental Costs of Bureaucratic Governance

NASA Astrophysics Data System (ADS)

Singer, S. Fred

The 15 contributors to this volume have an important message. They are convinced that both environmental and economic costs of bureaucratic management of natural resources are too high, and unnecessarily so. The main reason is an institutional one: Authority is given to those who do not bear responsibility for the consequences o f their actions.A classic case is the set of specific numerical emission standards for automobiles in the Clean Air Act Amendments of 1970. Congress arrived at these standards without a scientific basis, without technical analysis, and certainly without any consideration of costs and benefits. Only 3 years later did Senator Muskie ask the National Academy of Sciences to conduct a cost-benefit analysis. The NAS results were presented in a fashion that seemed to support the action of Congress; yet, the statutory emissions standards yielded marginal costs well beyond their marginal benefits. They had a major impact on Detroit during the 1970's, and very likely damaged, perhaps irreversibly, the competitive standing of the American automobile industry, a major segment of the U.S. economy. But the economic costs of these actions were never considered, least of all by the responsible bureaucrats. They were completely buffered from any consequences flowing from the exercise of their authority.

A PRELIMINARY METHODOLOGY FOR EVALUATING THE COST-EFFECTIVENESS OF ALTERNATIVE INDOOR AIR QUALITY APPROACHES

EPA Science Inventory

The report defines a simplified methodology that can be used by indoor air quality (IAQ) diagnosticians, architects/engineers, building owners/operators, and the scientific community for preliminary comparison of the cost-effectiveness of alternative IAQ control measures for any ...

NASA Electronic Publishing System: Cost/benefit Methodology

NASA Technical Reports Server (NTRS)

Tuey, Richard C.

1994-01-01

The NASA Scientific and Technical Information Office was assigned the responsibility to examine the benefits of the utilization of electronic printing and duplicating systems throughout NASA Installations and Headquarters. The subject of this report is the documentation of the methodology used in justifying the acquisition of the most cost beneficial solution for the printing and duplicating requirements of a duplicating facility that is contemplating the acquisition of an electronic printing and duplicating system. Four alternatives are presented with each alternative costed out with its associated benefits. The methodology goes a step further than just a cost benefit analysis through its comparison of risks associated with each alternative, sensitivity to number of impressions and productivity gains on the selected alternative and finally the return on investment for the selected alternative. The report can be used in conjunction with the two earlier reports, NASA-TM-106242 and TM-106510 in guiding others in determining the cost effective duplicating alternative.

A real-time web-based optimal Biomass Site Assessment Tool (BioSAT): Module 1. An economic assessment of mill residues for the southern U.S.

Treesearch

Timothy M. Young; James H. Perdue; Andy Hartsell; Robert C. Abt; Donald Hodges; Timothy G. Rials

2009-01-01

Optimal locations for biomass facilities that use mill residues are identified for 13 southern U.S. states. The Biomass Site Assessment Tool (BioSAT) model is used to identify the top 20 locations for 13 southern U.S. states. The trucking cost model of BioSAT is used with Timber Mart South 2009 price data to estimate the total cost, average cost, and marginal costs for...

Defense Department Profit and Contract Finance Policies and Their Effects on Contract and Contractor Performance

DTIC Science & Technology

2009-02-01

cost of capital ( WACC ). WACC is the cost of debt plus the cost of equity both weighted by the market values debt and equity, respectively. The cost...Beta WACC Technical Risk CPFF/CPAF …. FFP/ MYP - Contract Choice (FAR 16.1) Margin – (p = f(NBV, n, α, risk)) Payments (α) FCOM ( = f(NBV, Treasury...projections, layers on the profit and contract financing policy, estimates the levered WACC as the discount rate, and finally calculates the NPV of the

Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges?

PubMed

Huter, Kai; Dubas-Jakóbczyk, Katarzyna; Kocot, Ewa; Kissimova-Skarbek, Katarzyna; Rothgang, Heinz

2018-01-01

In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.

Program budgeting and marginal analysis: a case study in chronic airflow limitation.

PubMed

Crockett, A; Cranston, J; Moss, J; Scown, P; Mooney, G; Alpers, J

1999-01-01

Program budgeting and marginal analysis is a method of priority-setting in health care. This article describes how this method was applied to the management of a disease-specific group, chronic airflow limitation. A sub-program flow chart clarified the major cost drivers. After assessment of the technical efficiency of the sub-programs and careful and detailed analysis, incremental and decremental wish lists of activities were established. Program budgeting and marginal analysis provides a framework for rational resource allocation. The nurturing of a vigorous program management group, with members representing all participants in the process (including patients/consumers), is the key to a successful outcome.

No Regret Learning in Oligopolies: Cournot vs. Bertrand

NASA Astrophysics Data System (ADS)

Nadav, Uri; Piliouras, Georgios

Cournot and Bertrand oligopolies constitute the two most prevalent models of firm competition. The analysis of Nash equilibria in each model reveals a unique prediction about the stable state of the system. Quite alarmingly, despite the similarities of the two models, their projections expose a stark dichotomy. Under the Cournot model, where firms compete by strategically managing their output quantity, firms enjoy positive profits as the resulting market prices exceed that of the marginal costs. On the contrary, the Bertrand model, in which firms compete on price, predicts that a duopoly is enough to push prices down to the marginal cost level. This suggestion that duopoly will result in perfect competition, is commonly referred to in the economics literature as the "Bertrand paradox".

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

Life-cycle cost as basis to optimize waste collection in space and time: A methodology for obtaining a detailed cost breakdown structure.

PubMed

Sousa, Vitor; Dias-Ferreira, Celia; Vaz, João M; Meireles, Inês

2018-05-01

Extensive research has been carried out on waste collection costs mainly to differentiate costs of distinct waste streams and spatial optimization of waste collection services (e.g. routes, number, and location of waste facilities). However, waste collection managers also face the challenge of optimizing assets in time, for instance deciding when to replace and how to maintain, or which technological solution to adopt. These issues require a more detailed knowledge about the waste collection services' cost breakdown structure. The present research adjusts the methodology for buildings' life-cycle cost (LCC) analysis, detailed in the ISO 15686-5:2008, to the waste collection assets. The proposed methodology is then applied to the waste collection assets owned and operated by a real municipality in Portugal (Cascais Ambiente - EMAC). The goal is to highlight the potential of the LCC tool in providing a baseline for time optimization of the waste collection service and assets, namely assisting on decisions regarding equipment operation and replacement.

Cost accounting in radiology: new directions and importance for policy.

PubMed

Muchantef, Karl; Forman, Howard P

2005-12-01

The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next. The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.

Risk, Robustness and Water Resources Planning Under Uncertainty

NASA Astrophysics Data System (ADS)

Borgomeo, Edoardo; Mortazavi-Naeini, Mohammad; Hall, Jim W.; Guillod, Benoit P.

2018-03-01

Risk-based water resources planning is based on the premise that water managers should invest up to the point where the marginal benefit of risk reduction equals the marginal cost of achieving that benefit. However, this cost-benefit approach may not guarantee robustness under uncertain future conditions, for instance under climatic changes. In this paper, we expand risk-based decision analysis to explore possible ways of enhancing robustness in engineered water resources systems under different risk attitudes. Risk is measured as the expected annual cost of water use restrictions, while robustness is interpreted in the decision-theoretic sense as the ability of a water resource system to maintain performance—expressed as a tolerable risk of water use restrictions—under a wide range of possible future conditions. Linking risk attitudes with robustness allows stakeholders to explicitly trade-off incremental increases in robustness with investment costs for a given level of risk. We illustrate the framework through a case study of London's water supply system using state-of-the -art regional climate simulations to inform the estimation of risk and robustness.

Research with Children: The Same or Different from Research with Adults?

ERIC Educational Resources Information Center

Punch, Samantha

2002-01-01

Explores seven methodological issues illustrating aspects of the research process posing dilemmas for adult researchers working with children. Argues that research with children differs from that with adults primarily because of adult perceptions of children and children's marginalized position in adult society. Details advantages and…

"A Friend Who Understand Fully": Notes on Humanizing Research in a Multiethnic Youth Community

ERIC Educational Resources Information Center

Paris, Django

2011-01-01

In this article, I conceptualize ethnographic, qualitative, and social language research with marginalized and oppressed communities as "humanizing research". Humanizing research is a methodological stance, which requires that our inquiries involve dialogic consciousness-raising and the building of relationships of dignity and care for both…

The Threat of Unexamined Secondary Data: A Critical Race Transformative Convergent Mixed Methods

ERIC Educational Resources Information Center

Garcia, Nichole M.; Mayorga, Oscar J.

