Science.gov

Sample records for potential cost-effective alternative

  1. Deregulation and Nuclear Training: Cost Effective Alternatives

    SciTech Connect

    Richard P. Coe; Patricia A. Lake

    2000-11-12

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies.

  2. Thresholds for the cost-effectiveness of interventions: alternative approaches.

    PubMed

    Marseille, Elliot; Larson, Bruce; Kazi, Dhruv S; Kahn, James G; Rosen, Sydney

    2015-02-01

    Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

  3. Hepatitis C core antigen testing: a reliable, quick, and potentially cost-effective alternative to hepatitis C polymerase chain reaction in diagnosing acute hepatitis C virus infection.

    PubMed

    Cresswell, Fiona V; Fisher, Martin; Hughes, Daniel J; Shaw, Simon G; Homer, Gary; Hassan-Ibrahim, Mohammed O

    2015-01-15

    Hepatitis C virus (HCV) is increasingly common among human immunodeficiency virus (HIV)-infected men who have sex with men. We evaluated the efficacy of HCV core antigen in diagnosing acute HCV in an HIV-infected cohort. Compared with HCV polymerase chain reaction, core antigen proved sensitive (100%) and specific (97.9%). As a quick, simple, and cost-effective test, it has considerable utility in screening for acute HCV.

  4. The Potential Cost-Effectiveness of Amblyopia Screening Programs

    PubMed Central

    Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.

    2013-01-01

    Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675

  5. Cost Effectiveness of Alternative Route Special Education Teacher Preparation

    ERIC Educational Resources Information Center

    Sindelar, Paul T.; Dewey, James F.; Rosenberg, Michael S.; Corbett, Nancy L.; Denslow, David; Lotfinia, Babik

    2012-01-01

    In this study, the authors estimated costs of alternative route preparation to provide states a basis for allocating training funds to maximize production. Thirty-one special education alternative route program directors were interviewed and completed cost tables. Two hundred and twenty-four program graduates were also surveyed. The authors…

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

    PubMed

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

    2015-03-01

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

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

    PubMed

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

    2015-03-01

    Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. PMID:25575282

  8. Global warming and urban smog: The cost effectiveness of CAFE standards and alternative fuels

    SciTech Connect

    Krupnick, A.J.; Walls, M.A.; Collins, C.T.

    1992-01-01

    This paper evaluates alternative transportation policies for reducing greenhouse gas emissions and ozone precursors. The net cost-effectiveness -- i.e., the cost per ton of greenhouse gas reduced, adjusted for ozone reduction benefits -- of substituting methanol, compressed natural gas (CNG), and reformulated gasoline for conventional gasoline is assessed and compared with the cost-effectiveness of raising the corporate average fuel economy (CAFE) standard to 38 miles per gallon. Computing this [open quotes]net[close quotes] cost-effectiveness is one way of measuring the joint environmental benefits that these alternatives provide. Greenhouse gas emissions are assessed over the entire fuel cycle and include not only carbon dioxide emissions, but also methane, carbon monoxide, and nitrous oxide emissions. In computing cost-effectiveness, we account for the so-called [open quotes]rebound effect[close quotes] -- the impact on vehicle-miles traveled of higher or lower fuel costs. CNG is found to be the most cost-effective of these alternatives, followed by increasing the CAFE standard, substituting methanol for gasoline, and substituting reformulated for conventional gasoline. Including the ozone reduction benefits does not change the rankings of the alternatives, but does make the alternative fuels look better relative to increasing the CAFE standard. Incorporating the rebound effect greatly changes the magnitude of the estimates but does not change the rankings of the alternatives. None of the alternatives look cost-effective should a carbon tax of $35 per ton be passes (the proposal in the Stark bill, H.R. 1086), and only CNG under optimistic assumptions looks cost-effective if a tax of $100 per ton of carbon is passed.

  9. Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

    PubMed

    Halsing, David L; Moore, Michael R

    2008-04-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  10. Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

    PubMed

    Halsing, David L; Moore, Michael R

    2008-04-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  11. Cost-effective management alternatives for Snake river chinook salmon: A biological-economic synthesis

    USGS Publications Warehouse

    Halsing, D.L.; Moore, M.R.

    2008-01-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  12. Global warming and urban smog: Cost-effectiveness of CAFE standards and alternative fuels

    SciTech Connect

    Krupnick, A.J.; Walls, M.A.; Collins, C.T.

    1993-12-31

    In this paper we estimate the cost-effectiveness, in terms of reducing greenhouse gas emissions, of increasing the corporate average fuel economy (CAFE) standard to 38 miles per gallon and substituting methanol, compressed natural gas (CNG), and reformulated gasoline for conventional gasoline. Greenhouse gas emissions are assessed over the entire fuel cycle and include carbon dioxide, methane, carbon monoxide, and nitrous oxide emissions. To account for joint environmental benefits, the cost per ton of greenhouse gas reduced is adjusted for reductions in volatile organic compound (VOC) emissions, an ozone precursor. CNG is found to be the most cost-effective of these alternatives, followed by increasing the CAFE standard, substituting methanol for gasoline, and substituting reformulated for conventional gasoline. Including the VOC benefits does not change the ranking of the alternatives, but does make the alternative fuels look better relative to increasing the CAFE standard. None of the alternatives look cost-effective should a carbon tax of $35 per ton be passed, and only CNG under optimistic assumptions looks cost-effective with a tax of $100 per ton of carbon. 35 refs., 4 figs., 6 tabs.

  13. Cost-effective alternatives for mitigating Cryptosporidium risk in drinking water and enhancing ecosystem services

    NASA Astrophysics Data System (ADS)

    Bryan, B. A.; Kandulu, J. M.

    2009-08-01

    Under the multibarrier paradigm, water quality management barriers that mitigate risk to consumers are required at multiple points from the catchment to the tap. We present a cost-effectiveness analysis of 13 catchment- and treatment-based management alternatives for mitigating Cryptosporidium risk in the Myponga water supply catchment, South Australia. A broad range of costs and benefits are identified and valued, including setup, operation and maintenance, and opportunity costs, and benefits for ecosystem services including water quality, biodiversity, carbon sequestration, and farm production services. The results suggest that the cost-effectiveness of investment in water quality management can be substantially enhanced by considering the costs of management and the benefits for ecosystem services, in addition to Cryptosporidium removal effectiveness. Cost-effectiveness of investment in management alternatives is dependent upon the desired level of Cryptosporidium removal effectiveness by both the catchment and treatment barriers. The combination of a spatially targeted 25% restriction in water course access of nondairy cattle and treatment by enhanced coagulation provides the most (net) cost-effective Cryptosporidium risk mitigation strategy. This combination may achieve 0.614 log removal at a net cost of A0.7 million and (net) cost-effectiveness of A1.14 million per log removal. Additional risk mitigation can be achieved through the addition of ultraviolet irradiation treatment, higher levels of water course access restriction for cattle, and the adoption of dung beetles in the catchment. Economic valuation of a range of costs and benefits of management priorities can support cost-effective water quality management investment decisions and inform elements of policy design such as cost-sharing arrangements and spatial targeting.

  14. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    PubMed

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value.

  15. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    PubMed

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value. PMID

  16. A Potential Cost Effective Liquefaction Mitigation Countermeasure: Induced Partial Saturation

    SciTech Connect

    Bian Hanbing; Jia Yun; Shahrour, Isam

    2008-07-08

    This work is devoted to illustrate the potential liquefaction mitigation countermeasure: Induced Partial Saturation. Firstly the potential liquefaction mitigation method is briefly introduced. Then the numerical model for partially saturated sandy soil is presented. At last the dynamic responses of liquefiable free filed with different water saturation is given. It shows that the induced partial saturation is efficiency for preventing the liquefaction.

  17. On the potential cost effectiveness of scientific audits.

    PubMed

    Click, J L

    1989-09-01

    inefficient process for uncovering scientific fraud (5, 6, 9). Data from a survey of university scientists was also presented, indicating ". . . a reluctance to take prompt, corrective action not only when an investigator suspects another of misconduct but also should the investigator discover flaws in his or her own published reports-whether the flaws were the result of honest error or fraud"; (10). The uncritical acceptance by established scientists that the self-correcting process works compounds the problem. The Editor of Science has written that";. . . 99.9999 percent of reports are accurate and truthful. . ."; (8). If indeed only 0.0001% of published reports were inaccurate or untruthful, there would be little justification for scientific audits. However, congressional testimony from the National Institutes of Health (NIH) revealed that";. . . the NIH Director's office has handled an average of 15-20 allegations and reports of misconduct annually in its extramural programs, which supports the work of approximately 50,000 scientists"; (11). As I shall attempt to demonstrate, since NIH alone receives fraud-related complaints concerning the work of at least 0.03% of scientists it supports in other institutions, and since evidence indicates that the incidence of fraud is considerably greater than 0.03% (10, 12), the need to audit data is justifiable on the basis of being cost effective.

  18. Potential Cost-Effective Opportunities for Methane Emission Abatement

    SciTech Connect

    Warner, Ethan; Steinberg, Daniel; Hodson, Elke; Heath, Garvin

    2015-08-01

    The energy sector was responsible for approximately 84% of carbon dioxide equivalent (CO2e) greenhouse gas (GHG) emissions in the U.S. in 2012 (EPA 2014a). Methane is the second most important GHG, contributing 9% of total U.S. CO2e emissions. A large portion of those methane emissions result from energy production and use; the natural gas, coal, and oil industries produce approximately 39% of anthropogenic methane emissions in the U.S. As a result, fossil-fuel systems have been consistently identified as high priority sectors to contribute to U.S. GHG reduction goals (White House 2015). Only two studies have recently attempted to quantify the abatement potential and cost associated with the breadth of opportunities to reduce GHG emissions within natural gas, oil, and coal supply chains in the United States, namely the U.S. Environmental Protection Agency (EPA) (2013a) and ICF (2014). EPA, in its 2013 analysis, estimated the marginal cost of abatement for non-CO2 GHG emissions from the natural gas, oil, and coal supply chains for multiple regions globally, including the United States. Building on this work, ICF International (ICF) (2014) provided an update and re-analysis of the potential opportunities in U.S. natural gas and oil systems. In this report we synthesize these previously published estimates as well as incorporate additional data provided by ICF to provide a comprehensive national analysis of methane abatement opportunities and their associated costs across the natural gas, oil, and coal supply chains. Results are presented as a suite of marginal abatement cost curves (MACCs), which depict the total potential and cost of reducing emissions through different abatement measures. We report results by sector (natural gas, oil, and coal) and by supply chain segment - production, gathering and boosting, processing, transmission and storage, or distribution - to facilitate identification of which sectors and supply chain

  19. An Alternative Methodological Approach for Cost-Effectiveness Analysis and Decision Making in Genomic Medicine.

    PubMed

    Fragoulakis, Vasilios; Mitropoulou, Christina; van Schaik, Ron H; Maniadakis, Nikolaos; Patrinos, George P

    2016-05-01

    Genomic Medicine aims to improve therapeutic interventions and diagnostics, the quality of life of patients, but also to rationalize healthcare costs. To reach this goal, careful assessment and identification of evidence gaps for public health genomics priorities are required so that a more efficient healthcare environment is created. Here, we propose a public health genomics-driven approach to adjust the classical healthcare decision making process with an alternative methodological approach of cost-effectiveness analysis, which is particularly helpful for genomic medicine interventions. By combining classical cost-effectiveness analysis with budget constraints, social preferences, and patient ethics, we demonstrate the application of this model, the Genome Economics Model (GEM), based on a previously reported genome-guided intervention from a developing country environment. The model and the attendant rationale provide a practical guide by which all major healthcare stakeholders could ensure the sustainability of funding for genome-guided interventions, their adoption and coverage by health insurance funds, and prioritization of Genomic Medicine research, development, and innovation, given the restriction of budgets, particularly in developing countries and low-income healthcare settings in developed countries. The implications of the GEM for the policy makers interested in Genomic Medicine and new health technology and innovation assessment are also discussed. PMID:27096406

  20. A comparison of estimates of cost-effectiveness of alternative fuels and vehicles for reducing emissions

    SciTech Connect

    Hadder, G.R.

    1995-11-01

    The cost-effectiveness ratio (CER) is a measure of the monetary value of resources expended to obtain reductions in emissions of air pollutants. The CER can lead to selection of the most effective sequence of pollution reduction options. Derived with different methodologies and technical assumptions, CER estimates for alternative fuel vehicles (AFVs) have varied widely among pervious studies. In one of several explanations of LCER differences, this report uses a consistent basis for fuel price to re-estimate CERs for AFVs in reduction of emissions of criteria pollutants, toxics, and greenhouse gases. The re-estimated CERs for a given fuel type have considerable differences due to non-fuel costs and emissions reductions, but the CERs do provide an ordinal sense of cost-effectiveness. The category with CER less than $5,000 per ton includes compressed natural gas and ed Petroleum gas vehicles; and E85 flexible-fueled vehicles (with fuel mixture of 85 percent cellulose-derived ethanol in gasoline). The E85 system would be much less attractive if corn-derived ethanol were used. The CER for E85 (corn-derived) is higher with higher values placed on the reduction of gas emissions. CER estimates are relative to conventional vehicles fueled with Phase 1 California reformulated gasoline (RFG). The California Phase 2 RFG program will be implemented before significant market penetration by AFVs. CERs could be substantially greater if they are calculated incremental to the Phase 2 RFG program. Regression analysis suggests that different assumptions across studies can sometimes have predictable effects on the CER estimate of a particular AFV type. The relative differences in cost and emissions reduction assumptions can be large, and the effect of these differences on the CER estimate is often not predictable. Decomposition of CERs suggests that methodological differences can make large contributions to CER differences among studies.

  1. Mediation and arbitration of environmental disputes: Cost effective alternatives to litigation

    SciTech Connect

    Wisot, K.

    1995-12-31

    Environmental disputes typically involve multiple parties with divergent interests seeking resolution of complex technical issues. When first confronted with a maze of regulations, governmental agencies and court rulings, any interested party may find it difficult to conceive of an effective solution. In the process of airing differences in search of that solution, the traditional forum of litigation discourages the parties from raising sensitive issues. Litigation is an open, public process that is highly structured. Environmental disputes often depend upon technical speculation to determine the cause of contamination, and in assessing remediation. Political differences can significantly shape a party`s approach to resolution, and often provide the underlying motive for the dispute. In effect, these threshold issues cannot even be addressed in a lawsuit structured on pleadings, adversarial discovery, and a winner-take-all concept of judgment. Mediation and arbitration offer legitimate alternatives to the traditional forum of litigation. They act as cost effective processes which can avoid litigation completely, when initiated as an early preventive action, or as an adjunct to litigation that provides factual information in a cost-conscious, time-conscious, focused manner.

  2. The ARIEL Document Delivery System: A Cost-Effective Alternative to the Fax.

    ERIC Educational Resources Information Center

    Landes, Sonja

    1997-01-01

    ARIEL is a high-speed, high-quality, cost-effective document delivery system that runs on the Internet. Advantages over the fax include no long-distance phone charges, high image resolution, original source can be scanned, can send/receive simultaneously, does not require dedicated equipment, and documents can be stored and forwarded later.…

  3. Technological Minimalism: A Cost-Effective Alternative for Course Design and Development.

    ERIC Educational Resources Information Center

    Lorenzo, George

    2001-01-01

    Discusses the use of minimum levels of technology, or technological minimalism, for Web-based multimedia course content. Highlights include cost effectiveness; problems with video streaming, the use of XML for Web pages, and Flash and Java applets; listservs instead of proprietary software; and proper faculty training. (LRW)

  4. Cost-Effectiveness of Alternative Strategies for Annual Influenza Vaccination among Children Aged 6 Months to 14 Years in Four Provinces in China

    PubMed Central

    Zhou, Lei; Situ, Sujian; Feng, Zijian; Atkins, Charisma Y.; Fung, Isaac Chun-Hai; Xu, Zhen; Huang, Ting; Hu, Shixiong; Wang, Xianjun; Meltzer, Martin I.