2018-01-01

This article uses a critical race theory framework to conceptualize a Critical Race Transformative Convergent Mixed Methods (CRTCMM) in education. CRTCMM is a methodology that challenges normative educational research practices by acknowledging that racism permeates educational institutions and marginalizes Communities of Color. The focus of this…

The Awakening: The Multicultural Attitudes and Actions of Chief Executive School Officers

ERIC Educational Resources Information Center

Boske, Christa

2007-01-01

Purpose: The purpose of this study is to examine the interactions among superintendents' chief executive school officers, multicultural attitudes and actions for children from marginalized populations. Design/methodology/approach: Members of the American Association of School Administrators, 945 school superintendents, completed the self-reported,…

77 FR 10589 - Self-Regulatory Organizations; National Securities Clearing Corporation; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-22

... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-66398; File No. SR-NSCC-2012-02] Self-Regulatory Organizations; National Securities Clearing Corporation; Notice of Filing of Proposed Rule Change To Enhance Its Margining Methodology as Applied to Municipal and Corporate Bonds February 15, 2012...

PE Is Not for Me: When Boys' Masculinities Are Threatened

ERIC Educational Resources Information Center

Tischler, Amy; McCaughtry, Nate

2011-01-01

This study used hegemonic masculinity theory to examine the intersection of masculinities and school physical education from the perspectives of boys who embodied masculinities that were marginalized. Over a 13-week period using present-focused, student-centered, qualitative methodological approaches, we observed, interviewed, and worked in small…

Applying Indigenizing Principles of Decolonizing Methodologies in University Classrooms

ERIC Educational Resources Information Center

Louie, Dustin William; Pratt, Yvonne Poitras; Hanson, Aubrey Jean; Ottmann, Jacqueline

2017-01-01

This case study examines ongoing work to Indigenize education programs at one Canadian university. The history of the academy in Canada has been dominated by Western epistemologies, which have devalued Indigenous ways of knowing and set the grounds for continued marginalization of Indigenous students, communities, cultures, and histories. We argue…

77 FR 8101 - Antidumping Proceedings: Calculation of the Weighted-Average Dumping Margin and Assessment Rate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

... price, or constructed export price, exceeds normal value. Several World Trade Organization (``WTO... non-dumped comparisons while using monthly A-A comparisons in reviews, in a manner that parallels the... in reviews, in a manner that parallels the WTO- consistent methodology the Department currently...

No Proof that Federal R&D Boosts Economy

ERIC Educational Resources Information Center

Chemical and Engineering News, 1977

1977-01-01

Reports that federal funds provided for basic and applied research have been found to provide only marginal or no contribution to increased productivity and economic growth. However, these results may be due to the lack of economic methodology capable of detecting the impact of research funds on growth. (SL)

Methodology for the assessment of oxygen as an energy carrier

NASA Astrophysics Data System (ADS)

Yang, Ming Wei

Due to the energy intensity of the oxygen generating process, the electric power grid would benefit if the oxygen generating process was consumed electric power only during low demand periods. Thus, the question to be addressed in this study is whether oxygen production and/or usage can be modified to achieve energy storage and/or transmission objectives at lower cost. The specific benefit to grid would be a leveling, over time, of the demand profile and thus would require less installation capacity. In order to track the availability of electricity, a compressed air storage unit is installed between the cryogenic distillation section and the main air compressor of air separation unit. A profit maximizing scheme for sizing storage inventory and related equipments is developed. The optimum scheme is capable of market responsiveness. Profits of steel maker, oxy-combustion, and IGCC plants with storage facilities can be higher than those plants without storage facilities, especially, at high-price market. Price tracking feature of air storage integration will certainly increase profit margins of the plants. The integration may push oxy-combustion and integrated gasification combined cycle process into economic viability. Since oxygen is used in consumer sites, it may generate at remote locations and transport to the place needed. Energy losses and costs analysis of oxygen transportation is conducted for various applications. Energy consumptions of large capacity and long distance GOX and LOX pipelines are lower than small capacity pipelines. However, transportation losses and costs of GOX and LOX pipelines are still higher than electricity transmission.

A Discrete Choice Experiment to Elicit Patient Willingness to Pay for Attributes of Treatment-Induced Symptom Relief in Comorbid Insomnia

PubMed Central

Roy, Anuja N.; Madhavan, S. Suresh; Lloyd, Andrew

2016-01-01

Purpose Insomnia is a burdensome, commonly comorbid condition. How patients value various aspects of the safety and efficacy of available drugs has not been studied. The aim of the present study was to quantify patient-rated utility by studying willingness to pay (WTP) for attributes of symptom relief via a discrete choice experiment (DCE). Methodology Adult primary care patients (West Virginia University Hospital) with comorbid insomnia were enrolled. The attributes and levels examined were sleep onset latency (SOL; 10, 20, 30 minutes), awakenings (1, 2, 3), wake time after sleep onset (WASO; 15, 45, 60 minutes), total sleep time (TST; 6, 7, 8 hours), hangover (none, mild, moderate), FDA-approved duration of use (short term, not restricted to short term, no restrictions), and out-of-pocket cost per month ($20, $35, $50). Willingness to pay (WTP) data were analyzed using a random effects binary logistic regression model. Results A total of 82 patients completed the DCE (74 analyzed). SOL, WASO, TST, and cost were all found to predict treatment choice. Higher values of SOL, WASO, and cost resulted in decreased preference for a particular treatment, while higher TST predicted increased preference. Modeling revealed an estimated marginal WTP of $66.69 for an example product that improved SOL by 10 minutes, reduced WASO by 15 minutes, and improved TST by 1 hour. Conclusion Patient WTP for symptomatic relief in insomnia can help clinicians fine-tune interventions based on patient preferences, provide evidence for drug formulary and reimbursement decisions, and potentially guide the development of novel drugs. PMID:26489177

Preparing for budget-based payment methodologies: global payment and episode-based payment.

PubMed

Hudson, Mark E

2015-10-01

Use of budget-based payment methodologies (capitation and episode-based bundled payment) has been demonstrated to drive value in healthcare delivery. With a focus on high-volume, high-cost surgical procedures, inclusion of anaesthesiology services in these methodologies is likely. This review provides a summary of budget-based payment methodologies and practical information necessary for anaesthesiologists to prepare for participation in these programmes. Although few examples of anaesthesiologists' participation in these models exist, an understanding of the structure of these programmes and opportunities for participation are available. Prospective preparation in developing anaesthesiology-specific bundled payment profiles and early participation in pathway development associated with selected episodes of care are essential for successful participation as a gainsharing partner. With significant opportunity to contribute to care coordination and cost management, anaesthesiology can play an important role in budget-based payment programmes and should expect to participate as full gainsharing partners. Precise costing methodologies and accurate economic modelling, along with identification of quality management and cost control opportunities, will help identify participation opportunities and appropriate payment and gainsharing agreements. Anaesthesiology-specific examples with budget-based payment models are needed to help guide increased participation in these programmes.

Potential impact of ACA-related insurance expansion on trauma care reimbursement

PubMed Central

Scott, John W; Upadhyaya, Pooja; Najjar, Peter; Tsai, Thomas C; Scott, Kirstin W; Shrime, Mark G; Cutler, David M; Salim, Ali; Haider, Adil H

2017-01-01

Introduction Nearly one-quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. Methods We abstracted nonelderly adults (ages 18–64y) admitted for trauma from the Nationwide Inpatient Sample (NIS) during 2010—the last year prior to most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using NIS-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. Results 145,849 patients (representing 737,852 patients nationwide) were included. National inpatient trauma costs for 18–64y patients totaled $14.8 billion (95%CI:12.5,17.1). Pre-expansion reimbursements totaled $13.7 billion (10.8,14.7), yielding a national margin of −7.9% (−10.6, −5.1). Post-expansion projected reimbursements totaled $15.0 billion (12.7,17.3), increasing the margin by 9.3 absolute percentage-points to +1.4% (−0.3,+3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using post-expansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Conclusion Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers’ financial viability and their ability to provide care for their communities. Level of Evidence Level II: Sensible costs and alternatives; values obtained from limited sources; multi-way sensitivity analyses Study Type Policy Analysis / Economic Analysis PMID:28431415

Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy.