    2014-01-01

    Background To support policy making, we developed an initial model to assess the cost-effectiveness of potential strategies to increase influenza vaccination rates among children in China. Methods We studied on children aged 6 months to 14 years in four provinces (Shandong, Henan, Hunan, and Sichuan), with a health care system perspective. We used data from 2005/6 to 2010/11, excluding 2009/10. Costs are reported in 2010 U.S. dollars. Results In comparison with no vaccination, the mean (range) of Medically Attended Cases averted by the current self-payment policy for the two age groups (6 to 59 months and 60 months to 14 years) was 1,465 (23∼11,132) and 792 (36∼4,247), and the cost effectiveness ratios were $ 0 (-11-51) and $ 37 (6-125) per case adverted, respectively. In comparison with the current policy, the incremental cost effectiveness ratio (ICER) of alternative strategies, OPTION One-reminder and OPTION Two-comprehensive package, decreased as vaccination rate increased. The ICER for children aged 6 to 59 months was lower than that for children aged 60 months to 14 years. Conclusions The model is a useful tool in identifying elements for evaluating vaccination strategies. However, more data are needed to produce more accurate cost-effectiveness estimates of potential vaccination policies. PMID:24498145

  5. Potential alternate life biochemistries

    NASA Astrophysics Data System (ADS)

    Konesky, Gregory

    2013-09-01

    While life on Earth continues to be discovered in unlikely environments, the underlying biochemistry is all very similar, based on the element carbon, and requiring liquid water. We consider alternate biochemistries based on elements other than carbon, including other group IVA elements, such as silicon and germanium, and solvents other than water. Terminal electron acceptors other than oxygen are also discussed. A fundamental issue is raised related to the detection of, and even the definition of life, whether it is carbon or non-carbon based. An extreme example of this issue would be in consideration of speculative life based on electrically charged dusty plasmas, which may have no physical body.

  6. Cost-Effectiveness of Nitrogen Mitigation by Alternative Household Wastewater Management Technologies

    EPA Science Inventory

    Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain ...

  7. Portfolio theory and the alternative decision rule of cost-effectiveness analysis: theoretical and practical considerations.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Gafni, Amiram; Birch, Stephen

    2004-05-01

    Bridges and Terris (Soc. Sci. Med. (2004)) critique our paper on the alternative decision rule of economic evaluation in the presence of uncertainty and constrained resources within the context of a portfolio of health care programs (Sendi et al. Soc. Sci. Med. 57 (2003) 2207). They argue that by not adopting a formal portfolio theory approach we overlook the optimal solution. We show that these arguments stem from a fundamental misunderstanding of the alternative decision rule of economic evaluation. In particular, the portfolio theory approach advocated by Bridges and Terris is based on the same theoretical assumptions that the alternative decision rule set out to relax. Moreover, Bridges and Terris acknowledge that the proposed portfolio theory approach may not identify the optimal solution to resource allocation problems. Hence, it provides neither theoretical nor practical improvements to the proposed alternative decision rule.

  8. Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda

    PubMed Central

    Lubinga, Solomon J.; Atukunda, Esther C.; Wasswa-Ssalongo, George; Babigumira, Joseph B.

    2015-01-01

    Background In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives. Methods and Findings To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.0% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03). Mean costs were higher with prenatal misoprostol distribution from governmental by US$3.3 (95% CrI: 2.1, 4.2) and modified societal (by US$1.3; 95% CrI: -1.6, 2.8) perspectives. ICERs were US$191 (95% CrI: 82, 443) per DALY averted from a governmental perspective, and US$73 (95% CI: -86, 256) per DALY averted from a modified societal perspective. Conclusions Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be

  9. Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana.

    PubMed

    Hu, Delphine; Grossman, Daniel; Levin, Carol; Blanchard, Kelly; Adanu, Richard; Goldie, Sue J

    2010-06-01

    To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.

  10. Cheese whey: A cost-effective alternative for hyaluronic acid production by Streptococcus zooepidemicus.

    PubMed

    Amado, Isabel R; Vázquez, José A; Pastrana, Lorenzo; Teixeira, José A

    2016-05-01

    This study focuses on the optimisation of cheese whey formulated media for the production of hyaluronic acid (HA) by Streptococcus zooepidemicus. Culture media containing whey (W; 2.1g/L) or whey hydrolysate (WH; 2.4 g/L) gave the highest HA productions. Both W and WH produced high yields on protein consumed, suggesting cheese whey is a good nitrogen source for S. zooepidemicus production of HA. Polysaccharide concentrations of 4.0 g/L and 3.2g/L were produced in W and WH in a further scale-up to 5L bioreactors, confirming the suitability of the low-cost nitrogen source. Cheese whey culture media provided high molecular weight (>3000 kDa) HA products. This study revealed replacing the commercial peptone by the low-cost alternative could reduce HA production costs by up to a 70% compared to synthetic media.

  11. Strategies for cost-effective carbon reductions: A sensitivity analysis of alternative scenarios

    SciTech Connect

    Gumerman, Etan; Koomey, Jonathan G.; Brown, Marilyn

    2001-07-11

    Analyses of alternative futures often present results for a limited set of scenarios, with little if any sensitivity analysis to identify the factors affecting the scenario results. This approach creates an artificial impression of certainty associated with the scenarios considered, and inhibits understanding of the underlying forces. This paper summarizes the economic and carbon savings sensitivity analysis completed for the Scenarios for a Clean Energy Future study (IWG, 2000). Its 19 sensitivity cases provide insight into the costs and carbon-reduction impacts of a carbon permit trading system, demand-side efficiency programs, and supply-side policies. Impacts under different natural gas and oil price trajectories are also examined. The results provide compelling evidence that policy opportunities exist to reduce carbon emissions and save society money.

  12. Cheese whey: A cost-effective alternative for hyaluronic acid production by Streptococcus zooepidemicus.

    PubMed

    Amado, Isabel R; Vázquez, José A; Pastrana, Lorenzo; Teixeira, José A

    2016-05-01

    This study focuses on the optimisation of cheese whey formulated media for the production of hyaluronic acid (HA) by Streptococcus zooepidemicus. Culture media containing whey (W; 2.1g/L) or whey hydrolysate (WH; 2.4 g/L) gave the highest HA productions. Both W and WH produced high yields on protein consumed, suggesting cheese whey is a good nitrogen source for S. zooepidemicus production of HA. Polysaccharide concentrations of 4.0 g/L and 3.2g/L were produced in W and WH in a further scale-up to 5L bioreactors, confirming the suitability of the low-cost nitrogen source. Cheese whey culture media provided high molecular weight (>3000 kDa) HA products. This study revealed replacing the commercial peptone by the low-cost alternative could reduce HA production costs by up to a 70% compared to synthetic media. PMID:26769504

  13. Catalytically upgraded landfill gas as a cost-effective alternative for fuel cells

    NASA Astrophysics Data System (ADS)

    Urban, W.; Lohmann, H.; Gómez, J. I. Salazar

    The potential use of landfill gas as feeding fuel for the so-called molten carbonate fuel cells (MCFC) imposes the need for new upgrading technologies in order to meet the much tougher feed gas specifications of this type of fuel cells in comparison to gas engines. Nevertheless, MCFC has slightly lower purity demands than low temperature fuel cells. This paper outlines the idea of a new catalytic purification process for landfill gas conditioning, which may be supposed to be more competitive than state-of-the-art technologies and summarises some lab-scale results. This catalytic process transforms harmful landfill gas minor compounds into products that can be easily removed from the gas stream by a subsequent adsorption step. The optimal process temperature was found to be in the range 250-400 °C. After a catalyst screening, two materials were identified, which have the ability to remove all harmful minor compounds from landfill gas. The first material was a commercial alumina that showed a high activity towards the removal of organic silicon compounds. The alumina protects both a subsequent catalyst for the removal of other organic minor compounds and the fuel cell. Due to gradual deactivation caused by silica deposition, the activated alumina needs to be periodically replaced. The second material was a commercial V 2O 5/TiO 2-based catalyst that exhibited a high activity for the total oxidation of a broad spectrum of other harmful organic minor compounds into a simpler compound class "acid gases (HCl, HF and SO 2)", which can be easily removed by absorption with, e.g. alkalised alumina. The encouraging results obtained allow the scale-up of this LFG conditioning process to test it under real LFG conditions.

  14. Potential alternative approaches to xenotransplantation.

    PubMed

    Mou, Lisha; Chen, Fengjiao; Dai, Yifan; Cai, Zhiming; Cooper, David K C

    2015-11-01

    There is an increasing worldwide shortage of organs and cells for transplantation in patients with end-stage organ failure or cellular dysfunction. This shortage could be resolved by the transplantation of organs or cells from pigs into humans. What competing approaches might provide support for the patient with end-stage organ or cell failure? Four main approaches are receiving increasing attention - (i) implantable mechanical devices, although these are currently limited almost entirely to devices aimed at supporting or replacing the heart, (ii) stem cell technology, at present directed mainly to replace absent or failing cells, but which is also fundamental to progress in (iii) tissue engineering and regenerative medicine, in which the ultimate aim is to replace an entire organ. A final novel potential approach is (iv) blastocyst complementation. These potential alternative approaches are briefly reviewed, and comments added on their current status and whether they are now (or will soon become) realistic alternative therapies to xenotransplantation.

  15. A tutorial for analysing the cost-effectiveness of alternative methods for assessing chemical toxicity: the case of acute oral toxicity prediction.

    PubMed

    Norlen, Hedvig; Worth, Andrew P; Gabbert, Silke

    2014-05-01

    Compared with traditional animal methods for toxicity testing, in vitro and in silico methods are widely considered to permit a more cost-effective assessment of chemicals. However, how to assess the cost-effectiveness of alternative methods has remained unclear. This paper offers a user-oriented tutorial for applying cost-effectiveness analysis (CEA) to alternative (non-animal) methods. The purpose is to illustrate how CEA facilitates the identification of the alternative method, or the combination of methods, that offers the highest information gain per unit of cost. We illustrate how information gains and costs of single methods and method combinations can be assessed. By using acute oral toxicity as an example, we apply CEA to a set of four in silico methods (ToxSuite, TOPKAT, TEST, ADMET Predictor), one in vitro method (the 3T3 Neutral Red Uptake cytotoxicity assay), and various combinations of these methods. Our results underline that in silico tools are more cost-effective than the in vitro test. Battery combinations of alternative methods, however, do not necessarily outperform single methods, because additional information gains from the battery are easily outweighed by additional costs. PMID:24901905

  16. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Consider the cost of non-productive or lost work time while in travel status and certain other costs when... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY)...

  17. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Consider the cost of non-productive or lost work time while in travel status and certain other costs when... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY)...

  18. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Consider the cost of non-productive or lost work time while in travel status and certain other costs when... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY)...

  19. Preliminary methodology for evaluating the cost-effectiveness of alternative indoor air quality control approaches. Final report, March 1998--February 1999

    SciTech Connect

    Henschel, D.B.

    1999-06-01

    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 given commercial or institutional building. The preliminary methodology consists of text, logic diagrams, and worksheets that are intended to aid the user in: (1) assessing which IAQ control options(s) might apply to the specific building being addressed; (2) designing alternative control measures (involving increased outdoor air ventilation, air cleaning, or source management), and developing rough installed and operating costs for these measures; (3) estimating the approximate effectiveness of the alternative control measures in reducing occupant exposure to contaminants of concern; and (4) comparing the cost-effectiveness of the alternative control measures under consideration, to aid in selecting the optimal control approach.

  20. Sun-dried raisins are a cost-effective alternative to Sports Jelly Beans in prolonged cycling.

    PubMed

    Rietschier, Helena L; Henagan, Tara M; Earnest, Conrad P; Baker, Birgitta L; Cortez, Cory C; Stewart, Laura K

    2011-11-01

    The purpose of this study was to examine the effects of a natural carbohydrate (CHO) source in the form of sun-dried raisins (SDRs) vs. Sports Jelly Beans™ (SJBs) on endurance performance in trained cyclists and triathletes. Ten healthy men (18-33 years) completed 1 water-only acclimatization exercise trial and 2 randomized exercise trials administered in a crossover fashion. Each trial consisted of a 120-minute constant-intensity glycogen depletion period followed by a 10-km time trial (TT). During each experimental trial, participants consumed isocaloric amounts of SDRs or SJBs in 20-minute intervals. Measurements included time to complete 10-km TT, power output during 10-km TT, blood glucose levels and respiratory exchange ratio during glycogen depletion period, rate of perceived exertion (RPE), 'flow' questionnaire responses, and a hedonic (i.e., pleasantness) sensory acceptance test. There were no significant differences in endurance performance for TT time (SDRs vs. SJBs, 17.3 ± 0.4 vs. 17.3 ± 0.4 seconds) or power (229.3 ± 13.0 vs. 232.0 ± 13.6 W), resting blood glucose levels (5.8 ± 04 mmol·L(-1) for SDRs and 5.4 ± 0.2 mmol·L(-1) for SJBs), RPE, or flow experiences between SDR and SJB trials. However, the mean sensory acceptance scores were significantly higher for the SDRs compared to the SJBs (50.7 ± 1.7 vs. 44.3 ± 2.7). Consuming SDRs or SJBs during 120 minutes of intense cycling results in similar subsequent TT performances and are equally effective in maintaining blood glucose levels during exercise. Therefore, SDRs are a natural, pleasant, cost-effective CHO alternative to commercial SJBs that can be used during moderate- to high-intensity endurance exercise.

  1. [Health inequalities and cost-effectiveness: what do important health policy actors say about this potential conflict situation?].

    PubMed

    Hofmann, M; Mielck, A

    2015-02-01

    The German statutory health-care system is based on the principle of solidarity and thus it is committed to the objective of 'equal chances'. From an economic perspective it is also important to emphasise that scarcity of resources continuously pushes the services towards cost control and towards increasing cost-effect-iveness. There could be conflicts between the 2 objectives 'equal chances' and 'cost-effectiveness', of course, for example if measures for increasing cost-effectiveness lead to increased financial burdens of the insured. To date it has not been studied if and how this potential conflict is discussed in Germany.In a first step we searched for German publications discussing this potential conflict focusing on 3 major public health journals (Das Gesundheitswesen, Bundesgesundheitsblatt, Ethik in der Medizin) and on the internet portal "gerechte-gesundheit.de". For the main part of the paper, we looked for publications from 4 major health policy actors (Bundesärztekammer, Zentrale Ethikkommission bei der Bundesärztekammer, Deutscher Ethikrat, Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen). All papers published since the year 2000 were included in the system-atic qualitative analysis.The analyses show that the potential conflict between 'equal chances' and 'cost-effectiveness' is rarely discussed in any detail, at most in an implicit way. It would be important, though, to have an explicit discussion, supported by scientifically based analyses and recommendations. One step towards this objective could be, for example, a closer cooperation between social-epidemiologists and health--economists.

  2. Potential Cost-Effectiveness of Schistosomiasis Treatment for Reducing HIV Transmission in Africa – The Case of Zimbabwean Women

    PubMed Central

    Ndeffo Mbah, Martial L.; Poolman, Eric M.; Atkins, Katherine E.; Orenstein, Evan W.; Meyers, Lauren Ancel; Townsend, Jeffrey P.; Galvani, Alison P.