PubMed

Matulewicz, Richard S; Tosoian, Jeffrey J; Stimson, C J; Ross, Ashley E; Chappidi, Meera; Lotan, Tamara L; Humphreys, Elizabeth; Partin, Alan W; Schaeffer, Edward M

2017-05-01

Success in the era of value-based payment will depend on the capacity of health systems to improve quality while controlling costs. Comparative quality performance review can be used to drive improvements in surgical outcomes and thereby reduce costs. We sought to determine the efficacy of a comparative quality performance review to improve a surgeon-level measure of surgical oncologic quality, that is the positive surgical margin rate at the time of radical prostatectomy. Eight surgeons who performed consecutive radical prostatectomies at a single high volume institution between January 1, 2015 and December 31, 2015 were included in analysis. Individual surgeons were provided with confidential report cards every 6 months detailing their case mix, case volume and pT2 radical prostatectomy positive surgical margin rate relative to 1) their own self-matched data, 2) the de-identified data of their colleagues and 3) institutional aggregate data during the study period. Positive surgical margin rates were compared before and after intervention. Hierarchal logistic regression analysis was used to examine the association of study period on the odds of positive surgical margins, adjusted for prostate specific antigen level and National Comprehensive Cancer Network® risk group. Overall, 1,822 (1,392 before and 430 after intervention) radical prostatectomies were performed that met study inclusion criteria. The aggregate departmental unadjusted positive surgical margin rates were 10.6% and 7.4% in the pre-intervention and post-intervention groups, respectively. After adjusting for higher risk cancer in the post-intervention group, there was a significant protective association of post-intervention status on positive margins (OR 0.64, 95% CI 0.43-0.97, p = 0.03). All 5 surgeons with positive surgical margin rates higher than the aggregate department rate in the pre-intervention period showed improvement after intervention. Comparative quality performance review can be implemented at the surgeon level and can promote improvement in an objective measure of surgical oncology quality. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations.

PubMed

Doherty, Kathleen; Essajee, Shaffiq; Penazzato, Martina; Holmes, Charles; Resch, Stephen; Ciaranello, Andrea

2014-05-02

Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow. We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0-13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology. The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates. The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments.

Joint optimization of regional water-power systems

NASA Astrophysics Data System (ADS)

Pereira-Cardenal, Silvio J.; Mo, Birger; Gjelsvik, Anders; Riegels, Niels D.; Arnbjerg-Nielsen, Karsten; Bauer-Gottwein, Peter

2016-06-01

Energy and water resources systems are tightly coupled; energy is needed to deliver water and water is needed to extract or produce energy. Growing pressure on these resources has raised concerns about their long-term management and highlights the need to develop integrated solutions. A method for joint optimization of water and electric power systems was developed in order to identify methodologies to assess the broader interactions between water and energy systems. The proposed method is to include water users and power producers into an economic optimization problem that minimizes the cost of power production and maximizes the benefits of water allocation, subject to constraints from the power and hydrological systems. The method was tested on the Iberian Peninsula using simplified models of the seven major river basins and the power market. The optimization problem was successfully solved using stochastic dual dynamic programming. The results showed that current water allocation to hydropower producers in basins with high irrigation productivity, and to irrigation users in basins with high hydropower productivity was sub-optimal. Optimal allocation was achieved by managing reservoirs in very distinct ways, according to the local inflow, storage capacity, hydropower productivity, and irrigation demand and productivity. This highlights the importance of appropriately representing the water users' spatial distribution and marginal benefits and costs when allocating water resources optimally. The method can handle further spatial disaggregation and can be extended to include other aspects of the water-energy nexus.

Comparison of two matrix-assisted laser desorption ionization-time of flight mass spectrometry methods with conventional phenotypic identification for routine identification of bacteria to the species level.

PubMed

Cherkaoui, Abdessalam; Hibbs, Jonathan; Emonet, Stéphane; Tangomo, Manuela; Girard, Myriam; Francois, Patrice; Schrenzel, Jacques

2010-04-01

Bacterial identification relies primarily on culture-based methodologies requiring 24 h for isolation and an additional 24 to 48 h for species identification. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is an emerging technology newly applied to the problem of bacterial species identification. We evaluated two MALDI-TOF MS systems with 720 consecutively isolated bacterial colonies under routine clinical laboratory conditions. Isolates were analyzed in parallel on both devices, using the manufacturers' default recommendations. We compared MS with conventional biochemical test system identifications. Discordant results were resolved with "gold standard" 16S rRNA gene sequencing. The first MS system (Bruker) gave high-confidence identifications for 680 isolates, of which 674 (99.1%) were correct; the second MS system (Shimadzu) gave high-confidence identifications for 639 isolates, of which 635 (99.4%) were correct. Had MS been used for initial testing and biochemical identification used only in the absence of high-confidence MS identifications, the laboratory would have saved approximately US$5 per isolate in marginal costs and reduced average turnaround time by more than an 8-h shift, with no loss in accuracy. Our data suggest that implementation of MS as a first test strategy for one-step species identification would improve timeliness and reduce isolate identification costs in clinical bacteriology laboratories now.

Review article: Medical decision models of Helicobacter pylori therapy to prevent gastric cancer.

PubMed

Sonnenberg, A; Inadomi, J M

1998-02-01

The aim of the present article is to study the utility of Helicobacter pylori eradication programmes in decreasing the incidence of gastric cancer. Three types of decision models are employed to pursue this aim, i.e. decision tree, present value, and declining exponential approximation of life expectancy (DEALE). 1) A decision tree allows one to model the interaction of multiple variables in great detail and to calculate the marginal cost, as well as the marginal cost-benefit ratio, of a preventive strategy. The cost of gastric cancer, the efficacy of H. pylori therapy in preventing cancer, and the cumulative probability of developing gastric cancer exert the largest influence on the marginal cost of cancer prevention. The high cost of future gastric cancer and a high efficacy of therapy make screening for H. pylori and its eradication the preferred strategy. 2) The present value is an economic method to adjust future costs or benefits to their current value using a discount rate and the length of time between now and a given time point in the future. It accounts for the depreciation of money and all material values over time. During childhood, the present value of future gastric cancer is very low. Vaccination of children to prevent gastric cancer would need to be very inexpensive to be practicable. Cancer prevention becomes a feasible option, only if the time period between the preventive measures and the occurrence of gastric cancer can be made relatively short. 3) The DEALE provides a means to calculate the increase in life expectancy that would occur, if death from a particular disease became preventable. Life expectancy of the general population is hardly affected by gastric cancer. For life expectancy to increase appreciably by vaccination or antibiotic therapy directed against H. pylori infection, these interventions would need to be focused towards a sub-population with an a priori high risk for gastric cancer.

Analysis and methodology for aeronautical systems technology program planning

NASA Technical Reports Server (NTRS)

White, M. J.; Gershkoff, I.; Lamkin, S.

1983-01-01

A structured methodology was developed that allows the generation, analysis, and rank-ordering of system concepts by their benefits and costs, indicating the preferred order of implementation. The methodology is supported by a base of data on civil transport aircraft fleet growth projections and data on aircraft performance relating the contribution of each element of the aircraft to overall performance. The performance data are used to assess the benefits of proposed concepts. The methodology includes a computer program for performing the calculations needed to rank-order the concepts and compute their cumulative benefit-to-cost ratio. The use of the methodology and supporting data is illustrated through the analysis of actual system concepts from various sources.

Accounting for the drug life cycle and future drug prices in cost-effectiveness analysis.

PubMed

Hoyle, Martin

2011-01-01

Economic evaluations of health technologies typically assume constant real drug prices and model only the cohort of patients currently eligible for treatment. It has recently been suggested that, in the UK, we should assume that real drug prices decrease at 4% per annum and, in New Zealand, that real drug prices decrease at 2% per annum and at patent expiry the drug price falls. It has also recently been suggested that we should model multiple future incident cohorts. In this article, the cost effectiveness of drugs is modelled based on these ideas. Algebraic expressions are developed to capture all costs and benefits over the entire life cycle of a new drug. The lifetime of a new drug in the UK, a key model parameter, is estimated as 33 years, based on the historical lifetime of drugs in England over the last 27 years. Under the proposed methodology, cost effectiveness is calculated for seven new drugs recently appraised in the UK. Cost effectiveness as assessed in the future is also estimated. Whilst the article is framed in mathematics, the findings and recommendations are also explained in non-mathematical language. The 'life-cycle correction factor' is introduced, which is used to convert estimates of cost effectiveness as traditionally calculated into estimates under the proposed methodology. Under the proposed methodology, all seven drugs appear far more cost effective in the UK than published. For example, the incremental cost-effectiveness ratio decreases by 46%, from £61, 900 to £33, 500 per QALY, for cinacalcet versus best supportive care for end-stage renal disease, and by 45%, from £31,100 to £17,000 per QALY, for imatinib versus interferon-α for chronic myeloid leukaemia. Assuming real drug prices decrease over time, the chance that a drug is publicly funded increases over time, and is greater when modelling multiple cohorts than with a single cohort. Using the methodology (compared with traditional methodology) all drugs in the UK and New Zealand are predicted to be more cost effective. It is suggested that the willingness-to-pay threshold should be reduced in the UK and New Zealand. The ranking of cost effectiveness will change with drugs assessed as relatively more cost effective and medical devices and surgical procedures relatively less cost effective than previously thought. The methodology is very simple to implement. It is suggested that the model should be parameterized for other countries.

Monitoring costs in the ICU: a search for a pertinent methodology.

PubMed

Reis Miranda, D; Jegers, M

2012-10-01

Attempts to determine costs in the intensive care unit (ICU) were not successful until now, as they failed to detect differences of costs between patients. The methodology and/or the instruments used might be at the origin of this failure. Based on the results of the European ICUs studies and on the descriptions of the activities of care in the ICU, we gathered and analysed the relevant literature concerning the monitoring of costs in the ICU. The aim was to formulate a methodology, from an economic perspective, in which future research may be framed. A bottom-up microcosting methodology will enable to distinguish costs between patients. The resulting information will at the same time support the decision-making of top management and be ready to include in the financial system of the hospital. Nursing staff explains about 30% of the total costs. This relation remains constant irrespective of the annual nurse/patient ratio. In contrast with other scoring instruments, the nursing activities score (NAS) covers all nursing activities. (1) NAS is to be chosen for quantifying nursing activities; (2) an instrument for measuring the physician's activities is not yet available; (3) because the nursing activities have a large impact on total costs, the standardisation of the processes of care (following the system approach) will contribute to manage costs, making also reproducible the issue of quality of care; (4) the quantification of the nursing activities may be the required (proxy) input for the automated bottom-up monitoring of costs in the ICU. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

What makes up marginal lands and how can it be defined and classified?

NASA Astrophysics Data System (ADS)

Ivanina, Vadym

2017-04-01

Definitions of marginal lands are often not explicit. The term "marginal" is not supported by either a precise definition or research to determine which lands fall into this category. To identify marginal lands terminology/methodology is used which varies between physical characteristics and the current land use of a site as basic perspective. The term 'Marginal' is most commonly followed by 'degraded' lands, and other widely used terms such as 'abandoned', 'idle', 'pasture', 'surplus agricultural land', 'Conservation Reserve Programme' (CRP)', 'barren and carbon-poor land', etc. Some terms are used synonymously. To the category of "marginal" lands are predominantly included lands which are excluded from cultivation due to economic infeasibility or physical restriction for growing conventional crops. Such sites may still have potential to be used for alternative agricultural practice, e.g. bioenergy feedstock production. The existing categorizing of marginal lands does not allow evaluating soil fertility potential or to define type and level of constrains for growing crops as the reason of a low practical value with regards to land use planning. A new marginal land classification has to be established and developed. This classification should be built on criteria of soil biophysical properties, ecologic, environment and climate handicaps for growing crops, be easy in use and of high practical value. The SEEMLA consortium made steps to build such a marginal land classification which is based on direct criteria depicting soil properties and constrains, and defining their productivity potential. By this classification marginal lands are divided into eleven categories: shallow rooting, low fertility, stony texture, sandy texture, clay texture, salinic, sodicic, acidic, overwet, eroded, and contaminated. The basis of this classification was taken criteria modified after and adapted from Regulation EU (1305)2013. To define an area of marginal lands with climate and economic limitations, SEEMLA established and implemented the term "area of land marginality" with a broader on marginal lands. This term includes marginal lands themselves, evaluation of climate constrains and economic efficiency to grow crops. This approach allows to define, categorize and classify marginal land by direct indicators of soil biophysical properties, ecologic and environment constrains, and provides additional evaluation of lands marginality with regards to suitability for growing crops based on climate criteria.

Update of the Dutch manual for costing studies in health care

PubMed Central

Kanters, Tim A.; Bouwmans, Clazien A. M.; van der Linden, Naomi; Tan, Siok Swan; Hakkaart-van Roijen, Leona

2017-01-01

Objectives Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. Methods An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. Results The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. Conclusions The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines. PMID:29121647

Update of the Dutch manual for costing studies in health care.

PubMed

Kanters, Tim A; Bouwmans, Clazien A M; van der Linden, Naomi; Tan, Siok Swan; Hakkaart-van Roijen, Leona

2017-01-01

Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.

A Life-Cycle Cost Estimating Methodology for NASA-Developed Air Traffic Control Decision Support Tools

NASA Technical Reports Server (NTRS)

Wang, Jianzhong Jay; Datta, Koushik; Landis, Michael R. (Technical Monitor)

2002-01-01

This paper describes the development of a life-cycle cost (LCC) estimating methodology for air traffic control Decision Support Tools (DSTs) under development by the National Aeronautics and Space Administration (NASA), using a combination of parametric, analogy, and expert opinion methods. There is no one standard methodology and technique that is used by NASA or by the Federal Aviation Administration (FAA) for LCC estimation of prospective Decision Support Tools. Some of the frequently used methodologies include bottom-up, analogy, top-down, parametric, expert judgement, and Parkinson's Law. The developed LCC estimating methodology can be visualized as a three-dimensional matrix where the three axes represent coverage, estimation, and timing. This paper focuses on the three characteristics of this methodology that correspond to the three axes.

Pitfalls, Potentials, and Ethics of Online Survey Research: LGBTQ and Other Marginalized and Hard-to-Access Youths

PubMed Central

McInroy, Lauren B.

2016-01-01

Online research methodologies may serve as an important mechanism for population-focused data collection in social work research. Online surveys have become increasingly prevalent in research inquiries with young people and have been acknowledged for their potential in investigating understudied and marginalized populations and subpopulations, permitting increased access to communities that tend to be less visible—and thus often less studied—in offline contexts. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people are a socially stigmatized, yet digitally active, youth population whose participation in online surveys has been previously addressed in the literature. Many of the opportunities and challenges of online survey research identified with LGBTQ youths may be highly relevant to other populations of marginalized and hard-to-access young people, who are likely present in significant numbers in the online environment (for example, ethnoracialized youths and low-income youths). In this article, the utility of online survey methods with marginalized young people is discussed, and recommendations for social work research are provided. PMID:27257362

Dietary cost associated with adherence to the Mediterranean diet, and its variation by socio-economic factors in the UK Fenland study

PubMed Central

Tong, Tammy Y.N.; Imamura, Fumiaki; Monsivais, Pablo; Brage, Søren; Griffin, Simon J.; Wareham, Nicholas J.; Forouhi, Nita G.