    2013-01-01

    Background Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection. Methods We developed a mathematical model of female genital schistosomiasis (FGS) and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa. Findings We showed that for a variation of efficacy between 30–70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16–101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30–70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36−92 million over a ten-year period. Conclusions In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel

  3. Incorporating the productivity benefits into the assessment of cost effective energy savings potential using conservation supply curves

    SciTech Connect

    Laitner, John A.; Ruth, Michael; Worrell, Ernst

    2001-07-24

    We review the relationship between energy efficiency improvement measures and productivity in industry. We propose a method to include productivity benefits in the economic assessment of the potential for energy efficiency improvement. The paper explores the implications of how this change in perspective might affect the evaluation of energy-efficient technologies for a study of the iron and steel industry in the U.S. It is found that including productivity benefits explicitly in the modeling parameters would double the cost-effective potential for energy efficiency improvement, compared to an analysis excluding those benefits. We provide suggestions for future research for this important area.

  4. Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data

    PubMed Central

    Pouwels, Koen B.; Bozdemir, Sefika E.; Yegenoglu, Selen; Celebi, Solmaz; McIntosh, E. David; Unal, Serhat; Postma, Maarten J.; Hacimustafaoglu, Mustafa

    2016-01-01

    Background Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey. Methods A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained. Results Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER. Conclusion RSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using

  5. Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis

    PubMed Central

    Phillips, Andrew N; Cambiano, Valentina; Miners, Alec; Revill, Paul; Pillay, Deenan; Lundgren, Jens D; Bennett, Diane; Raizes, Elliott; Nakagawa, Fumiyo; De Luca, Andrea; Vitoria, Marco; Barcarolo, Jhoney; Perriens, Joseph; Jordan, Michael R; Bertagnolio, Silvia

    2016-01-01

    Summary Background With continued roll-out of antiretroviral therapy (ART) in resource-limited settings, evidence is emerging of increasing levels of transmitted drug-resistant HIV. We aimed to compare the effectiveness and cost-effectiveness of different potential public health responses to substantial levels of transmitted drug resistance. Methods We created a model of HIV transmission, progression, and the effects of ART, which accounted for resistance generation, transmission, and disappearance of resistance from majority virus in the absence of drug pressure. We simulated 5000 ART programmatic scenarios with different prevalence levels of detectable resistance in people starting ART in 2017 (t0) who had not previously been exposed to antiretroviral drugs. We used the model to predict cost-effectiveness of various potential changes in policy triggered by different prevalence levels of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) measured in the population starting ART. Findings Individual-level resistance testing before ART initiation was not generally a cost-effective option, irrespective of the cost-effectiveness threshold. At a cost-effectiveness threshold of US$500 per quality-adjusted life-year (QALY), no change in policy was cost effective (ie, no change in policy would involve paying less than $500 per QALY gained), irrespective of the prevalence of pretreatment NNRTI resistance, because of the increased cost of the policy alternatives. At thresholds of $1000 or higher, and with the prevalence of pretreatment NNRTI resistance greater than 10%, a policy to measure viral load 6 months after ART initiation became cost effective. The policy option to change the standard first-line treatment to a boosted protease inhibitor regimen became cost effective at a prevalence of NNRTI resistance higher than 15%, for cost-effectiveness thresholds greater than $2000. Interpretation Cost-effectiveness of potential policies to adopt in response

  6. Potential of renewable and alternative energy sources

    NASA Astrophysics Data System (ADS)

    Konovalov, V.; Pogharnitskaya, O.; Rostovshchikova, A.; Matveenko, I.

    2015-11-01

    The article deals with application potential of clean alternative renewable energy sources. By means of system analysis the forecast for consumption of electrical energy in Tomsk Oblast as well as main energy sources of existing energy system have been studied up to 2018. Engineering potential of renewable and alternative energy sources is evaluated. Besides, ranking in the order of their efficiency descending is performed. It is concluded that Tomsk Oblast has high potential of alternative and renewable energy sources, among which the most promising development perspective is implementation of gasification stations to save fuel consumed by diesel power stations as well as building wind-power plants.

  7. Cost-effectiveness analysis of the direct and indirect impact of intranasal live attenuated influenza vaccination strategies in children: alternative country profiles

    PubMed Central

    Gibson, Edward; Begum, Najida; Martinón-Torres, Federico; Safadi, Marco Aurélio; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

    2016-01-01

    Background Influenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise. Objective The goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2–17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan). Methods The direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted. Results In the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice. Conclusion In addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in

  8. Potential interactions between alternative therapies and warfarin.

    PubMed

    Heck, A M; DeWitt, B A; Lukes, A L

    2000-07-01

    Potential and documented interactions between alternative therapy agents and warfarin are discussed. An estimated one third of adults in the United States use alternative therapies, including herbs. A major safety concern is potential interactions of alternative medicine products with prescription medications. This issue is especially important with respect to drugs with narrow therapeutic indexes, such as warfarin. Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark. Products that have been associated with documented reports of potential interactions with warfarin include coenzyme Q10, danshen, devil's claw, dong quai, ginseng, green tea, papain, and vitamin E. Interpretation of the available information on herb-warfarin interactions is difficult because nearly all of it is based on in vitro data, animal studies, or individual case reports. More study is needed to confirm and assess the clinical significance of these potential interactions. There is evidence that a wide range of alternative therapy products have the potential to interact with warfarin. Pharmacists and other health care professionals should question all patients about use of alternative therapies and report documented interactions to FDA's MedWatch program. PMID:10902065

  9. Potential interactions between alternative therapies and warfarin.

    PubMed

    Heck, A M; DeWitt, B A; Lukes, A L

    2000-07-01

    Potential and documented interactions between alternative therapy agents and warfarin are discussed. An estimated one third of adults in the United States use alternative therapies, including herbs. A major safety concern is potential interactions of alternative medicine products with prescription medications. This issue is especially important with respect to drugs with narrow therapeutic indexes, such as warfarin. Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark. Products that have been associated with documented reports of potential interactions with warfarin include coenzyme Q10, danshen, devil's claw, dong quai, ginseng, green tea, papain, and vitamin E. Interpretation of the available information on herb-warfarin interactions is difficult because nearly all of it is based on in vitro data, animal studies, or individual case reports. More study is needed to confirm and assess the clinical significance of these potential interactions. There is evidence that a wide range of alternative therapy products have the potential to interact with warfarin. Pharmacists and other health care professionals should question all patients about use of alternative therapies and report documented interactions to FDA's MedWatch program.

  10. An Analytical Process Model for Cost-Effectiveness/Productivity Evaluations of Alternative Educational Programs. Technical Report No. 390 (Parts, 1, 2, and 3).

    ERIC Educational Resources Information Center

    Marinelli, Joseph J.

    The purposes of this study were (1) to ascertain the state of the art with regard to cost effectiveness and productivity analyses in education and (2) to develop an appropriate cost effectiveness analytical process model for education. Chapters I through III present a review of the literature on cost effectiveness analysis, cost benefit analysis,…

  11. Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries

    PubMed Central

    Harmon, Thomas M.; Fisher, Kevin A.; McGlynn, Margaret G.; Stover, John; Warren, Mitchell J.; Teng, Yu; Näveke, Arne

    2016-01-01

    Background The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE. Methods An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost. Results If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios. Interpretation Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels. PMID:26731116

  12. Development of cost-effective media to increase the economic potential for larger-scale bioproduction of natural food additives by Lactobacillus rhamnosus , Debaryomyces hansenii , and Aspergillus niger.

    PubMed

    Salgado, José Manuel; Rodríguez, Noelia; Cortés, Sandra; Domínguez, José Manuel

    2009-11-11

    Yeast extract (YE) is the most common nitrogen source in a variety of bioprocesses in spite of the high cost. Therefore, the use of YE in culture media is one of the major technical hurdles to be overcome for the development of low-cost fermentation routes, making the search for alternative-cheaper nitrogen sources particularly desired. The aim of the current study is to develop cost-effective media based on corn steep liquor (CSL) and locally available vinasses in order to increase the economic potential for larger-scale bioproduction. Three microorganisms were evaluated: Lactobacillus rhamnosus , Debaryomyces hansenii , and Aspergillus niger . The amino acid profile and protein concentration was relevant for the xylitol and citric acid production by D. hansenii and A. niger , respectively. Metals also played an important role for citric acid production, meanwhile, D. hansenii showed a strong dependence with the initial amount of Mg(2+). Under the best conditions, 28.8 g lactic acid/L (Q(LA) = 0.800 g/L.h, Y(LA/S) = 0.95 g/g), 35.3 g xylitol/L (Q(xylitol) = 0.380 g/L.h, Y(xylitol/S) = 0.69 g/g), and 13.9 g citric acid/L (Q(CA) = 0.146 g/L.h, Y(CA/S) = 0.63 g/g) were obtained. The economic efficiency (E(p/euro)) parameter identify vinasses as a lower cost and more effective nutrient source in comparison to CSL.

  13. Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

    PubMed Central

    Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

    2014-01-01

    Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing

  14. Making Sense of Cost-Effectiveness and Benefit-Cost Analyses.

    ERIC Educational Resources Information Center

    Temkin, Sanford

    Although two economic methods, cost effectiveness and benefit-cost analysis, are frequently mentioned as useful tools for educational decision making, only one, cost effectiveness, has potential for making a contribution to this field. A benefit-cost analysis tries for each alternative to measure benefits and costs, which are then discounted to…

  15. A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.

    PubMed

    Bicki, Alexandra; Silva, Adam; Joseph, Valerie; Handoko, Ryan; Rico, Sheryl-vi; Burns, Jacqueline; Simonelli, Anna; Harrop, Jordan; Nedow, Jennifer; De Groot, Anne S

    2013-12-01

    Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

  16. Laparoscopic-Assisted Single-Port Appendectomy in Children: It Is a Safe and Cost-Effective Alternative to Conventional Laparoscopic Techniques?

    PubMed Central

    Sesia, Sergio B.; Haecker, Frank-Martin

    2013-01-01

    Aim. Laparoscopic-assisted single-port appendectomy (SPA), although combining the advantages of open and conventional laparoscopic surgery, is still not widely used in childhood. The aim of this study was to evaluate the safety and the cost effectiveness of SPA in children. Methods. After institutional review board approval, we retrospectively evaluated 262 children who underwent SPA. The appendix was dissected outside the abdominal cavity as in open surgery. For stump closure, we used two 3/0 vicryl RB-1 sutures. Results. We identified 146 boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1–15.9). Closure of the appendiceal stump using two sutures (cost: USD 15) was successful in all patients. Neither a stapler (cost: USD 276) nor endoloops (cost: USD 89) were used. During a follow-up of up to 69 months (range, 30–69), six obese children (2.3%, body mass index >95th percentile) developed an intra-abdominal abscess after perforated appendicitis. No insufficiency of the appendiceal stump was observed by ultrasound. Five of them were treated successfully by antibiotics, one child required drainage. Conclusion. The SPA technique with conventional extracorporal closure of the appendiceal stump is safe and cost effective. In our unit, SPA is the standard procedure for appendectomy in children. PMID:24381754

  17. Diagnostic Accuracy and Cost-Effectiveness of Alternative Methods for Detection of Soil-Transmitted Helminths in a Post-Treatment Setting in Western Kenya

    PubMed Central

    Kepha, Stella; Kihara, Jimmy H.; Njenga, Sammy M.; Pullan, Rachel L.; Brooker, Simon J.

    2014-01-01

    Objectives This study evaluates the diagnostic accuracy and cost-effectiveness of the Kato-Katz and Mini-FLOTAC methods for detection of soil-transmitted helminths (STH) in a post-treatment setting in western Kenya. A cost analysis also explores the cost implications of collecting samples during school surveys when compared to household surveys. Methods Stool samples were collected from children (n = 652) attending 18 schools in Bungoma County and diagnosed by the Kato-Katz and Mini-FLOTAC coprological methods. Sensitivity and additional diagnostic performance measures were analyzed using Bayesian latent class modeling. Financial and economic costs were calculated for all survey and diagnostic activities, and cost per child tested, cost per case detected and cost per STH infection correctly classified were estimated. A sensitivity analysis was conducted to assess the impact of various survey parameters on cost estimates. Results Both diagnostic methods exhibited comparable sensitivity for detection of any STH species over single and consecutive day sampling: 52.0% for single day Kato-Katz; 49.1% for single-day Mini-FLOTAC; 76.9% for consecutive day Kato-Katz; and 74.1% for consecutive day Mini-FLOTAC. Diagnostic performance did not differ significantly between methods for the different STH species. Use of Kato-Katz with school-based sampling was the lowest cost scenario for cost per child tested ($10.14) and cost per case correctly classified ($12.84). Cost per case detected was lowest for Kato-Katz used in community-based sampling ($128.24). Sensitivity analysis revealed the cost of case detection for any STH decreased non-linearly as prevalence rates increased and was influenced by the number of samples collected. Conclusions The Kato-Katz method was comparable in diagnostic sensitivity to the Mini-FLOTAC method, but afforded greater cost-effectiveness. Future work is required to evaluate the cost-effectiveness of STH surveillance in different settings. PMID

  18. Hematopoietic Progenitor Cell Mobilization with “Just-in-Time” Plerixafor Approach is a Cost Effective Alternative to Routine Plerixafor Use

    PubMed Central

    Veltri, Lauren; Cumpston, Aaron; Shillingburg, Alexandra; Wen, Sijin; Luo, Jin; Leadmon, Sonia; Watkins, Kathy; Craig, Michael; Hamadani, Mehdi; Kanate, Abraham S.

    2015-01-01

    Hematopoietic progenitor cell (HPC) mobilization with granulocyte-colony stimulating factor (G-CSF) and plerixafor results in superior CD34+ cell yield, when compared to mobilization with G-CSF alone in patients with myeloma and lymphoma. However, plerixafor-based approaches are associated with high costs. To circumvent this, several institutions use a so-called “just-in-time” plerixafor (JIT-P) approach, where plerixafor is only administered to patients likely to fail mobilization with G-CSF alone. Whether such a JIT-P approach is cost effective has not been confirmed to date. We present here, results of 136 patients with myeloma or lymphoma who underwent mobilization with two different approaches of plerixafor utilization. Between Jan 2010-Oct 2012 (n=76) patients uniformly received mobilization with G-CSF and plerixafor (routine G+P cohort). To reduce mobilization costs, between Nov 2012-Jun 2014 (n=60) patients were mobilized with JIT-P where plerixafor was only administered to patients likely to fail mobilization with G-CSF alone. Patients in routine G+P group had a higher median peak peripheral blood CD34+ cell count (62 vs. 29 cells/μL, p<0.001) and a higher median day 1 CD34+ cell yield (2.9 × 106 CD34+ cells/kg vs. 2.1 × 106 CD34+ cells/kg, p=0.001). The median total CD34+ cell collection was also higher in routine G+P group (5.8 × 106 CD34+ cells/kg vs. 4.5 × 106 CD34+ cells/kg, p=0.007). In the JIT-P group 40% (n=24) completed adequate HPC collection without plerixafor. There was no difference in mobilization failure rates. The mean number of plerixafor doses utilized in JIT-P was lower (1.3 vs. 2.1, p=0.0002). The mean estimated cost in the routine G+P group was higher than that in the JIT-P group (USD 27,513 vs. USD 23,597, p=0.01). Our analysis demonstrates that mobilization with a JIT-P approach is a safe, effective and cost efficient strategy for HPC collection. PMID:26475754

  19. Cost-effectiveness analysis of sandhill crane habitat management

    USGS Publications Warehouse

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  20. Alternating potentials assisted electrochemical deposition of mineralized collagen coatings.