2018-01-01

High cost of healthy foods could be a barrier to healthy eating. We aimed to examine the association between dietary cost and adherence to the Mediterranean diet in a non-Mediterranean country. We evaluated cross-sectional data from 12,417 adults in the UK Fenland Study. Responses to 130-item food frequency questionnaires were used to calculate a Mediterranean diet score (MDS). Dietary cost was estimated by matching food consumption data with retail prices of five major supermarkets. Using multivariable-adjusted linear regression, we examined the association of MDS and individual foods with dietary cost in absolute and relative scales. Subsequently, we assessed how much the association was explained by education, income, marital status, and occupation, by conducting mediation analysis and testing interaction by these variables. High compared to low MDS (top to bottom third) was associated with marginally higher cost by 5.4% (95% CI 4.4. 6.4%) or £0.20/day (£0.16, 0.25). Participants with high adherence had higher cost associated with the healthier components (e.g. vegetables, fruits, and fish), and lower cost associated with the unhealthy components (e.g. red meat, processed meat and sweets) (p<0.001 each for trend). 20.7% (14.3, 27.0%) of the MDS-cost association was explained by the selected socio-economic factors, and the MDS-cost association was of greater magnitude in lower socio-economic groups (p interaction<0.005). Overall, greater adherence to the Mediterranean diet was associated with marginally higher dietary cost, partly modified and explained by socio-economic status, but the potential economic barriers of high adherence might be offset by cost saving from reducing unhealthy food consumption. PMID:29553031

Cost and efficiency of a hybrid mobile multi-disease testing approach with high HIV testing coverage in East Africa

PubMed Central

Chang, Wei; Chamie, Gabriel; Mwai, Daniel; Clark, Tamara D.; Thirumurthy, Harsha; Charlebois, Edwin D.; Petersen, Maya; Kabami, Jane; Ssemmondo, Emmanuel; Kadede, Kevin; Kwarisiima, Dalsone; Sang, Norton; Bukusi, Elizabeth A.; Cohen, Craig R.; Kamya, Moses; Havlir, Diane V.; Kahn, James G.

2016-01-01

Background In 2013-14, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: 1) overall cost and efficiency of this approach; and 2) costs associated with point-of-care (POC) CD4 testing, multi-disease services, and community mobilization. Methods We applied micro-costing methods to estimate costs of population-wide HIV testing in 12 SEARCH Trial communities. Main intervention components of the hybrid approach are census, multi-disease community health campaigns (CHC), and home-based testing (HBT) for CHC non-attendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. Results The mean cost per adult tested for HIV was $20.5 (range: $17.1 - $32.1) [2014 US$], including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 via HBT. The cost per HIV+ adult identified was $231 ($87 - $1,245), with variability due mainly to HIV prevalence among persons tested (i.e., HIV positivity rate). The marginal costs of multi-disease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. Conclusions The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multi-disease services were offered at low marginal costs. PMID:27741031

Marginal biotin deficiency can be induced experimentally in humans using a cost-effective outpatient design.

PubMed

Stratton, Shawna L; Henrich, Cindy L; Matthews, Nell I; Bogusiewicz, Anna; Dawson, Amanda M; Horvath, Thomas D; Owen, Suzanne N; Boysen, Gunnar; Moran, Jeffery H; Mock, Donald M

2012-01-01

To date, marginal, asymptomatic biotin deficiency has been successfully induced experimentally by the use of labor-intensive inpatient designs requiring rigorous dietary control. We sought to determine if marginal biotin deficiency could be induced in humans in a less expensive outpatient design incorporating a self-selected, mixed general diet. We sought to examine the efficacy of three outpatient study designs: two based on oral avidin dosing and one based on a diet high in undenatured egg white for a period of 28 d. In study design 1, participants (n = 4; 3 women) received avidin in capsules with a biotin binding capacity of 7 times the estimated dietary biotin intake of a typical self-selected diet. In study design 2, participants (n = 2; 2 women) received double the amount of avidin capsules (14 times the estimated dietary biotin intake). In study design 3, participants (n = 5; 3 women) consumed egg-white beverages containing avidin with a biotin binding capacity of 7 times the estimated dietary biotin intake. Established indices of biotin status [lymphocyte propionyl-CoA carboxylase activity; urinary excretion of 3-hydroxyisovaleric acid, 3-hydroxyisovaleryl carnitine (3HIA-carnitine), and biotin; and plasma concentration of 3HIA-carnitine] indicated that study designs 1 and 2 were not effective in inducing marginal biotin deficiency, but study design 3 was as effective as previous inpatient study designs that induced deficiency by egg-white beverage. Marginal biotin deficiency can be induced experimentally by using a cost-effective outpatient design by avidin delivery in egg-white beverages. This design should be useful to the broader nutritional research community.

System Guidelines for EMC Safety-Critical Circuits: Design, Selection, and Margin Demonstration

NASA Technical Reports Server (NTRS)

Lawton, R. M.

1996-01-01

Demonstration of required safety margins on critical electrical/electronic circuits in large complex systems has become an implementation and cost problem. These margins are the difference between the activation level of the circuit and the electrical noise on the circuit in the actual operating environment. This document discusses the origin of the requirement and gives a detailed process flow for the identification of the system electromagnetic compatibility (EMC) critical circuit list. The process flow discusses the roles of engineering disciplines such as systems engineering, safety, and EMC. Design and analysis guidelines are provided to assist the designer in assuring the system design has a high probability of meeting the margin requirements. Examples of approaches used on actual programs (Skylab and Space Shuttle Solid Rocket Booster) are provided to show how variations of the approach can be used successfully.

Role of specimen US for predicting resection margin status in breast conserving therapy

PubMed Central

MOSCHETTA, M.; TELEGRAFO, M.; INTRONA, T.; COI, L.; RELLA, L.; RANIERI, V.; CIRILLI, A.; IANORA, A.A. STABILE; ANGELELLI, G.

2015-01-01

Aim To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. Patients and methods A total of 132 consecutive patients (age range, 34–87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. Results The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Conclusions Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status. PMID:26712255

Use of nonlinear programming to optimize performance response to energy density in broiler feed formulation.

PubMed

Guevara, V R

2004-02-01

A nonlinear programming optimization model was developed to maximize margin over feed cost in broiler feed formulation and is described in this paper. The model identifies the optimal feed mix that maximizes profit margin. Optimum metabolizable energy level and performance were found by using Excel Solver nonlinear programming. Data from an energy density study with broilers were fitted to quadratic equations to express weight gain, feed consumption, and the objective function income over feed cost in terms of energy density. Nutrient:energy ratio constraints were transformed into equivalent linear constraints. National Research Council nutrient requirements and feeding program were used for examining changes in variables. The nonlinear programming feed formulation method was used to illustrate the effects of changes in different variables on the optimum energy density, performance, and profitability and was compared with conventional linear programming. To demonstrate the capabilities of the model, I determined the impact of variation in prices. Prices for broiler, corn, fish meal, and soybean meal were increased and decreased by 25%. Formulations were identical in all other respects. Energy density, margin, and diet cost changed compared with conventional linear programming formulation. This study suggests that nonlinear programming can be more useful than conventional linear programming to optimize performance response to energy density in broiler feed formulation because an energy level does not need to be set.

Co-benefits of mitigating global greenhouse gas emissions for future air quality and human health

NASA Astrophysics Data System (ADS)

West, J. Jason; Smith, Steven J.; Silva, Raquel A.; Naik, Vaishali; Zhang, Yuqiang; Adelman, Zachariah; Fry, Meridith M.; Anenberg, Susan; Horowitz, Larry W.; Lamarque, Jean-Francois

2013-10-01

Actions to reduce greenhouse gas (GHG) emissions often reduce co-emitted air pollutants, bringing co-benefits for air quality and human health. Past studies typically evaluated near-term and local co-benefits, neglecting the long-range transport of air pollutants, long-term demographic changes, and the influence of climate change on air quality. Here we simulate the co-benefits of global GHG reductions on air quality and human health using a global atmospheric model and consistent future scenarios, via two mechanisms: reducing co-emitted air pollutants, and slowing climate change and its effect on air quality. We use new relationships between chronic mortality and exposure to fine particulate matter and ozone, global modelling methods and new future scenarios. Relative to a reference scenario, global GHG mitigation avoids 0.5+/-0.2, 1.3+/-0.5 and 2.2+/-0.8 million premature deaths in 2030, 2050 and 2100. Global average marginal co-benefits of avoided mortality are US$50-380 per tonne of CO2, which exceed previous estimates, exceed marginal abatement costs in 2030 and 2050, and are within the low range of costs in 2100. East Asian co-benefits are 10-70 times the marginal cost in 2030. Air quality and health co-benefits, especially as they are mainly local and near-term, provide strong additional motivation for transitioning to a low-carbon future.

Interregional sharing of energy conservation targets in China: Efficiency and equity

NASA Astrophysics Data System (ADS)

Wei, Dan

Energy conservation is a long-term strategic policy in China to support its economic and social development. This policy strategy is important for saving resources, protecting the environment, and ensuring the secure supply of energy to all economic activities. However, energy conservation often involves large amounts of investment and may also have dampening impacts on some local and regional economies. Moreover, energy conservation and efficiency improvement have many features of a public good. Therefore, government policy and intervention play a strong role to foster regional efforts and cooperative interregional actions on this issue. This dissertation introduces and analyzes a promising policy instrument---an interregional energy conservation-quota trading system---to help China fulfill its national energy conservation objective in an efficient and equitable way. To analyze the workings of the energy conservation-quota trading system, trading entities are first determined. In this study, statistical analyses (principal component analysis and cluster analysis) are applied to identify regional aggregations of provinces of China to act as the trading units. The marginal energy conservation cost curves of these regions are developed using engineering-economic methods and regression analysis. Simulations of interregional conservation-quota trading are undertaken after China's conservation goals in 2010 are allocated among regions according to several equity criteria. Various equity criteria are applied and analyzed in this study because of the philosophical differences in the appropriate definition of the concept. The trading simulations yield several important findings. First, the introduction of an interregional quota trading system can minimize both regional net compliance costs and national total conservation costs, irrespective of how the conservation tasks are initially allocated among regions according to different equity rules. Second, regional welfare implications differ across the applications of various equity criteria. However, for the energy production-based sovereignty and egalitarian equity criteria, the poorest region (in terms of per capita gross regional product) can enjoy net profits from trading, while the clustered region of wealthy coastal provinces shoulders the highest cost. This indicates that a conservation-quota trading system applying these two equity criteria is consistent with the national strategy in China to reduce regional income disparities and to develop the interior and western less-developed regions of the country. Third, compared with trading among conventional regions, trading among statistically clustered regions can more sharply apply the equity criteria to burden sharing and utilize larger differences in marginal conservation costs between regions to achieve a lower total net cost for the country as a whole. In sum, this research develops a useful methodology and identifies an operational way to attain energy conservation targets in China. It offers insights for similar interregional burden-sharing or benefit-sharing policies for China in the future, such as greenhouse gas emission trading, which is closely related to the energy conservation issue.

Home health care cost-function analysis

PubMed Central

Hay, Joel W.; Mandes, George

1984-01-01

An exploratory home health care (HHC) cost-function model is estimated using State rate-setting data for the 74 traditional (nonprofit) Connecticut agencies. The analysis demonstrates U-shaped average costs curves for agencies' provision of skilled nursing visits, with substantial diseconomies of scale in the observable range. It is determined from the estimated cost function that the sample representative agency is providing fewer visits than optimal, and its marginal cost is significantly below average cost. The finding that an agency's costs are predominantly related to output levels, with little systematic variation due to other agency or patient characteristics, suggests that the economic inefficiency in a cost-based HHC reimbursement policy may be substantial. PMID:10310596

Economic evaluation of progeny-testing and genomic selection schemes for small-sized nucleus dairy cattle breeding programs in developing countries.

PubMed

Kariuki, C M; Brascamp, E W; Komen, H; Kahi, A K; van Arendonk, J A M

2017-03-01

In developing countries minimal and erratic performance and pedigree recording impede implementation of large-sized breeding programs. Small-sized nucleus programs offer an alternative but rely on their economic performance for their viability. We investigated the economic performance of 2 alternative small-sized dairy nucleus programs [i.e., progeny testing (PT) and genomic selection (GS)] over a 20-yr investment period. The nucleus was made up of 453 male and 360 female animals distributed in 8 non-overlapping age classes. Each year 10 active sires and 100 elite dams were selected. Populations of commercial recorded cows (CRC) of sizes 12,592 and 25,184 were used to produce test daughters in PT or to create a reference population in GS, respectively. Economic performance was defined as gross margins, calculated as discounted revenues minus discounted costs following a single generation of selection. Revenues were calculated as cumulative discounted expressions (CDE, kg) × 0.32 (€/kg of milk) × 100,000 (size commercial population). Genetic superiorities, deterministically simulated using pseudo-BLUP index and CDE, were determined using gene flow. Costs were for one generation of selection. Results show that GS schemes had higher cumulated genetic gain in the commercial cow population and higher gross margins compared with PT schemes. Gross margins were between 3.2- and 5.2-fold higher for GS, depending on size of the CRC population. The increase in gross margin was mostly due to a decreased generation interval and lower running costs in GS schemes. In PT schemes many bulls are culled before selection. We therefore also compared 2 schemes in which semen was stored instead of keeping live bulls. As expected, semen storage resulted in an increase in gross margins in PT schemes, but gross margins remained lower than those of GS schemes. We conclude that implementation of small-sized GS breeding schemes can be economically viable for developing countries. The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Estimating costs in the economic evaluation of medical technologies.

PubMed

Luce, B R; Elixhauser, A

1990-01-01

The complexities and nuances of evaluating the costs associated with providing medical technologies are often underestimated by analysts engaged in economic evaluations. This article describes the theoretical underpinnings of cost estimation, emphasizing the importance of accounting for opportunity costs and marginal costs. The various types of costs that should be considered in an analysis are described; a listing of specific cost elements may provide a helpful guide to analysis. The process of identifying and estimating costs is detailed, and practical recommendations for handling the challenges of cost estimation are provided. The roles of sensitivity analysis and discounting are characterized, as are determinants of the types of costs to include in an analysis. Finally, common problems facing the analyst are enumerated with suggestions for managing these problems.

The National Practice Benchmark for oncology, 2014 report on 2013 data.

PubMed

Towle, Elaine L; Barr, Thomas R; Senese, James L

2014-11-01

The National Practice Benchmark (NPB) is a unique tool to measure oncology practices against others across the country in a way that allows meaningful comparisons despite differences in practice size or setting. In today's economic environment every oncology practice, regardless of business structure or affiliation, should be able to produce, monitor, and benchmark basic metrics to meet current business pressures for increased efficiency and efficacy of care. Although we recognize that the NPB survey results do not capture the experience of all oncology practices, practices that can and do participate demonstrate exceptional managerial capability, and this year those practices are recognized for their participation. In this report, we continue to emphasize the methodology introduced last year in which we reported medical revenue net of the cost of the drugs as net medical revenue for the hematology/oncology product line. The effect of this is to capture only the gross margin attributable to drugs as revenue. New this year, we introduce six measures of clinical data density and expand the radiation oncology benchmarks. Copyright © 2014 by American Society of Clinical Oncology.

Realistic respiratory motion margins for external beam partial breast irradiation

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

Conroy, Leigh; Quirk, Sarah; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dosemore » profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was described. It was found that the currently used respiratory margin of 5 mm in partial breast irradiation may be overly conservative for many 3DCRT PBI patients. Amplitude alone was found to be insufficient to determine patient-specific margins: individual respiratory trace shape and baseline drift both contributed to the dosimetric target coverage. With respiratory coaching, individualized respiratory margins smaller than the full extent of motion could reduce planning target volumes while ensuring adequate coverage under respiratory motion.« less

Total and Marginal Cost Analysis for a High School Based Bystander Intervention

ERIC Educational Resources Information Center

Bush, Joshua L.; Bush, Heather M.; Coker, Ann L.; Brancato, Candace J.; Clear, Emily R.; Recktenwald, Eileen A.

2018-01-01

Costs of providing the Green Dot bystander-based intervention, shown to be effective in the reduction of sexual violence among Kentucky high school students, were estimated based on data from a large cluster-randomized clinical trial. Rape Crisis Center Educators were trained to provide Green Dot curriculum to students. Implementing Green Dot in…

A Pedagogical Note on the Superiority of Price-Cap Regulation to Rate-of-Return Regulation

ERIC Educational Resources Information Center

Currier, Kevin M.; Jackson, Brian K.

2008-01-01

The two forms of natural monopoly regulation that are typically discussed in intermediate microeconomics textbooks are marginal cost pricing and average cost pricing (rate-of-return regulation). However, within the last 20 years, price-cap regulation has largely replaced rate-of-return regulation because of the former's potential to generate more…

Structural mapping from MSS-LANDSAT imagery: A proposed methodology for international geological correlation studies

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Crepani, E.; Martini, P. R.