    PubMed

    Zhuang, Junjun; Lin, Jun; Li, Juan; Weng, Wenjian; Cheng, Kui; Wang, Huiming

    2015-12-01

    Mineralized collagen coatings were synthesized by electrochemical deposition with alternating negative and positive potentials. The obtained coatings demonstrated a multi-layer structure alternating consisting of weakly and highly mineralized collagen layers and the proportion of each layer could be controlled by adjusting the deposition time. The coatings deposited using alternating potentials assisted electrochemical deposition (AP-ECD) showed significantly enhanced osteoblasts proliferation, and rhBMP-2 loading capability compared to those of the coatings deposited using constant potential electrochemical deposition (CP-ECD). The enhanced cytocompatibility and rhBMP-2 loading capability of the coatings might be attributed to their high proportion of weakly mineralized collagen layer. Furthermore, the deposition mechanism for alternating potentials is proposed as that positive potential induces deposition of negatively charged collagen fibrils to form a weakly mineralized collagen layer. Our results suggest that the present deposition method could be a promising approach to engineer mineralized collagen coating with better biological performances.

  1. Alternate Assessments Based on Alternate Achievement Standards: Policy, Practice, and Potential

    ERIC Educational Resources Information Center

    Schafer, William D., Ed.; Lissitz, Robert W., Ed.

    2009-01-01

    What really works in alternate assessment based on alternate achievement standards? Every state is working to know the answer--both to comply with federal requirements for evaluating students with severe cognitive disabilities, and to ensure that all students reach their full potential. This comprehensive book is the first to gather today's best…

  2. Wireless data communication alternatives for small public safety agencies: how one community cost-effectively solved its expanding field data requirements

    NASA Astrophysics Data System (ADS)

    Canning, Ryan M.; Lefebvre, Eric

    2005-06-01

    A growing number of Public Safety agencies have begun leveraging wireless data communication technology to improve tactical response capabilities as well as overall productivity. For years police departments subscribed to CDPD (Cellular Digital Packet Data) services to provide officers with basic dispatch data and criminal database access. Now as cellular carriers have deactivated CDPD and shifted to 2.5G and 3G data services such as 1xRTT, GPRS and EDGE, police departments are scrambling to fill the void. Not surprisingly, the extraordinary investments cellular carriers made to upgrade their infrastructures have been transferred to the customer, with monthly fees running as high as $80 a month per user. It's no wonder public safety agencies have been reluctant to adopt these services. Lost in the fray are those smaller police departments which account for nearly 90% of the nation's total. This group has increasingly sought out alternative data communication solutions that are not predicated on budget-busting monthly access fees. One such example is the Marco Island Police Department (MIPD) in Southwestern Florida that received a Federal grant to augment its existing voice communications with data. After evaluating several different technologies and vendors, MIPD chose a 900 MHz ad hoc mesh network solution based on its ability to provide reliable, high-speed and secure IP-based data communications over extensive distances. This paper will discuss technical details of Marco Island's mobile mesh network implementation; including: coverage area with 900 MHz spread spectrum radios, strategic repeater tower placement, interference, throughput performance, and the necessity for application-persistence software.

  3. Exactly Solvable Quantum Mechanical Potentials: An Alternative Approach.

    ERIC Educational Resources Information Center

    Pronchik, Jeremy N.; Williams, Brian W.

    2003-01-01

    Describes an alternative approach to finding exactly solvable, one-dimensional quantum mechanical potentials. Differs from the usual approach in that instead of starting with a particular potential and seeking solutions to the related Schrodinger equations, it begins with known solutions to second-order ordinary differential equations and seeks to…

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

    PubMed Central

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

    2016-01-01

    countries with substantial numbers of people with untreated, advanced HIV disease such as South Africa, CrAg screening before initiation of ART has the potential to reduce cryptococcal meningitis and save lives. Reflex screening compared to provider-initiated screening saves more lives and is likely to be cost saving or have low additional costs per additional year of life saved. PMID:27390864

  5. The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

    PubMed Central

    Chambers, Jeffrey; Généreux, Philippe; Lee, Arthur; Lewin, Jack; Young, Christopher; Crittendon, Janna; Mann, Marita; Garrison, Louis P.

    2015-01-01

    Background: Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360® Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective. Methods and results: In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895. Conclusions: Based on economic modeling

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

    SciTech Connect

    Letschert, Virginie E.; Bojda, Nicholas; Ke, Jing; McNeil, Michael A.

    2012-07-01

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

  7. An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

    PubMed

    Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

    2016-01-01

    Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem.

  8. An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

    PubMed

    Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

    2016-01-01

    Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. PMID:25926282

  9. Evaluation of the hypersensitivity potential of alternative butter flavorings

    PubMed Central

    Anderson, Stacey E.; Franko, Jennifer; Wells, J.R.; Lukomska, Ewa; Meade, B. Jean

    2015-01-01

    Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3 = 17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25–50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers. PMID:24007741

  10. Evaluation of the hypersensitivity potential of alternative butter flavorings.

    PubMed

    Anderson, Stacey E; Franko, Jennifer; Wells, J R; Lukomska, Ewa; Meade, B Jean

    2013-12-01

    Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3=17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25-50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers.

  11. Describing current and potential markets for alternative-fuel vehicles

    SciTech Connect

    1996-03-26

    Motor vehicles are a major source of greenhouse gases, and the rising numbers of motor vehicles and miles driven could lead to more harmful emissions that may ultimately affect the world`s climate. One approach to curtailing such emissions is to use, instead of gasoline, alternative fuels: LPG, compressed natural gas, or alcohol fuels. In addition to the greenhouse gases, pollutants can be harmful to human health: ozone, CO. The Clean Air Act Amendments of 1990 authorized EPA to set National Ambient Air Quality Standards to control this. The Energy Policy Act of 1992 (EPACT) was the first new law to emphasize strengthened energy security and decreased reliance on foreign oil since the oil shortages of the 1970`s. EPACT emphasized increasing the number of alternative-fuel vehicles (AFV`s) by mandating their incremental increase of use by Federal, state, and alternative fuel provider fleets over the new few years. Its goals are far from being met; alternative fuels` share remains trivial, about 0.3%, despite gains. This report describes current and potential markets for AFV`s; it begins by assessing the total vehicle stock, and then it focuses on current use of AFV`s in alternative fuel provider fleets and the potential for use of AFV`s in US households.

  12. Cost-Effective Fuel Treatment Planning

    NASA Astrophysics Data System (ADS)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  13. Cost effective energy conservation measures

    SciTech Connect

    Mashburn, W.H.

    1997-06-01

    Determining the cost effectiveness of energy conservation measures (ECM`s) consists of more than determining simple payback or life cycle costing. If strategic energy planning is involved, then establishment of an energy management program is of major importance. Training incorporated into the energy auditing process enhances the audit by involving knowledgeable employees, as well an increasing the chance of implementation of measures identified and reported. Involving employees in the process gives them ownership, and greatly improves the implementation rate. Once a company gets turned on to saving energy, it spreads like wildfire through the plant. Consultants who incorporate training as part of their audit will enhance their marketability. This paper discusses training techniques as a part of the auditing process, and lists major potential ECM`s that the author has found to have a high priority.

  14. Potential Alternatives Report for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes

    NASA Technical Reports Server (NTRS)

    Lewis, pattie

    2011-01-01

    Identifying and selecting alternative materials and technologies that have the potential to reduce the identified HazMats and hazardous air pollutants (HAPs), while incorporating sound corrosion prevention and control technologies, is a complicated task due to the fast pace at which new technologies emerge and rules change. The alternatives are identified through literature searches, electronic database and Internet searches, surveys, and/or personal and professional contacts. Available test data was then compiled on the proposed alternatives to determine if the materials meet the test objectives or if further)laboratory or field-testing will be required. After reviewing technical information documented in the PAR, government representatives, technical representatives from the affected facilities, and other stakeholders involved in the process will select the list of viable alternative coatings for consideration and testing under the project's Joint Test Protocol entitled Joint Test Protocol for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes and Field Test Plan entitled Field Evaluations Test Plan for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes, both prepared by ITB. Test results will be reported in a Joint Test Report upon completion oftesting. The selection rationale and conclusions are documented in this PAR. A cost benefit analysis will be prepared to quantify the estimated capital and process costs of coating alternatives and cost savings relative to the current coating processes, however, some initial cost data has been included in this PAR. For this coatings project, isocyanates, as found in aliphatic isocyanate polyurethanes, were identified as the target HazMat to be eliminated. Table 1-1 lists the target HazMats, the related process and application, current specifications, and affected programs.

  15. Potential alternative energy technologies on the Outer Continental Shelf.

    SciTech Connect

    Elcock, D.; Environmental Assessment

    2007-04-20

    This technical memorandum (TM) describes the technology requirements for three alternative energy technologies for which pilot and/or commercial projects on the U.S. Outer Continental Shelf (OCS) are likely to be proposed within the next five to seven years. For each of the alternative technologies--wind, wave, and ocean current--the TM first presents an overview. After each technology-specific overview, it describes the technology requirements for four development phases: site monitoring and testing, construction, operation, and decommissioning. For each phase, the report covers the following topics (where data are available): facility description, electricity generated, ocean area (surface and bottom) occupied, resource requirements, emissions and noise sources, hazardous materials stored or used, transportation requirements, and accident potential. Where appropriate, the TM distinguishes between pilot-scale (or demonstration-scale) facilities and commercial-scale facilities.

  16. Potential of trans fats policies to reduce socioeconomic inequalities in mortality from coronary heart disease in England: cost effectiveness modelling study

    PubMed Central

    Pearson-Stuttard, Jonathan; Hooton, William; Diggle, Peter; Capewell, Simon; O’Flaherty, Martin

    2015-01-01

    Objectives To determine health and equity benefits and cost effectiveness of policies to reduce or eliminate trans fatty acids from processed foods, compared with consumption remaining at most recent levels in England. Design Epidemiological modelling study. Setting Data from National Diet and Nutrition Survey, Low Income Diet and Nutrition Survey, Office of National Statistics, and health economic data from other published studies Participants Adults aged ≥25, stratified by fifths of socioeconomic circumstance. Interventions Total ban on trans fatty acids in processed foods; improved labelling of trans fatty acids; bans on trans fatty acids in restaurants and takeaways. Main outcome measures Deaths from coronary heart disease prevented or postponed; life years gained; quality adjusted life years gained. Policy costs to government and industry; policy savings from reductions in direct healthcare, informal care, and productivity loss. Results A total ban on trans fatty acids in processed foods might prevent or postpone about 7200 deaths (2.6%) from coronary heart disease from 2015-20 and reduce inequality in mortality from coronary heart disease by about 3000 deaths (15%). Policies to improve labelling or simply remove trans fatty acids from restaurants/fast food could save between 1800 (0.7%) and 3500 (1.3%) deaths from coronary heart disease and reduce inequalities by 600 (3%) to 1500 (7%) deaths, thus making them at best half as effective. A total ban would have the greatest net cost savings of about £265m (€361m, $415m) excluding reformulation costs, or £64m if substantial reformulation costs are incurred outside the normal cycle. Conclusions A regulatory policy to eliminate trans fatty acids from processed foods in England would be the most effective and equitable policy option. Intermediate policies would also be beneficial. Simply continuing to rely on industry to voluntary reformulate products, however, could have negative health and economic outcomes

  17. Effects of disputes and easement violations on the cost-effectiveness of land conservation

    PubMed Central

    Arcese, Peter

    2015-01-01

    Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments. PMID:26413430

  18. Effects of disputes and easement violations on the cost-effectiveness of land conservation.

    PubMed

    Schuster, Richard; Arcese, Peter

    2015-01-01

    Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments.

  19. Alternative Fuels and Their Potential Impact on Aviation

    NASA Technical Reports Server (NTRS)

    Daggett, D.; Hendricks, R.; Walther, R.

    2006-01-01

    With a growing gap between the growth rate of petroleum production and demand, and with mounting environmental needs, the aircraft industry is investigating issues related to fuel availability, candidates for alternative fuels, and improved aircraft fuel efficiency. Bio-derived fuels, methanol, ethanol, liquid natural gas, liquid hydrogen, and synthetic fuels are considered in this study for their potential to replace or supplement conventional jet fuels. Most of these fuels present the airplane designers with safety, logistical, and performance challenges. Synthetic fuel made from coal, natural gas, or other hydrocarbon feedstock shows significant promise as a fuel that could be easily integrated into present and future aircraft with little or no modification to current aircraft designs. Alternatives, such as biofuel, and in the longer term hydrogen, have good potential but presently appear to be better suited for use in ground transportation. With the increased use of these fuels, a greater portion of a barrel of crude oil can be used for producing jet fuel because aircraft are not as fuel-flexible as ground vehicles.

  20. Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries.

    PubMed Central

    Robberstad, Bjarne; Strand, Tor; Black, Robert E.; Sommerfelt, Halvor

    2004-01-01

    OBJECTIVE: To analyse the incremental costs, effects and cost-effectiveness of zinc used as adjunct therapy to standard treatment of acute childhood diarrhoea, including dysentery, and to reassess the cost-effectiveness of standard case management with oral rehydration salt (ORS). METHODS: A decision tree was used to model expected clinical outcomes and expected costs under four alternative treatment strategies. The best available epidemiological, clinical and economic evidence was used in the calculations, and the United Republic of Tanzania was the reference setting. Probabilistic cost-effectiveness analysis was performed using a Monte-Carlo simulation technique and the potential impacts of uncertainty in single parameters were explored in one-way sensitivity analyses. FINDINGS: ORS was found to be less cost-effective than previously thought. The use of zinc as adjunct therapy significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness. The results were particularly sensitive to mortality rates in non-dysenteric diarrhoea, but the alternative interventions can be defined as highly cost-effective even in pessimistic scenarios. CONCLUSION: There is sufficient evidence to recommend the inclusion of zinc into standard case management of both dysenteric and non-dysenteric acute diarrhoea.A direct transfer of our findings from the United Republic of Tanzania to other settings is not justified, but there are no indications of large geographical differences in the efficacy of zinc. It is therefore plausible that our findings are also applicable to other developing countries. PMID:15500284

  1. Alternate corrections for estimating actual wetland evapotranspiration from potential evapotranspiration

    USGS Publications Warehouse

    Barclay, Shoemaker W.; Sumner, D.M.

    2006-01-01

    Corrections can be used to estimate actual wetland evapotranspiration (AET) from potential evapotranspiration (PET) as a means to define the hydrology of wetland areas. Many alternate parameterizations for correction coefficients for three PET equations are presented, covering a wide range of possible data-availability scenarios. At nine sites in the wetland Everglades of south Florida, USA, the relatively complex PET Penman equation was corrected to daily total AET with smaller standard errors than the PET simple and Priestley-Taylor equations. The simpler equations, however, required less data (and thus less funding for instrumentation), with the possibility of being corrected to AET with slightly larger, comparable, or even smaller standard errors. Air temperature generally corrected PET simple most effectively to wetland AET, while wetland stage and humidity generally corrected PET Priestley-Taylor and Penman most effectively to wetland AET. Stage was identified for PET Priestley-Taylor and Penman as the data type with the most correction ability at sites that are dry part of each year or dry part of some years. Finally, although surface water generally was readily available at each monitoring site, AET was not occurring at potential rates, as conceptually expected under well-watered conditions. Apparently, factors other than water availability, such as atmospheric and stomata resistances to vapor transport, also were limiting the PET rate. ?? 2006, The Society of Wetland Scientists.

  2. 76 FR 24925 - Solicitation for Public Comment on Potential Alternatives To Resolve Generic Safety Issue 191...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-03

    ... COMMISSION Solicitation for Public Comment on Potential Alternatives To Resolve Generic Safety Issue 191, Pressurized Water Reactor Sump Performance AGENCY: Nuclear Regulatory Commission (NRC). ACTION: Solicitation of public comment. SUMMARY: The NRC is seeking public comment on potential alternatives for...

  3. The Sunk Cost Effect in Pigeons and Humans

    ERIC Educational Resources Information Center

    Navarro, Anton D.; Fantino, Edmund

    2005-01-01

    The sunk cost effect is the increased tendency to persist in an endeavor once an investment of money, effort, or time has been made. To date, humans are the only animal in which this effect has been observed unambiguously. We developed a behavior-analytic model of the sunk cost effect to explore the potential for this behavior in pigeons as well…

  4. Cost-Effective Applications of Computer-Based Education

    ERIC Educational Resources Information Center

    Avner, R. A.

    1978-01-01

    Cost effective applications of CBE do exist; however, they demand detailed cost information for all appropriate alternatives to CAI, a thorough understanding of instructional design, and an expert knowledge of the relative capabilities of alternative media in supporting particular instructional approaches. (Author/RAO)

  5. Sublingual Delivery of Frovatriptan: An Indication of Potential Alternative Route

    PubMed Central

    Verma, Surajpal; Prasad, Shyam Baboo

    2014-01-01

    Frovatriptan, a 5-HT1B and 5-HT1D receptor agonist, is used for the treatment of acute migraine attack. This molecule is classified into second line therapy because of its slow onset of action (peak response obtained after 4 hours of administration) and low bioavailability (25%). Moreover, its therapy is the most costly among all triptans. Attempt has been made in present work to suggest a way out to fasten its onset of action and to enhance its bioavailability. Prepared tablets were evaluated by physicochemical tests, in vitro permeation studies, ex vivo permeation studies, and histopathological studies. Suitable mathematical calculations were performed to calculate the minimum amount of bioavailability that could be enhanced. Tablets containing chitosan (5% w/w) were found to give optimum results. Prepared tablets can double the bioavailability of frovatriptan and can initiate its response within 10 minutes of its administration. Suggestive alternative has the potential to increase the efficacy of frovatriptan for treating acute migraine attack. PMID:27433492

  6. Potential Alternatives Report for Validation of Alternative Low-Emission Surface PreparationlDepainting Technologies for Structural Steel

    NASA Technical Reports Server (NTRS)

    Lewis, Pattie

    2006-01-01

    For this project, particulates and solvents used during the depainting process of steel structures were the identified hazardous material (HazMat) targeted for elimination or reduction. This Potential Alternatives Report (PAR) provides technical analyses of identified alternatives to the current coating removal processes, criteria used to select alternatives for further analysis, and a list of those alternatives recommended for testing. The initial coating removal alternatives list was compiled using literature searches and center participant recommendations. The involved project participants initially considered fifteen (15) alternatives. In late 2004, stakeholders down-selected the list and identified specific processes as potential alternatives to the current depainting methods. The selected alternatives were: 1. Plastic Blast Media 2. Hard Abrasive Media 3. Sponge Blast Media 4. Mechanical Removal with Vacuum Attachment 5. Liquid Nitrogen 6. Laser Coating Removal Available information about these processes was used to analyze the technical merits and the potential environmental, safety, and occupational health (ESOH) impacts of these methods. A preliminary cost benefit analysis will be performed to determine if implementation of alternative technologies is economically justified. NASA AP2

  7. Airports offer unrealized potential for alternative energy production.

    PubMed

    DeVault, Travis L; Belant, Jerrold L; Blackwell, Bradley F; Martin, James A; Schmidt, Jason A; Wes Burger, L; Patterson, James W

    2012-03-01

    Scaling up for alternative energy such as solar, wind, and biofuel raises a number of environmental issues, notably changes in land use and adverse effects on wildlife. Airports offer one of the few land uses where reductions in wildlife abundance and habitat quality are necessary and socially acceptable, due to risk of wildlife collisions with aircraft. There are several uncertainties and limitations to establishing alternative energy production at airports, such as ensuring these facilities do not create wildlife attractants or other hazards. However, with careful planning, locating alternative energy projects at airports could help mitigate many of the challenges currently facing policy makers, developers, and conservationists.

  8. Airports Offer Unrealized Potential for Alternative Energy Production

    NASA Astrophysics Data System (ADS)

    Devault, Travis L.; Belant, Jerrold L.; Blackwell, Bradley F.; Martin, James A.; Schmidt, Jason A.; Wes Burger, L.; Patterson, James W.

    2012-03-01

    Scaling up for alternative energy such as solar, wind, and biofuel raises a number of environmental issues, notably changes in land use and adverse effects on wildlife. Airports offer one of the few land uses where reductions in wildlife abundance and habitat quality are necessary and socially acceptable, due to risk of wildlife collisions with aircraft. There are several uncertainties and limitations to establishing alternative energy production at airports, such as ensuring these facilities do not create wildlife attractants or other hazards. However, with careful planning, locating alternative energy projects at airports could help mitigate many of the challenges currently facing policy makers, developers, and conservationists.

  9. Phytogenic Compounds as Alternatives to In-Feed Antibiotics: Potentials and Challenges in Application

    PubMed Central

    Yang, Chengbo; Chowdhury, M .A. Kabir; Hou, Yongqing; Gong, Joshua

    2015-01-01

    This article summarizes current experimental knowledge on the efficacy, possible mechanisms and feasibility in the application of phytogenic products as feed additives for food-producing animals. Phytogenic compounds comprise a wide range of plant-derived natural bioactive compounds and essential oils are a major group. Numerous studies have demonstrated that phytogenic compounds have a variety of functions, including antimicrobial/antiviral, antioxidative and anti-inflammation effects and improvement in the palatability of feed and gut development/health. However, the mechanisms underlying their functions are still largely unclear. In the past, there has been a lack of consistency in the results from both laboratory and field studies, largely due to the varied composition of products, dosages, purities and growing conditions of animals used. The minimal inhibitory concentration (MIC) of phytogenic compounds required for controlling enteric pathogens may not guarantee the best feed intake, balanced immunity of animals and cost-effectiveness in animal production. The lipophilic nature of photogenic compounds also presents a challenge in effective delivery to the animal gut and this can partially be resolved by microencapsulation and combination with other compounds (synergistic effect). Interestingly, the effects of photogenic compounds on anti-inflammation, gut chemosensing and possible disruption of bacterial quorum sensing could explain a certain number of studies with different animal species for the better production performance of animals that have received phytogenic feed additives. It is obvious that phytogenic compounds have good potential as an alternative to antibiotics in feed for food animal production and the combination of different phytogenic compounds appears to be an approach to improve the efficacy and safety of phytogenic compounds in the application. It is our expectation that the recent development of high-throughput and

  10. Cost-effectiveness of colorectal cancer screening - an overview.

    PubMed

    Lansdorp-Vogelaar, Iris; Knudsen, Amy B; Brenner, Hermann

    2010-08-01

    There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.

  11. Cost-effective conservation of an endangered frog under uncertainty.

    PubMed

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  12. Cost-effective conservation of an endangered frog under uncertainty.

    PubMed

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  13. Cognitive-behavioral treatment for panic disorder with agoraphobia: a randomized, controlled trial and cost-effectiveness analysis.

    PubMed

    Roberge, Pasquale; Marchand, André; Reinharz, Daniel; Savard, Pierre

    2008-05-01

    A randomized, controlled trial was conducted to examine the cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants were randomly assigned to standard (n = 33), group (n = 35), and brief (n = 32) treatment conditions. Results show significant clinical and statistical improvement on standard symptom measures and quality of life from baseline to posttreatment and 3-month follow-up, with no significant differences between treatment conditions. Compared with standard CBT, brief and group CBT incurred lower treatment costs and had a superior cost-effectiveness ratio, suggesting the potential of these alternative treatment conditions in increasing access to effective treatment. PMID:18391051

  14. Winter safflower, a potential alternative crop for the Pacific Northwest

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The dryland cropping system in the Pacific Northwest is dominated by a winter wheat-summer fallow cropping system that occupies more than 90% of the dryland hectares. Success in finding a viable alternative crop has been limited because the annual precipitation in this region varies from less than 1...

  15. The Costs and Potential Benefits of Alternative Scholarly Publishing Models

    ERIC Educational Resources Information Center

    Houghton, John W.

    2011-01-01

    Introduction: This paper reports on a study undertaken for the UK Joint Information Systems Committee (JISC), which explored the economic implications of alternative scholarly publishing models. Rather than simply summarising the study's findings, this paper focuses on the approach and presents a step-by-step account of the research process,…

  16. Heterologously expressed Aspergillus aculeatus β-glucosidase in Saccharomyces cerevisiae is a cost-effective alternative to commercial supplementation of β-glucosidase in industrial ethanol production using Trichoderma reesei cellulases.

    PubMed

    Treebupachatsakul, Treesukon; Nakazawa, Hikaru; Shinbo, Hideaki; Fujikawa, Hiroki; Nagaiwa, Asami; Ochiai, Nobuhiro; Kawaguchi, Takashi; Nikaido, Mitsuru; Totani, Kazuhide; Shioya, Koki; Shida, Yosuke; Morikawa, Yasushi; Ogasawara, Wataru; Okada, Hirofumi

    2016-01-01

    Trichoderma reesei is a filamentous organism that secretes enzymes capable of degrading cellulose to cellobiose. The culture supernatant of T. reesei, however, lacks sufficient activity to convert cellobiose to glucose using β-glucosidase (BGL1). In this study, we identified a BGL (Cel3B) from T. reesei (TrCel3B) and compared it with the active β-glucosidases from Aspergillus aculeatus (AaBGL1). AaBGL1 showed higher stability and conversion of sugars to ethanol compared to TrCel3B, and therefore we chose to express this recombinant protein for use in fermentation processes. We expressed the recombinant protein in the yeast Saccharomyces cerevisiae, combined it with the superb T. reesei cellulase machinery and used the combination in a simultaneous saccharification and fermentation (SSF) process, with the hope that the recombinant would supplement the BGL activity. As the sugars were processed, the yeast immediately converted them to ethanol, thereby eliminating the problem posed by end product inhibition. Recombinant AaBGL1 activity was compared with Novozyme 188, a commercially available supplement for BGL activity. Our results show that the recombinant protein is as effective as the commercial supplement and can process sugars with equal efficiency. Expression of AaBGL1 in S. cerevisiae increased ethanol production effectively. Thus, heterologous expression of AaBGL1 in S. cerevisiae is a cost-effective and efficient process for the bioconversion of ethanol from lignocellulosic biomass.

  17. Electronic cigarettes: a safer alternative or potential poison?

    PubMed

    Smith, Janet E

    2014-10-01

    Electronic cigarettes have been marketed as a safer alternative to cigarettes, and their use is expanding exponentially. However, there is a severe lack of scientific data about the ingredients in the liquid used in the device and the health consequences of using electronic cigarettes. As technology has outpaced regulations, the production and sale of electronic cigarettes are, as yet, unregulated and do not fall under the purview of the Food and Drug Administration. This article will review the mechanism of action and what is currently known about the safety of electronic cigarettes. The risk of poisoning for children will also be identified, as well as the implications for home healthcare clinicians.

  18. Cost-Effectiveness Analysis of School Desegregation Plans.

    ERIC Educational Resources Information Center

    Rossell, Christine H.

    Cost-effectiveness analysis provides a useful tool for choosing between alternative desegregation plans or justifying one particular plan. Previous analyses of school desegregation effects on white enrollment, which focus only upon costs, have had limited use for policy. Traditional cost-benefit analysis poses problems because of the difficulty of…

  19. Evaluating the Cost-Effectiveness of Instructional Programs.

    ERIC Educational Resources Information Center

    Alkin, Marvin C.

    A model of cost-effectiveness is outlined which enables consideration of some non-financial, as well as financial, elements of educational systems at school or district levels. The model enables the decision-maker to compare educational outcomes of different units, to assess the impact of alternative levels of financial input, and to select…

  20. Assessing the Cost-Effectiveness of Family Connections

    ERIC Educational Resources Information Center

    DePanfilis, Diane; Dubowitz, Howard; Kunz, James

    2008-01-01

    Objective: To assess the cost-effectiveness of two alternate forms of Family Connections (FC), a child neglect prevention program, in relation to changes in risk and protective factors and improvements in child safety and behavioral outcomes. Methods: In the original FC study, a sample of 154 families (473 children) in a poor, urban neighborhood,…

  1. The AGS (alternating gradient synchrotron): Performance and potential

    SciTech Connect

    Ratner, L.G.

    1989-01-01

    This report discusses the following topics on the Brookhaven AGS: basic parameters, description of the accelerator complex and proton operation; operation with heavy ions and polarized protons; AGS upgrades and expanded potential. (LSP)

  2. Organization of potential alternative nitrogenase genes from Clostridium pasteurianum.

    PubMed

    Zinoni, F; Robson, R M; Robson, R L

    1993-07-18

    A 3.3 kb HindIII genomic DNA fragment from Clostridium pasteurianum ATCC 6013 which hybridized to the anfDGK genes for the Fe-only 'alternative' nitrogenase from Azotobacter vinelandii was cloned. Open reading frames (ORFs D, G, and K) with high sequence identity to anfD, anfG, and part of anfK were located in the nucleotide sequence obtained for 2494 bp of this fragment. In C. pasteurianum, ORFD maps approximately 1.8 kb downstream of nifH3 and is transcribed in the same direction. There was no evidence for additional copies of ORFDGK-like sequences in the genome of C. pasteurianum, other than those encoding the Mo-nitrogenase. Physiological and biochemical studies suggest that a nitrogenase not requiring molybdenum may occur in C. pasteurianum. This enzyme is probably encoded by nifH3 and ORFs D, G, and K identified here. PMID:8334167

  3. Heterologously expressed Aspergillus aculeatus β-glucosidase in Saccharomyces cerevisiae is a cost-effective alternative to commercial supplementation of β-glucosidase in industrial ethanol production using Trichoderma reesei cellulases.

    PubMed

    Treebupachatsakul, Treesukon; Nakazawa, Hikaru; Shinbo, Hideaki; Fujikawa, Hiroki; Nagaiwa, Asami; Ochiai, Nobuhiro; Kawaguchi, Takashi; Nikaido, Mitsuru; Totani, Kazuhide; Shioya, Koki; Shida, Yosuke; Morikawa, Yasushi; Ogasawara, Wataru; Okada, Hirofumi

    2016-01-01

    Trichoderma reesei is a filamentous organism that secretes enzymes capable of degrading cellulose to cellobiose. The culture supernatant of T. reesei, however, lacks sufficient activity to convert cellobiose to glucose using β-glucosidase (BGL1). In this study, we identified a BGL (Cel3B) from T. reesei (TrCel3B) and compared it with the active β-glucosidases from Aspergillus aculeatus (AaBGL1). AaBGL1 showed higher stability and conversion of sugars to ethanol compared to TrCel3B, and therefore we chose to express this recombinant protein for use in fermentation processes. We expressed the recombinant protein in the yeast Saccharomyces cerevisiae, combined it with the superb T. reesei cellulase machinery and used the combination in a simultaneous saccharification and fermentation (SSF) process, with the hope that the recombinant would supplement the BGL activity. As the sugars were processed, the yeast immediately converted them to ethanol, thereby eliminating the problem posed by end product inhibition. Recombinant AaBGL1 activity was compared with Novozyme 188, a commercially available supplement for BGL activity. Our results show that the recombinant protein is as effective as the commercial supplement and can process sugars with equal efficiency. Expression of AaBGL1 in S. cerevisiae increased ethanol production effectively. Thus, heterologous expression of AaBGL1 in S. cerevisiae is a cost-effective and efficient process for the bioconversion of ethanol from lignocellulosic biomass. PMID:26073313

  4. An alternating-direction implicit algorithm for unsteady potential flow

    NASA Technical Reports Server (NTRS)

    Chipman, R.; Jameson, A.