1980-01-01

A methodology is proposed for international geological correlation studies based on LANDSAT-MSS imagery, Bullard's model of continental fit and compatible structural trends between Northeast Brazil and the West African counterpart. Six extensive lineaments in the Brazilian study area are mapped and discussed according to their regional behavior and in relation to the adjacent continental margin. Among the first conclusions, correlations were found between the Sobral Pedro II Lineament and the megafaults that surround the West African craton; and the Pernambuco Lineament with the Ngaurandere Linemanet in Cameroon. Ongoing research to complete the methodological stages includes the mapping of the West African structural framework, reconstruction of the pre-drift puzzle, and an analysis of the counterpart correlations.

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

NASA Technical Reports Server (NTRS)

Jones, R. E.

1981-01-01

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

Modelling of nuclear power plant decommissioning financing.

PubMed

Bemš, J; Knápek, J; Králík, T; Hejhal, M; Kubančák, J; Vašíček, J

2015-06-01

Costs related to the decommissioning of nuclear power plants create a significant financial burden for nuclear power plant operators. This article discusses the various methodologies employed by selected European countries for financing of the liabilities related to the nuclear power plant decommissioning. The article also presents methodology of allocation of future decommissioning costs to the running costs of nuclear power plant in the form of fee imposed on each megawatt hour generated. The application of the methodology is presented in the form of a case study on a new nuclear power plant with installed capacity 1000 MW. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Defense AT and L Magazine. Volume 45, Number 2, March-April 2016

DTIC Science & Technology

2016-03-01

preferred contract type (Fixed Price Incentive Firm and Cost Plus Incentive Fee may be effective) 5. Provide sufficient contract length for the...example would be an incentive on pay- load margin for our medium launch vehicle, where the mini - mum requirement is 100 pounds of margin and the...involving a mini -UAV initiative with Indian industry partners. In discussing the Make in India initiative, U.S. officials note that it requires time

Toward Affordable Systems: Portfolio Analysis and Management for Army Science and Technology Programs

DTIC Science & Technology

2009-01-01

PROGRAM ELEMENT NUMBER 6. AUTHOR (S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand...Decision Authority MDAP major defense acquisition program Abbreviations xxvii MIC marginal implementation cost MOMC marginal operating and...the Milestone Decision Authority (MDA).1 1 This section is based on U.S. Army, 2003, pp. 30–33. This 2003 Army document had taken into account the

Cost Containment in Europe

PubMed Central

Culyer, A. J.

1989-01-01

Health care cost containment is not in itself a sensible policy objective, because any assessment of the appropriateness of health care expenditure in aggregate, as of that on specific programs, requires a balancing of costs and benefits at the margin. International data on expenditures can, however, provide indications of the likely impact on costs and expenditures of structural features of health care systems. Data from the Organization for Economic Cooperation and Development for both European countries and a wider set are reviewed, and some current policies in Europe that are directed at controlling health care costs are outlined. PMID:10313433

Elastic thickness estimates at northeast passive margin of North America and its implications

NASA Astrophysics Data System (ADS)

Kumar, R. T. Ratheesh; Maji, Tanmay K.; Kandpal, Suresh Ch; Sengupta, D.; Nair, Rajesh R.

2011-06-01

Global estimates of the elastic thickness (Te) of the structure of passive continental margins show wide and varying results owing to the use of different methodologies. Earlier estimates of the elastic thickness of the North Atlantic passive continental margins that used flexural modelling yielded a Te value of ~20-100 km. Here, we compare these estimates with the Te value obtained using orthonormalized Hermite multitaper recovered isostatic coherence functions. We discuss how Te is correlated with heat flow distribution and depth of necking. The E-W segment in the southern study region comprising Nova Scotia and the Southern Grand Banks show low Te values, while the zones comprising the NE-SW zones, viz., Western Greenland, Labrador, Orphan Basin and the Northern Grand Bank show comparatively high Te values. As expected, Te broadly reflects the depth of the 200-400°C isotherm below the weak surface sediment layer at the time of loading, and at the margins most of the loading occurred during rifting. We infer that these low Te measurements indicate Te frozen into the lithosphere. This could be due to the passive nature of the margin when the loads were emplaced during the continental break-up process at high temperature gradients.

Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.

PubMed

Neighbors, Charles J; Barnett, Nancy P; Rohsenow, Damaris J; Colby, Suzanne M; Monti, Peter M

2010-05-01

Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained. Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases. Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates. This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa.

PubMed

Chang, Wei; Chamie, Gabriel; Mwai, Daniel; Clark, Tamara D; Thirumurthy, Harsha; Charlebois, Edwin D; Petersen, Maya; Kabami, Jane; Ssemmondo, Emmanuel; Kadede, Kevin; Kwarisiima, Dalsone; Sang, Norton; Bukusi, Elizabeth A; Cohen, Craig R; Kamya, Moses; Havlir, Diane V; Kahn, James G

2016-11-01

In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization. We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.

A review of costing methodologies in critical care studies.

PubMed

Pines, Jesse M; Fager, Samuel S; Milzman, David P

2002-09-01

Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

Towards a More Meaningful Involvement of Librarians in Academic Program Reviews

ERIC Educational Resources Information Center

Bowker, Lynne

2018-01-01

Purpose: Using a descriptive case study approach, this paper aims to validate academic librarians' perceptions that they are marginalized by faculty during academic program reviews, and recommends ways for the two groups to collaborate more effectively to make program reviews more meaningful. Design/methodology/approach: The paper describes a case…

A Bootstrap Generalization of Modified Parallel Analysis for IRT Dimensionality Assessment

ERIC Educational Resources Information Center

Finch, Holmes; Monahan, Patrick

2008-01-01

This article introduces a bootstrap generalization to the Modified Parallel Analysis (MPA) method of test dimensionality assessment using factor analysis. This methodology, based on the use of Marginal Maximum Likelihood nonlinear factor analysis, provides for the calculation of a test statistic based on a parametric bootstrap using the MPA…

78 FR 332 - Self-Regulatory Organizations; ICE Clear Europe Limited; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-03

..., the SPAN Arrays published by ICE Clear Europe include the Volatility Risk Credit Rate (the Offset Rate... Rule Change Related to SPAN Margin Methodology Enhancements to Inter-Contract Credits and Average..., the Proposed Rule Change In addition to providing clearing services for credit default swaps, ICE...

12 CFR Appendix A to Subpart B of... - Risk-Based Capital Test Methodology and Specifications

Code of Federal Regulations, 2010 CFR

2010-01-01

... Statistical Rating Organization (NRSRO) for this security, as of the reporting date Wt Avg Gross Margin Gross... Nationally Recognized Statistical Rating Organization (NRSRO) for this security, as of the reporting date [c... The most current rating issued by any Nationally Recognized Statistical Rating Organization (NRSRO...

Citizenship Education in Croatia: At the Margins of the System

ERIC Educational Resources Information Center

Kekez, Anka; Horvat, Martina; Šalaj, Berto

2017-01-01

Purpose: This paper unfolds the ways in which Croatia, as a young post-communist democracy, has aligned its transition and consolidation with the development of education programs that would support the protection of human rights and the creation of a democratic political culture. Design/methodology/approach: By combining the existing studies with…

In the Margins of Training and Learning

ERIC Educational Resources Information Center

Silvennoinen, Heikki; Nori, Hanna

2017-01-01

Purpose: The purpose of this paper is to examine the distribution of learning and training opportunities in the Finnish workforce. It will concentrate on the sectors of the workforce that lack these opportunities. Design/Methodology/Approach: The Working Conditions Barometer (WCB) data from 2008, 2009 and 2010 are used (N = 3,326) in this…

Inclusion of Radiation Environment Variability in Total Dose Hardness Assurance Methodology

NASA Technical Reports Server (NTRS)

Xapsos, M. A.; Stauffer, C.; Phan, A.; McClure, S. S.; Ladbury, R. L.; Pellish, J. A.; Campola, M. J.; LaBel, K. A.

2015-01-01

Variability of the space radiation environment is investigated with regard to parts categorization for total dose hardness assurance methods. It is shown that it can have a significant impact. A modified approach is developed that uses current environment models more consistently and replaces the design margin concept with one of failure probability.

75 FR 55619 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-13

... Numerical Simulations Risk Management Methodology September 7, 2010. Pursuant to Section 19(b)(1) of the... for incorporation in the System for Theoretical Analysis and Numerical Simulations (``STANS'') risk... ETFs \\3\\ in the STANS margin calculation process.\\4\\ When OCC began including common stock and ETFs in...

Critical Methods in Longitudinal Research with Latino Immigrant Families

ERIC Educational Resources Information Center

Díaz, Yethzèll; Denner, Jill; Ortiz, Eloy

2017-01-01

We have an ethical and a scientific imperative to do research that reflects the views and learning experiences of historically marginalized groups. Most studies that use a critical methodological approach rely on qualitative data. This article describes how a critical approach to recruitment, data collection, and retention can help to ensure that…

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

PubMed

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

2010-07-01

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

Impact of Patient and Procedure Mix on Finances of Perinatal Centres – Theoretical Models for Economic Strategies in Perinatal Centres

PubMed Central

Hildebrandt, T.; Kraml, F.; Wagner, S.; Hack, C. C.; Thiel, F. C.; Kehl, S.; Winkler, M.; Frobenius, W.; Faschingbauer, F.; Beckmann, M. W.; Lux, M. P.

2013-01-01

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the “best” patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs. PMID:24771932

Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations

PubMed Central

2014-01-01

Background Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow. Methods We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0–13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology. Results The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates. Conclusions The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments. PMID:24885453

Model-Based Control of a Nonlinear Aircraft Engine Simulation using an Optimal Tuner Kalman Filter Approach

NASA Technical Reports Server (NTRS)

Connolly, Joseph W.; Csank, Jeffrey Thomas; Chicatelli, Amy; Kilver, Jacob

2013-01-01

This paper covers the development of a model-based engine control (MBEC) methodology featuring a self tuning on-board model applied to an aircraft turbofan engine simulation. Here, the Commercial Modular Aero-Propulsion System Simulation 40,000 (CMAPSS40k) serves as the MBEC application engine. CMAPSS40k is capable of modeling realistic engine performance, allowing for a verification of the MBEC over a wide range of operating points. The on-board model is a piece-wise linear model derived from CMAPSS40k and updated using an optimal tuner Kalman Filter (OTKF) estimation routine, which enables the on-board model to self-tune to account for engine performance variations. The focus here is on developing a methodology for MBEC with direct control of estimated parameters of interest such as thrust and stall margins. Investigations using the MBEC to provide a stall margin limit for the controller protection logic are presented that could provide benefits over a simple acceleration schedule that is currently used in traditional engine control architectures.

Polymerization shrinkage stress of composite resins and resin cements - What do we need to know?

PubMed

Soares, Carlos José; Faria-E-Silva, André Luis; Rodrigues, Monise de Paula; Vilela, Andomar Bruno Fernandes; Pfeifer, Carmem Silvia; Tantbirojn, Daranee; Versluis, Antheunis

2017-08-28

Polymerization shrinkage stress of resin-based materials have been related to several unwanted clinical consequences, such as enamel crack propagation, cusp deflection, marginal and internal gaps, and decreased bond strength. Despite the absence of strong evidence relating polymerization shrinkage to secondary caries or fracture of posterior teeth, shrinkage stress has been associated with post-operative sensitivity and marginal stain. The latter is often erroneously used as a criterion for replacement of composite restorations. Therefore, an indirect correlation can emerge between shrinkage stress and the longevity of composite restorations or resin-bonded ceramic restorations. The relationship between shrinkage and stress can be best studied in laboratory experiments and a combination of various methodologies. The objective of this review article is to discuss the concept and consequences of polymerization shrinkage and shrinkage stress of composite resins and resin cements. Literature relating to polymerization shrinkage and shrinkage stress generation, research methodologies, and contributing factors are selected and reviewed. Clinical techniques that could reduce shrinkage stress and new developments on low-shrink dental materials are also discussed.

Grassland agriculture

USDA-ARS?s Scientific Manuscript database

Agriculture in grassland environments is facing multiple stresses from: shifting demographics, declining and fragmented agricultural landscapes, declining environmental quality, variable and changing climate, volatile and increasing energy costs, marginal economic returns, and globalization. Degrad...

The relationship of hospital ownership and service composition to hospital charges

PubMed Central

Eskoz, Robin; Peddecord, K. Michael

1985-01-01

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals. PMID:10311161

Investigation and evaluation of shuttle/GPS navigation system

NASA Technical Reports Server (NTRS)

Nilsen, P. W.

1977-01-01

Iterative procedures were used to analyze the performance of two preliminary shuttle/GPS navigation system configurations: an early OFT experimental system and a more sophisticated system which consolidates several separate navigation functions thus permitting net cost savings from decreased shuttle avionics weight and power consumption, and from reduced ground data processing. The GPS system can provide on-orbit navigation accuracy an order of magnitude better than the baseline system, with very adequate link margins. The worst-case link margin is 4.3 dB. This link margin accounts for shuttle RF circuit losses which were minimized under the constraints of program schedule and environmental limitations. Implicit in the link analyses are the location trade-offs for preamplifiers and antennas.

A cost-effective methodology for the design of massively-parallel VLSI functional units

NASA Technical Reports Server (NTRS)

Venkateswaran, N.; Sriram, G.; Desouza, J.

1993-01-01

In this paper we propose a generalized methodology for the design of cost-effective massively-parallel VLSI Functional Units. This methodology is based on a technique of generating and reducing a massive bit-array on the mask-programmable PAcube VLSI array. This methodology unifies (maintains identical data flow and control) the execution of complex arithmetic functions on PAcube arrays. It is highly regular, expandable and uniform with respect to problem-size and wordlength, thereby reducing the communication complexity. The memory-functional unit interface is regular and expandable. Using this technique functional units of dedicated processors can be mask-programmed on the naked PAcube arrays, reducing the turn-around time. The production cost of such dedicated processors can be drastically reduced since the naked PAcube arrays can be mass-produced. Analysis of the the performance of functional units designed by our method yields promising results.

Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer.

PubMed

Leung, Henry W C; Chan, Agnes L F; Leung, Matthew S H; Lu, Chin-Li

2013-04-01

To systematically review and assess the quality of cost-effectiveness analyses (CEAs) of pharmaceutical therapies for metastatic colorectal cancer (mCRC). The MEDLINE, EMBASE, Cochrane, and EconLit databases were searched for the Medical Subject Headings or text key words quality-adjusted, QALY, life-year gained (LYG), and cost-effectiveness (January 1, 1999-December 31, 2009). Original CEAs of mCRC pharmacotherapy published in English were included. CEAs that measured health effects in units other than quality-adjusted life years or LYG and letters to the editor, case reports, posters, and editorials were excluded. Each article was independently assessed by 2 trained reviewers according to a quality checklist created by the Panel on Cost-Effectiveness in Health and Medicine. Twenty-four CEA studies pertaining to pharmaceutical therapies for mCRC were identified. All studies showed a wide variation in methodologic approaches, which resulted in a different range of incremental cost-effectiveness ratios reported for each regimen. We found common methodologic flaws in a significant number of CEA studies, including lack of clear description for critique of data quality; lack of method for adjusting costs for inflation and methods for obtaining expert judgment; no results of model validation; wide differences in the types of perspective, time horizon, study design, cost categories, and effect outcomes; and no quality assessment of data (cost and effectiveness) for the interventions evaluation. This study has shown a wide variation in the methodology and quality of cost-effectiveness analysis for mCRC. Improving quality and harmonization of CEA for cancer treatment is needed. Further study is suggested to assess the quality of CEA methodology outside the mCRC disease state.

10 CFR 436.14 - Methodological assumptions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Methodological assumptions. 436.14 Section 436.14 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.14 Methodological assumptions. (a) Each Federal Agency shall...

10 CFR 436.14 - Methodological assumptions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Methodological assumptions. 436.14 Section 436.14 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.14 Methodological assumptions. (a) Each Federal Agency shall...

10 CFR 436.14 - Methodological assumptions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Methodological assumptions. 436.14 Section 436.14 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.14 Methodological assumptions. (a) Each Federal Agency shall...

10 CFR 436.14 - Methodological assumptions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Methodological assumptions. 436.14 Section 436.14 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.14 Methodological assumptions. (a) Each Federal Agency shall...

10 CFR 436.14 - Methodological assumptions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Methodological assumptions. 436.14 Section 436.14 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.14 Methodological assumptions. (a) Each Federal Agency shall...