    1981-01-01

    An implicit finite-difference scheme is presented for the efficient computation of unsteady potential flow about airfoils. The formulation uses density and the velocity potential as dependent variables and is cast in conservation form to assure the theoretically correct determination of shockwave location and speed. To enable boundary conditions to be imposed directly on the airfoil surface, a time-varying sheared-rectilinear coordinate transformation is employed. Calculated time-history solutions on a pulsating airfoil are compared with the results of other unsteady transonic codes, including a previous method of the authors. The present method is demonstrated to be unconditionally stable and to give accurate solutions with sharply resolved shocks.

  5. Learning Potential Tests: An Alternative to Intelligence Tests?

    ERIC Educational Resources Information Center

    Wijnstra, Johan M.

    This paper presents preliminary results regarding the predictive validity of learning potential tests administered in an exploratory study in Rotterdam (Holland) concerning the referral of minority students to special education. The central question of the study was why some students of Surinamese, Turkish, and Moroccan origin were placed in…

  6. Cost-Effectiveness of Payments for Ecosystem Services with Dual Goals of Environment and Poverty Alleviation

    NASA Astrophysics Data System (ADS)

    Gauvin, Crystal; Uchida, Emi; Rozelle, Scott; Xu, Jintao; Zhan, Jinyan

    2010-03-01

    The goal of this article is to understand strategies by which both the environmental and poverty alleviation objectives of PES programs can be achieved cost effectively. To meet this goal, we first create a conceptual framework to understand the implications of alternative targeting when policy makers have both environmental and poverty alleviation goals. We then use the Grain for Green program in China, the largest PES program in the developing world, as a case study. We also use a data set from a survey that we designed and implemented to evaluate the program. Using the data set we first evaluate what factors determined selection of program areas for the Grain for Green program. We then demonstrate the heterogeneity of parcels and households and examine the correlations across households and their parcels in terms of their potential environmental benefits, opportunity costs of participating, and the asset levels of households as an indicator of poverty. Finally, we compare five alternative targeting criteria and simulate their performance in terms of cost effectiveness in meeting both the environmental and poverty alleviation goals when given a fixed budget. Based on our simulations, we find that there is a substantial gain in the cost effectiveness of the program by targeting parcels based on the “gold standard,” i.e., targeting parcels with low opportunity cost and high environmental benefit managed by poorer households.

  7. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

    PubMed

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

    2013-06-01

    Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.

  8. Cost-Effectiveness of Aspirin Adjuvant Therapy in Early Stage Colorectal Cancer in Older Patients

    PubMed Central

    Soon, Swee Sung; Chia, Whay-Kuang; Chan, Mun-ling Sarah; Ho, Gwo Fuang; Jian, Xiao; Deng, Yan Hong; Tan, Chuen-Seng; Sharma, Atul; Segelov, Eva; Mehta, Shaesta; Ali, Raghib; Toh, Han-Chong; Wee, Hwee-Lin

    2014-01-01

    Background & Aims Recent observational studies showed that post-operative aspirin use reduces cancer relapse and death in the earliest stages of colorectal cancer. We sought to evaluate the cost-effectiveness of aspirin as an adjuvant therapy in Stage I and II colorectal cancer patients aged 65 years and older. Methods Two five-state Markov models were constructed separately for Stage I and II colorectal cancer using TreeAge Pro 2014. Two hypothetical cohorts of 10,000 individuals at a starting age of 65 years and with colorectal cancer in remission were put through the models separately. Cost-effectiveness of aspirin was evaluated against no treatment (Stage I and II) and capecitabine (Stage II) over a 20-year period from the United States societal perspective. Extensive one-way sensitivity analyses and multivariable Probabilistic Sensitivity Analyses (PSA) were performed. Results In the base case analyses, aspirin was cheaper and more effective compared to other comparators in both stages. Sensitivity analyses showed that no treatment and capecitabine (Stage II only) can be cost-effective alternatives if the utility of taking aspirin is below 0.909, aspirin’s annual fatal adverse event probability exceeds 0.57%, aspirin’s relative risk of disease progression is 0.997 or more, or when capecitabine’s relative risk of disease progression is less than 0.228. Probabilistic Sensitivity Analyses (PSA) further showed that aspirin could be cost-effective 50% to 80% of the time when the willingness-to-pay threshold was varied from USD20,000 to USD100,000. Conclusion Even with a modest treatment benefit, aspirin is likely to be cost-effective in Stage I and II colorectal cancer, thus suggesting a potential unique role in secondary prevention in this group of patients. PMID:25250815

  9. A critical evaluation of the cost-effectiveness of radon protection methods in new homes in a radon affected area of England.

    PubMed

    Coskeran, Thomas; Denman, Antony; Phillips, Paul; Tornberg, Roger

    2009-08-01

    In the UK, building new homes in areas prone to radon gas is currently subject to regulations that require installation of radon-proof membranes. These membranes are not, however, the only way to protect residents of new homes against radon's potential to cause lung cancer. Alternative regulatory regimes can be constructed that would achieve the same end. The purpose of this paper is to examine the cost-effectiveness of four alternative regimes and so determine if building regulations for new homes could be altered to protect residents from the effects of radon more cost-effectively than at present. In addressing this question, the paper also contributes to the wider debate on how best to reduce the effect on public health of exposure to radon. The measure of cost-effectiveness used, cost per quality-adjusted life-year gained, is determined from radon test results obtained in properties in Brixworth, England, UK, a radon Affected Area. Confidence intervals for the cost-effectiveness estimates are also derived using bootstrap techniques. The central estimates of cost-effectiveness range from 2870 pounds per quality-adjusted life-year gained for the most cost-effective of the alternative regimes to 6182 pounds for the current regime. These results suggest that alternative regimes may be more cost-effective in tackling the radon problem. A definitive assessment of the most suitable to adopt will require extensive negotiation between government departments, the construction industry, and other interested parties to ensure acceptance of any new regime. The paper offers suggestions for future research that should help in the process of identifying the key features of a new regulatory approach.

  10. Chemical heat pump cost effectiveness evaluation

    NASA Astrophysics Data System (ADS)

    Standley, W. R.

    1982-02-01

    The cost-effectiveness and energy-effectiveness of existing chemical heat pump (CHP) concepts is compared with a baseline of conventional energy technologies and a group of near-term emerging energy technologies with which CHPs are expected to compete. The analysis is structured to evaluate these systems functioning as the primary space conditioning unit of both a 'standard' single-family detached home and a 'representative' commercial building. Each HVAC system and application is analyzed in each of two locations in the United States, the southwest (Albuquerque, NM) and the northeast (Boston, MA). In addition, the CHPs are evaluated in a 'representative' industrial waste heat upgrading application, and compared to potentially-competitive technologies for industrial 'heat pumping'.

  11. Ficus deltoidea: A Potential Alternative Medicine for Diabetes Mellitus.

    PubMed

    Adam, Zainah; Khamis, Shafii; Ismail, Amin; Hamid, Muhajir

    2012-01-01

    Ficus deltoidea from the Moraceae family has been scientifically proven to reduce hyperglycemia at different prandial states. In this study, we evaluate the mechanisms that underlie antihyperglycemic action of Ficus deltoidea. The results had shown that hot aqueous extract of Ficus deltoidea stimulated insulin secretion significantly with the highest magnitude of stimulation was 7.31-fold (P < 0.001). The insulin secretory actions of the hot aqueous extract involved K(+) (ATP) channel-dependent and K(+) (ATP)-channel-independent pathway. The extract also has the ability to induce the usage of intracellular Ca(2+) to trigger insulin release. The ethanolic and methanolic extracts enhanced basal and insulin-mediated glucose uptake into adipocytes cells. The extracts possess either insulin-mimetic or insulin-sensitizing property or combination of both properties during enhancing glucose uptake into such cells. Meanwhile, the hot aqueous and methanolic extracts augmented basal and insulin-stimulated adiponectin secretion from adipocytes cells. From this study, it is suggested that Ficus deltoidea has the potential to be developed as future oral antidiabetic agent.

  12. Ficus deltoidea: A Potential Alternative Medicine for Diabetes Mellitus

    PubMed Central

    Adam, Zainah; Khamis, Shafii; Ismail, Amin; Hamid, Muhajir

    2012-01-01

    Ficus deltoidea from the Moraceae family has been scientifically proven to reduce hyperglycemia at different prandial states. In this study, we evaluate the mechanisms that underlie antihyperglycemic action of Ficus deltoidea. The results had shown that hot aqueous extract of Ficus deltoidea stimulated insulin secretion significantly with the highest magnitude of stimulation was 7.31-fold (P < 0.001). The insulin secretory actions of the hot aqueous extract involved K+ ATP channel-dependent and K+ ATP-channel-independent pathway. The extract also has the ability to induce the usage of intracellular Ca2+ to trigger insulin release. The ethanolic and methanolic extracts enhanced basal and insulin-mediated glucose uptake into adipocytes cells. The extracts possess either insulin-mimetic or insulin-sensitizing property or combination of both properties during enhancing glucose uptake into such cells. Meanwhile, the hot aqueous and methanolic extracts augmented basal and insulin-stimulated adiponectin secretion from adipocytes cells. From this study, it is suggested that Ficus deltoidea has the potential to be developed as future oral antidiabetic agent. PMID:22701507

  13. A Proposed Alternative Measure for Climate Change Potential

    NASA Astrophysics Data System (ADS)

    DeGroff, F. A.

    2015-12-01

    Background/Issue There currently exists no comprehensive metric to measure and value anthropogenic changes in carbon flux between geospheric carbon sinks. We propose that changes in carbon residence time within geospheres be used as a metric to assess anthropogenic changes in carbon flux, and the term 'carbon quality' (cq) be used to describe such changes. Carbon residence time represents the inverse of carbon flux; as carbon flux increases, the corresponding cq will decrease, and vice versa. Focusing on atmospheric carbon emissions as a measure of anthropogenic activity on the environment ignores the fungible characteristics of carbon that are crucial in both the biosphere and the worldwide economy. The ubiquitous carbon molecule enables the enormous diversity in the biosphere, as well as the widespread, strategic economic presence of carbon in the world economy. Focusing on a single form of inorganic carbon as a proxy metric for the plethora of anthropogenic activity and carbon compounds will prove inadequate, convoluted, and unmanageable. A broader, more basic metric is needed to capture the breath and scope of carbon activity. Results/Conclusions We propose a logarithmic vector scale for cq to measure anthropogenic carbon flux. The distance between vector points, e.g. the starting and ending residence times, would represent the change in cq. A base-10 logarithmic scale would allow the addition and subtraction of exponents to calculate changes in cq. As carbon moves between carbon reservoirs, the change in cq is measured as: cq = b ( log10 [mean carbon residence time] ) where b represents the carbon price coefficient for a particular country. For any country, cq measures the climate change potential for any organic carbon when converted to inorganic CO2, or to any lower residence time carbon state. The greater the carbon fees for a country, the larger the b coefficient would be, and the greater the import fees would be to achieve carbon parity on imports from

  14. Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis

    PubMed Central

    Klein, Eili Y.; Smith, David L.; Cohen, Justin M.; Laxminarayan, Ramanan

    2015-01-01

    The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage. PMID:25994293

  15. Cost-Effectiveness Analysis. Instructor Guide. Working for Clean Water: An Information Program for Advisory Groups.

    ERIC Educational Resources Information Center

    Buskirk, E. Drannon, Jr.

    Presented is the instructor's manual for a one-hour presentation on cost-effectiveness analysis. Topics covered are the scope of cost-effectiveness analysis, basic assessment procedures, and the role of citizens in the analysis of alternatives. A supplementary audiovisual program is available. These materials are part of the Working for Clean…

  16. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  17. The Cost-Effectiveness of Comprehensive School Reform and Rapid Assessment

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2008-01-01

    Analysis of the cost-effectiveness of 29 Comprehensive School Reform (CSR) models suggests that all 29 models are less cost-effective than an alternative approach for raising student achievement, involving rapid assessment systems that test students 2 to 5 times per week in math and reading and provide rapid feedback of the results to students and…

  18. Cost-Effectiveness Analysis of the New South Wales Adult Drug Court Program

    ERIC Educational Resources Information Center

    Shanahan, Marian; Lancsar, Emily; Haas, Marion; Lind, Bronwyn; Weatherburn, Don; Chen, Shuling

    2004-01-01

    In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the…

  19. The Sunk Cost Effect with Pigeons: Some Determinants of Decisions about Persistence

    ERIC Educational Resources Information Center

    Macaskill, Anne C.; Hackenberg, Timothy D.

    2012-01-01

    The sunk cost effect occurs when an individual persists following an initial investment, even when persisting is costly in the long run. The current study used a laboratory model of the sunk cost effect. Two response alternatives were available: Pigeons could persist by responding on a schedule key with mixed ratio requirements, or escape by…

  20. In Search of Cost-Effective Schools.

    ERIC Educational Resources Information Center

    Raywid, Mary Anne; Shaheen, Thomas A.

    1994-01-01

    Examines major cost-effectiveness proposals, describing developments that highlight concerns over making schools cost effective. The article discusses ways to blend the concerns of educational quality, equity, and costs (district consolidations, shared service and facilities arrangements, new accountability strategies, new information systems,…

  1. Geography of Existing and Potential Alternative Fuel Markets in the United States

    SciTech Connect

    Johnson, C.; Hettinger, D.

    2014-11-01

    When deploying alternative fuels, it is paramount to match the right fuel with the right location, in accordance with local market conditions. We used six market indicators to evaluate the existing and potential regional market health for each of the five most commonly deployed alternative fuels: electricity (used by plug-in electric vehicles), biodiesel (blends of B20 and higher), E85 ethanol, compressed natural gas (CNG), and propane. Each market indicator was mapped, combined, and evaluated by industry experts. This process revealed the weight the market indicators should be given, with the proximity of fueling stations being the most important indicator, followed by alternative fuel vehicle density, gasoline prices, state incentives, nearby resources, and finally, environmental benefit. Though markets vary among states, no state received 'weak' potential for all five fuels, indicating that all states have an opportunity to use at least one alternative fuel. California, Illinois, Indiana, Pennsylvania, and Washington appear to have the best potential markets for alternative fuels in general, with each sporting strong markets for four of the fuels. Wyoming showed the least potential, with weak markets for all alternative fuels except for CNG, for which it has a patchy market. Of all the fuels, CNG is promising in the greatest number of states--largely because freight traffic provides potential demand for many far-reaching corridor markets and because the sources of CNG are so widespread geographically.

  2. Cost effectiveness of ramipril treatment for cardiovascular risk reduction

    PubMed Central

    Malik, I; Bhatia, V; Kooner, J

    2001-01-01

    OBJECTIVE—To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death.
DESIGN—Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively).
SETTING—UK population using 1998 government actuary department data.
MAIN OUTCOME MEASURE—Cost per life year gained at five years and lifetime treatment with ramipril.
RESULTS—Cost effectiveness was £36 600, £13 600, and £4000 per life year gained at five years and £5300, £1900, and £100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis (£25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional £360 million but would prevent 12 000 deaths per annum.
CONCLUSIONS—Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by £360 million.


Keywords: angiotensin converting enzyme inhibitor; cardiovascular risk; cost effectiveness; ramipril PMID:11303006

  3. Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space

    PubMed Central

    McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

    2015-01-01

    Introduction Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses—where outcomes are considered separately, with their joint relationship under uncertainty ignored—lead to incorrect inference regarding preferred strategies. Objective The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Results Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home (1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding

  4. Biobanks and Electronic Medical Records: Enabling Cost-Effective Research

    PubMed Central

    Bowton, Erica; Field, Julie R.; Wang, Sunny; Schildcrout, Jonathan S.; Van Driest, Sara L.; Delaney, Jessica T.; Cowan, James; Weeke, Peter; Mosley, Jonathan D.; Wells, Quinn S.; Karnes, Jason H.; Shaffer, Christian; Peterson, Josh F.; Denny, Joshua C.; Roden, Dan M.; Pulley, Jill M.

    2014-01-01

    The use of electronic medical record data linked to biological specimens in health care settings is expected to enable cost-effective and rapid genomic analyses. Here, we present a model that highlights potential advantages for genomic discovery and describe the operational infrastructure that facilitated multiple simultaneous discovery efforts. PMID:24786321

  5. Cost effectiveness of type 2 diabetes screening: A systematic review

    PubMed Central

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Background: Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. Methods: We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond’s checklist for appraising the quality of studies. Results: The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. Conclusion: A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening. PMID:27390696

  6. Evaluation of the cost effectiveness of HOV (high-occupancy vehicle) lanes. Final report

    SciTech Connect

    Ulberg, C.

    1987-07-01

    The cost effectiveness of high-occupancy vehicle (HOV) lanes was analyzed by comparing the costs and benefits of existing HOV lanes with the hypothetical alternatives of doing nothing or adding a lane for general traffic. Three specific sites in the Seattle area were studied. A life-cycle costing approach was used. The main result of the study was that for the three locations studied the construction of HOV lanes was the most cost-effective alternative.

  7. Performance-Based Staff Development: The Cost-Effective Alternative.

    ERIC Educational Resources Information Center

    Boyer, Catherine M.

    1981-01-01

    Describes how to use the performance-based concept in developing staff. Discusses the identification of objectives based on performance expectations and the development of learning experiences that (1) emphasize application of knowledge; (2) integrate adult learning principles; and (3) make use of learning contracts, self-learning packages,…

  8. Cost-Effective Stress Management Training.

    ERIC Educational Resources Information Center

    Shea, Gordon F.

    1980-01-01

    Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

  9. Cost-Effectiveness and Educational Policy.

    ERIC Educational Resources Information Center

    Levin, Henry M.

    1988-01-01

    Techniques of cost-effectiveness analysis and their applications to educational policy are discussed. Recommendations are made to increase the capacity of evaluators, policy analysts, and decision makers to use these tools appropriately for resource allocation. (SLD)

  10. The polypill: at what price would it become cost effective?

    PubMed Central

    Franco, Oscar H; Steyerberg, Ewout W

    2006-01-01

    Introduction A promising concept in cardiovascular disease prevention (the polypill) was introduced in 2003. Although the polypill may seem as an effective intervention, data on its costs and cost effectiveness remain unknown. The aim of this study was to determine the maximum price of the polypill for it to be a cost effective alternative in the primary prevention of cardiovascular disease. Methods Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a €20 000/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age. Results To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than €302 or €410 for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower. Conclusion Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in the primary prevention of cardiovascular disease. PMID:16476750

  11. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    SciTech Connect

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  12. Cost-effective network design for groundwater flow monitoring

    NASA Astrophysics Data System (ADS)

    Andricevic, R.

    1990-03-01

    The extensive use of groundwater resources has increased the need for developing cost-effective monitoring networks to provide an indication of the degree to which the subsurface environment has been affected by human activities. This study presents a cost-effective approach to the design of groundwater flow monitoring networks. The groundwater network design is formulated with two problem formats: maximizing the statistical monitoring power for specified budget constraint and minimizing monitoring cost for statistical power requirement. The statistical monitoring power constraint is introduced with an information reliability threshold value. A branch and bound technique is employed to select the optimal solution from a discrete set of possible network alternatives. The method is tested to the design of groundwater flow monitoring problem in the Pomona County, California.

  13. Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines.

    PubMed

    Newall, A T; Jit, M; Hutubessy, R

    2014-06-01

    The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.

  14. Climate-change impact potentials as an alternative to global warming potentials

    NASA Astrophysics Data System (ADS)

    Kirschbaum, Miko U. F.

    2014-03-01

    For policy applications, such as for the Kyoto Protocol, the climate-change contributions of different greenhouse gases are usually quantified through their global warming potentials. They are calculated based on the cumulative radiative forcing resulting from a pulse emission of a gas over a specified time period. However, these calculations are not explicitly linked to an assessment of ultimate climate-change impacts. A new metric, the climate-change impact potential (CCIP), is presented here that is based on explicitly defining the climate-change perturbations that lead to three different kinds of climate-change impacts. These kinds of impacts are: (1) those related directly to temperature increases; (2) those related to the rate of warming; and (3) those related to cumulative warming. From those definitions, a quantitative assessment of the importance of pulse emissions of each gas is developed, with each kind of impact assigned equal weight for an overall impact assessment. Total impacts are calculated under the RCP6 concentration pathway as a base case. The relevant climate-change impact potentials are then calculated as the marginal increase of those impacts over 100 years through the emission of an additional unit of each gas in 2010. These calculations are demonstrated for CO2, methane and nitrous oxide. Compared with global warming potentials, climate-change impact potentials would increase the importance of pulse emissions of long-lived nitrous oxide and reduce the importance of short-lived methane.

  15. AFM-assisted fabrication of thiol SAM pattern with alternating quantified surface potential

    PubMed Central

    2011-01-01

    Thiol self-assembled monolayers (SAMs) are widely used in many nano- and bio-technology applications. We report a new approach to create and characterize a thiol SAMs micropattern with alternating charges on a flat gold-coated substrate using atomic force microscopy (AFM) and Kelvin probe force microscopy (KPFM). We produced SAMs-patterns made of alternating positively charged, negatively charged, and hydrophobic-terminated thiols by an automated AFM-assisted manipulation, or nanografting. We show that these thiol patterns possess only small topographical differences as revealed by AFM, and distinguished differences in surface potential (20-50 mV), revealed by KPFM. The pattern can be helpful in the development of biosensor technologies, specifically for selective binding of biomolecules based on charge and hydrophobicity, and serve as a model for creating surfaces with quantified alternating surface potential distribution. PMID:21711703

  16. Alternative Delivery Systems: A Potential Partnership for Education and Public Broadcasting.

    ERIC Educational Resources Information Center

    Baltzer, Jan A.

    If educators and public broadcasters are to realize their potential for providing high quality educational and cultural material to the public, they must be aware of current and upcoming technologies and work in concert to achieve their goals. Several alternative delivery systems are currently available to help educators and broadcasters expand…

  17. Brain Games as a Potential Nonpharmaceutical Alternative for the Treatment of ADHD

    ERIC Educational Resources Information Center

    Wegrzyn, Stacy C.; Hearrington, Doug; Martin, Tim; Randolph, Adriane B.

    2013-01-01

    Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed childhood neurobehavioral disorder, affecting approximately 5.5 million children, of which approximately 66% take ADHD medication daily. This study investigated a potential nonpharmaceutical alternative to address the academic engagement of 5th through 11th grade…

  18. Cost-effective x-ray lithography

    NASA Astrophysics Data System (ADS)

    Roltsch, Tom J.

    1991-08-01

    The push towards faster, denser VLSI device structures and eventually to ULSI devices means ever-decreasing design rules for IC manufacturers. In order to define patterns on silicon and gallium arsenide substrates with feature sizes of 0.25 microns, lithography, metallization, and electronic materials processing techniques will be pushed beyond current limitations. Of these technologies, lithography in the sub-0.5 micron region appears to be the main obstacle yet to be overcome. As deep-UV optical systems become more expensive and the useful field sized decrease in the attempt to achieve finer resolutions, the question of whether to switch to an alternate lithographic method becomes imminent. X-ray lithography is the leading candidate. In this paper, the question of whether x-ray lithography is economically superior to optical lithography and the cost-effectiveness of x-ray lithography are addressed. Also, the question of how x-ray lithography can be performed in a production environment is considered. First shown is that more elaborate optical systems are simply not going to match x-ray proximity system in terms of resolution because of the need to use exotic lens materials or complicated and ever finer reflection systems, none of which can correct for diffraction effects, yet must be corrected for every other aberration. The economic superiority of a synchrotron-based x- ray lithography beamline is demonstrated in a production facility using a processing-cost model based on Shinji Okazaki's cost-per-bit model. Considered, as well, is the strong possibility that exists for the use of an optically based production line which would use an anode or plasma x-ray stepper to define only the smallest geometries, such as the gate level on a DRAM chip. It is shown that it is unlikely, even pushing the limits of materials and optics, that deep-UV systems will be able to define patterns below 0.35 microns in a production environment. X-ray lithography systems could define 0

  19. The potential of tissue engineering for developing alternatives to animal experiments: a systematic review.

    PubMed

    de Vries, Rob B M; Leenaars, Marlies; Tra, Joppe; Huijbregtse, Robbertjan; Bongers, Erik; Jansen, John A; Gordijn, Bert; Ritskes-Hoitinga, Merel

    2015-07-01

    An underexposed ethical issue raised by tissue engineering is the use of laboratory animals in tissue engineering research. Even though this research results in suffering and loss of life in animals, tissue engineering also has great potential for the development of alternatives to animal experiments. With the objective of promoting a joint effort of tissue engineers and alternative experts to fully realise this potential, this study provides the first comprehensive overview of the possibilities of using tissue-engineered constructs as a replacement of laboratory animals. Through searches in two large biomedical databases (PubMed, Embase) and several specialised 3R databases, 244 relevant primary scientific articles, published between 1991 and 2011, were identified. By far most articles reviewed related to the use of tissue-engineered skin/epidermis for toxicological applications such as testing for skin irritation. This review article demonstrates, however, that the potential for the development of alternatives also extends to other tissues such as other epithelia and the liver, as well as to other fields of application such as drug screening and basic physiology. This review discusses which impediments need to be overcome to maximise the contributions that the field of tissue engineering can make, through the development of alternative methods, to the reduction of the use and suffering of laboratory animals.

  20. Designing to cost effectiveness - Enhancing quality

    NASA Astrophysics Data System (ADS)

    Brennan, James R.; Stracener, Jerrell T.

    The authors present a practical application of cost-effectiveness analysis techniques through the definition and solution of a representative design tradeoff study using cost-effectiveness as a figure of merit for quality. They also describe a decision process based on the results of tradeoff studies to provide a method of integrating the 'ilities' with design and manufacturing engineering to help accomplish integrated product development (IPD). While the approach is demonstrated in an aircraft application, the method is equally applicable in almost any product and any operational scenario, military or commercial.

  1. Selecting cost-effective areas for restoration of ecosystem services.

    PubMed

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services.

  2. Supported employment: cost-effectiveness across six European sites.

    PubMed

    Knapp, Martin; Patel, Anita; Curran, Claire; Latimer, Eric; Catty, Jocelyn; Becker, Thomas; Drake, Robert E; Fioritti, Angelo; Kilian, Reinhold; Lauber, Christoph; Rössler, Wulf; Tomov, Toma; van Busschbach, Jooske; Comas-Herrera, Adelina; White, Sarah; Wiersma, Durk; Burns, Tom

    2013-02-01

    A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment. PMID:23471803

  3. French Brittany macroalgae screening: composition and methane potential for potential alternative sources of energy and products.

    PubMed

    Jard, G; Marfaing, H; Carrère, H; Delgenes, J P; Steyer, J P; Dumas, C

    2013-09-01

    Macroalgae are biomass resources that represent a valuable feedstock to be used entirely for human consumption or for food additives after some extractions (mainly colloids) and/or for energy production. In order to better develop the algal sector, it is important to determine the capacity of macroalgae to produce these added-values molecules for food and/or for energy industries on the basis of their biochemical characteristics. In this study, ten macroalgae obtained from French Brittany coasts (France) were selected. The global biochemical composition (proteins, lipids, carbohydrates, fibers), the presence and characteristics of added-values molecules (alginates, polyphenols) and the biochemical methane potential of these algae were determined. Regarding its biochemical composition, Palmaria palmata is interesting for food (rich in nutrients) and for anaerobic digestion (0.279 LCH4/gVS). Saccharina latissima could be used for alginate extraction (242 g/kgTS, ratio between mannuronic and guluronic acid M/G=1.4) and Sargassum muticum for polyphenol extraction (19.8 g/kgTS).

  4. French Brittany macroalgae screening: composition and methane potential for potential alternative sources of energy and products.

    PubMed

    Jard, G; Marfaing, H; Carrère, H; Delgenes, J P; Steyer, J P; Dumas, C

    2013-09-01

    Macroalgae are biomass resources that represent a valuable feedstock to be used entirely for human consumption or for food additives after some extractions (mainly colloids) and/or for energy production. In order to better develop the algal sector, it is important to determine the capacity of macroalgae to produce these added-values molecules for food and/or for energy industries on the basis of their biochemical characteristics. In this study, ten macroalgae obtained from French Brittany coasts (France) were selected. The global biochemical composition (proteins, lipids, carbohydrates, fibers), the presence and characteristics of added-values molecules (alginates, polyphenols) and the biochemical methane potential of these algae were determined. Regarding its biochemical composition, Palmaria palmata is interesting for food (rich in nutrients) and for anaerobic digestion (0.279 LCH4/gVS). Saccharina latissima could be used for alginate extraction (242 g/kgTS, ratio between mannuronic and guluronic acid M/G=1.4) and Sargassum muticum for polyphenol extraction (19.8 g/kgTS). PMID:23896436

  5. Key aspects of cost effective collector and solar field design

    NASA Astrophysics Data System (ADS)

    von Reeken, Finn; Nicodemo, Dario; Keck, Thomas; Weinrebe, Gerhard; Balz, Markus

    2016-05-01

    A study has been performed where different key parameters influencing solar field cost are varied. By using levelised cost of energy as figure of merit it is shown that parameters like GoToStow wind speed, heliostat stiffness or tower height should be adapted to respective site conditions from an economical point of view. The benchmark site Redstone (Northern Cape Province, South Africa) has been compared to an alternate site close to Phoenix (AZ, USA) regarding site conditions and their effect on cost-effective collector and solar field design.

  6. A cost effective data management subsystem for the LST

    NASA Technical Reports Server (NTRS)

    Dougherty, J. A.; Patterson, T. D.; Cole, A. E.

    1975-01-01

    The paper outlines the approach used in developing DMS (Data Management Subsystem) alternatives for the LST (Large Space Telescope) and in selecting the concept considered to be the most cost effective means of implementing the LST DMS requirements. Two candidate DMS concepts are discussed: a functionally integrated and a functionally separated one. For the single vehicle LST program, separation of the DMS functions best provides high reliability, operations flexibility, minimal interface complexity, and the least complex software development and verification task. The use of available hardware and NASA standard components is stressed.

  7. Soil Gas Surveys: A cost-effective site assessment technique

    SciTech Connect

    Barker, G.W.; Brown, D.R.; Corgan, J.M.

    1995-12-01

    Accurate delineation of the extent of subsurface hydrocarbon contamination in soils and ground water is important when initiating a monitoring plan or considering remediation options at E&P sites. Traditional site-assessment techniques used to delineate subsurface hydrocarbon contaminants (e.g., soil boreholes, excavation, monitor well installation, etc.) can be expensive, time-consuming, and disruptive to local land use or production operations. Soil gas surveys can provide a rapid, cost-effective, nonobtrusive alternative to traditional site-assessment techniques.

  8. Hepatocellular carcinoma: cost-effectiveness of screening. A systematic review.

    PubMed

    Ruggeri, Matteo

    2012-01-01

    Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. HCC is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations. Curative therapy is possible only for small tumors and screening strategy has been recommended by the US, Italian, and other international liver societies and is practiced widely, but its benefits are not clearly established. The objective of this study was to review the available evidence with respect to the cost-effectiveness of key technologies in the prevention HCC. The literature search was conducted with the support of PubMed. Firstly we selected articles by reading the abstracts. Secondly, we read the articles and the revision was further restricted, with the following as inclusion criteria: (1) full economic evaluation of HCC screening programs; (2) comparison between HCC techniques; (3) outcome measures expressed in terms of quality adjusted life years (QALY); (4) full text availability. The initial review of the literature yielded 346 articles. Of those, 288 were excluded at the first stage. Of those excluded, 108 did not meet the target, 106 did not present the cost analysis, 33 did not analyze the treatment of the disease, and in 41 the abstract was not available. Of the 58 included in the first step, seven examined the cost-effectiveness of different HCC screening techniques, seven investigated the cost-effectiveness of HCC screening versus no screening, and one looked at the cost-effectiveness of timing for HCC surveillance and monitoring, while 43 were about HBV vaccination and screening. We included only the seven articles examining the cost-effectiveness of different HCC screening techniques. In general, incidence is the key parameter which determines the cost-effectiveness of HCC screening. Discrepancies in the results exist when determining the type of technology to be used. Ultrasound (US) alone or in association with alpha fetoprotein (AFP) technology is

  9. Seasonal Influenza Vaccination for Children in Thailand: A Cost-Effectiveness Analysis

    PubMed Central

    Meeyai, Aronrag; Praditsitthikorn, Naiyana; Kotirum, Surachai; Kulpeng, Wantanee; Putthasri, Weerasak; Cooper, Ben S.; Teerawattananon, Yot

    2015-01-01

    Background Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly. Methods and Findings We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and

  10. The cost-effectiveness of health communication programs: what do we know?

    PubMed

    Hutchinson, Paul; Wheeler, Jennifer

    2006-01-01

    While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

  11. Cost-Effective School Nurse Practitioner Services.

    ERIC Educational Resources Information Center

    Sobolewski, Susan D.

    1981-01-01

    A broader utilization of school nurse practitioners by school districts represents a cost-effective approach in meeting educational goals. School nurse practitioners provide extended nursing services to high risk children, assist in coordinating health services between the school and the child's parents, participate in classroom presentations on…

  12. Cost-Effectiveness of Interactive Courseware.

    ERIC Educational Resources Information Center

    Fletcher, J. D.

    What is known about the cost effectiveness of interactive courseware (ICW) is reviewed, and issues that remain are summarized. Effect size is used for reporting the effectiveness of ICW programs. Two ICW media are considered: computer-based instruction and interactive videodisc instruction. Effect sizes for computer-based instruction have been…

  13. Cost-Effectiveness of Online Teacher Training

    ERIC Educational Resources Information Center

    Jung, Insung

    2005-01-01

    This study aims to compare the cost-effectiveness of an online teacher training method with a face-to-face training method in teaching "ICT integration in the school curriculum". In addition, the study explores the possibilities of a school-based voluntary training method in supporting other approaches to ICT teacher training. The analyses of…

  14. Cost Effectiveness of CBI in Defense Training.

    ERIC Educational Resources Information Center

    Fletcher, J. D.; Orlansky, Jesse

    This presentation provides an in-process review of researching efforts at the U.S. Army Research Institute and the Institute for Defense Analysis to update their earlier studies of Computer Based Instruction (CBI) cost-effectiveness. In the presentation five topics are addressed: (1) the differences between education and training, and why they…

  15. Cost-Effective Analysis of Teletraining.

    ERIC Educational Resources Information Center

    Shatzer, Linda

    1987-01-01

    Presents case study on personal computer teleconferencing to compare its cost effectiveness with that of on-site training. A model is described that uses a checklist for decision making in three areas: (1) initial considerations, (2) planning considerations, i.e., design elements, and (3) technical considerations, i.e., review and selection…

  16. The cost-effectiveness of harm reduction.

    PubMed

    Wilson, David P; Donald, Braedon; Shattock, Andrew J; Wilson, David; Fraser-Hurt, Nicole

    2015-02-01

    HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But

  17. A review of potential alternatives for air cleaning at the Hanford Waste Vitrification Plant

    SciTech Connect

    Sehmel, G.A.

    1990-07-01

    Pacific Northwest Laboratory conducted this review in support of the Hanford Waste Vitrification Plant (HWVP) being designed by Fluor Daniel Inc. for the US Department of Energy (DOE). The literature on air cleaning systems is reviewed to identify potential air cleaning alternatives that might be included in the design of HWVP. An overview of advantages/disadvantages of the various air cleaning technologies follows. Information and references are presented for the following potential air cleaning alternatives: deep-bed glass-fiber filters (DBGF), high-efficiency particulate air filters (HEPA), remote modular filter systems, high-efficiency mist eliminators (HEME), electrostatic precipitators, and the sand filter. Selected information is summarized for systems in the United States, Belgium, Japan, and West Germany. This review addresses high-capacity air cleaning systems currently used in the nuclear industry and emphasizes recent developments. 10 refs., 9 figs., 3 tabs.

  18. Cost-Effectiveness of Norovirus Vaccination in Children in Peru

    PubMed Central

    Mirelman, Andrew; Ballard, Sarah-Blythe; Saito, Mayuko; Kosek, Margaret; Gilman, Robert H.

    2015-01-01

    Background With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. Methods We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru’s routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Results Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. Conclusions The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence

  19. Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities.

    PubMed

    Pasquel, Francisco J; Hendrick, Andrew M; Ryan, Martha; Cason, Emily; Ali, Mohammed K; Narayan, K M Venkat

    2016-03-01

    Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

  20. Cost effectiveness of a medical digital library.

    PubMed

    Roussel, F; Darmoni, S J; Thirion, B

    2001-01-01

    The rapid increase in the price of electronic journals has made the optimization of collection management an urgent task. As there is currently no standard procedure for the evaluation of this problem, we applied the Reading Factor (RF), an electronically computed indicator used for consultation of individual articles. The aim of our study was to assess the cost effective impact of modifications in our digital library (i.e. change of access from the Intranet to the Internet or change in editorial policy). The digital OVID library at Rouen University Hospital continues to be cost-effective in comparison with the interlibrary loan costs. Moreover, when electronic versions are offered alongside a limited amount of interlibrary loans, a reduction in library costs was observed.

  1. Future costs in cost effectiveness analysis.

    PubMed

    Lee, Robert H

    2008-07-01

    This paper resolves several controversies in CEA. Generalizing [Garber, A.M., Phelps, C.E., 1997. Economic foundations of cost-effectiveness analysis. Journal of Health Economics 16 (1), 1-31], the paper shows accounting for unrelated future costs distorts decision making. After replicating [Meltzer, D., 1997. Accounting for future costs in medical cost-effectiveness analysis. Journal of Health Economics 16 (1), 33-64] quite different conclusion that unrelated future costs should be included in CEA, the paper shows that Meltzer's findings result from modeling the budget constraint as an annuity, which is problematic. The paper also shows that related costs should be included in CEA. This holds for a variety of models, including a health maximization model. CEA should treat costs in the manner recommended by Garber and Phelps.

  2. Benefit-cost and cost-effectiveness analysis: theory and application.

    PubMed

    McCarthy, N J

    1979-01-01

    Benefit-cost analysis and cost-effectivensss analysis are terms used with increasing frequency by health planners and those concerned with review and evaluation of specific programs. The economic bases for these formal techniques are however often obscured by adaptations of convenience or misapplications of the concepts by biological scientists (and others). This paper reviews briefly the theory of benefit-cost analysis and its potential as a tool in choosing programs of optimum size, of maximum economic efficiency as a given size, and in choosing amongst worthwhile alternative projects. Because of the difficulties of quantification of necessary data and the political nature of many policy decisions, the technique of benefit-cost analysis seldom finds application but cost-effectiveness emerges as a calculus of more practical use and acceptability. Examples are drawn from WHO papers and the medical literature to illustrate the "benefits and risks" of these techniques.

  3. High-throughput and Cost-effective Chicken Genotyping Using Next-Generation Sequencing.

    PubMed

    Pértille, Fábio; Guerrero-Bosagna, Carlos; Silva, Vinicius Henrique da; Boschiero, Clarissa; Nunes, José de Ribamar da Silva; Ledur, Mônica Corrêa; Jensen, Per; Coutinho, Luiz Lehmann

    2016-01-01

    Chicken genotyping is becoming common practice in conventional animal breeding improvement. Despite the power of high-throughput methods for genotyping, their high cost limits large scale use in animal breeding and selection. In the present paper we optimized the CornellGBS, an efficient and cost-effective genotyping by sequence approach developed in plants, for its application in chickens. Here we describe the successful genotyping of a large number of chickens (462) using CornellGBS approach. Genomic DNA was cleaved with the PstI enzyme, ligated to adapters with barcodes identifying individual animals, and then sequenced on Illumina platform. After filtering parameters were applied, 134,528 SNPs were identified in our experimental population of chickens. Of these SNPs, 67,096 had a minimum taxon call rate of 90% and were considered 'unique tags'. Interestingly, 20.7% of these unique tags have not been previously reported in the dbSNP. Moreover, 92.6% of these SNPs were concordant with a previous Whole Chicken-genome re-sequencing dataset used for validation purposes. The application of CornellGBS in chickens showed high performance to infer SNPs, particularly in exonic regions and microchromosomes. This approach represents a cost-effective (~US$50/sample) and powerful alternative to current genotyping methods, which has the potential to improve whole-genome selection (WGS), and genome-wide association studies (GWAS) in chicken production. PMID:27220827

  4. High-throughput and Cost-effective Chicken Genotyping Using Next-Generation Sequencing

    PubMed Central

    Pértille, Fábio; Guerrero-Bosagna, Carlos; Silva, Vinicius Henrique da; Boschiero, Clarissa; Nunes, José de Ribamar da Silva; Ledur, Mônica Corrêa; Jensen, Per; Coutinho, Luiz Lehmann

    2016-01-01

    Chicken genotyping is becoming common practice in conventional animal breeding improvement. Despite the power of high-throughput methods for genotyping, their high cost limits large scale use in animal breeding and selection. In the present paper we optimized the CornellGBS, an efficient and cost-effective genotyping by sequence approach developed in plants, for its application in chickens. Here we describe the successful genotyping of a large number of chickens (462) using CornellGBS approach. Genomic DNA was cleaved with the PstI enzyme, ligated to adapters with barcodes identifying individual animals, and then sequenced on Illumina platform. After filtering parameters were applied, 134,528 SNPs were identified in our experimental population of chickens. Of these SNPs, 67,096 had a minimum taxon call rate of 90% and were considered ‘unique tags’. Interestingly, 20.7% of these unique tags have not been previously reported in the dbSNP. Moreover, 92.6% of these SNPs were concordant with a previous Whole Chicken-genome re-sequencing dataset used for validation purposes. The application of CornellGBS in chickens showed high performance to infer SNPs, particularly in exonic regions and microchromosomes. This approach represents a cost-effective (~US$50/sample) and powerful alternative to current genotyping methods, which has the potential to improve whole-genome selection (WGS), and genome-wide association studies (GWAS) in chicken production. PMID:27220827

  5. Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?

    PubMed

    Slinn, Simon J; Froom, Stephen R; Stacey, Mark R W; Gildersleve, Christopher D

    2015-01-01

    Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care. PMID:25370686

  6. Cost effective management of space venture risks

    NASA Technical Reports Server (NTRS)

    Giuntini, Ronald E.; Storm, Richard E.

    1986-01-01

    The development of a model for the cost-effective management of space venture risks is discussed. The risk assessment and control program of insurance companies is examined. A simplified system development cycle which consists of a conceptual design phase, a preliminary design phase, a final design phase, a construction phase, and a system operations and maintenance phase is described. The model incorporates insurance safety risk methods and reliability engineering, and testing practices used in the development of large aerospace and defense systems.

  7. Theater SBI cost-effectiveness ratios

    SciTech Connect

    Canavan, G.H.

    1993-11-01

    To address M missiles spaced at intervals longer than the constillation reconstitution time t, the defense needs at the absentee ratio N{sub a} of SBIs to fill the belt plus the M SBIs needed for the intercepts; the resulting cost effectiveness scales as M/(M + N{sub a}). N{sub a} is large and CER small for small ranges and numbers of missiles. For several-hundred missile threats, CERs are greater than unity for ranges of interest.

  8. [Cost effectiveness and health sector reform].

    PubMed

    Musgrove, P

    1995-01-01

    The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.

  9. Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

    PubMed Central

    Hume, Anne L; Quilliam, Brian J; Goldman, Roberta; Eaton, Charles

    2011-01-01

    Objective To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design Literature review, expert panel and focus group. Setting Primary care with access to e-prescribing systems. Participants Primary care physicians using e-prescribing systems receiving medication history. Interventions Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. Main outcome measure Development of 15 treatment algorithms suggesting alternative therapies. Results Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. Conclusion Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events. PMID:21719560

  10. Cost-effectiveness of Chlamydia Vaccination Programs for Young Women

    PubMed Central

    Chesson, Harrell W.; Gift, Thomas L.; Brunham, Robert C.; Bolan, Gail

    2015-01-01

    We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15–24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15–24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective. PMID:25989525

  11. Cost effectiveness of detritiating water with resin columns

    SciTech Connect

    Drake, R.H.; Williams, D.S.

    1997-10-01

    There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory`s Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system`s costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies.

  12. Cost effectiveness of stream-gaging program in Michigan

    USGS Publications Warehouse

    Holtschlag, D.J.

    1985-01-01

    This report documents the results of a study of the cost effectiveness of the stream-gaging program in Michigan. Data uses and funding sources were identified for the 129 continuous gaging stations being operated in Michigan as of 1984. One gaging station was identified as having insufficient reason to continue its operation. Several stations were identified for reactivation, should funds become available, because of insufficiencies in the data network. Alternative methods of developing streamflow information based on routing and regression analyses were investigated for 10 stations. However, no station records were reproduced with sufficient accuracy to replace conventional gaging practices. A cost-effectiveness analysis of the data-collection procedure for the ice-free season was conducted using a Kalman-filter analysis. To define missing-record characteristics, cross-correlation coefficients and coefficients of variation were computed at stations on the basis of daily mean discharge. Discharge-measurement data were used to describe the gage/discharge rating stability at each station. The results of the cost-effectiveness analysis for a 9-month ice-free season show that the current policy of visiting most stations on a fixed servicing schedule once every 6 weeks results in an average standard error of 12.1 percent for the current $718,100 budget. By adopting a flexible servicing schedule, the average standard error could be reduced to 11.1 percent. Alternatively, the budget could be reduced to $700,200 while maintaining the current level of accuracy. A minimum budget of $680,200 is needed to operate the 129-gaging-station program; a budget less than this would not permit proper service and maintenance of stations. At the minimum budget, the average standard error would be 14.4 percent. A budget of $789,900 (the maximum analyzed) would result in a decrease in the average standard error to 9.07 percent. Owing to continual changes in the composition of the network

  13. Alternative derivation of an exchange-only density-functional optimized effective potential

    SciTech Connect

    Joubert, D. P.

    2007-10-15

    An alternative derivation of the exchange-only density-functional optimized effective potential equation is given. It is shown that the localized Hartree-Fock-common energy denominator Green's function approximation (LHF-CEDA) for the density-functional exchange potential proposed independently by Della Sala and Goerling [J. Chem. Phys. 115, 5718 (2001)] and Gritsenko and Baerends [Phys. Rev. A 64, 42506 (2001)] can be derived as an approximation to the OEP exchange potential in a similar way that the KLI approximation [Phys. Rev. A 45, 5453 (1992)] was derived. An exact expression for the correction term to the LHF-CEDA approximation can thus be found. The correction term can be expressed in terms of the first-order perturbation-theory many-electron wave function shift when the Kohn-Sham Hamiltonian is subjected to a perturbation equal to the difference between the density-functional exchange potential and the Hartree-Fock nonlocal potential, expressed in terms of the Kohn-Sham orbitals. An explicit calculation shows that the density weighted mean of the correction term is zero, confirming that the LHF-CEDA approximation can be interpreted as a mean-field approximation. The corrected LHF-CEDA equation and the optimized effective potential equation are shown to be identical, with information distributed differently between terms in the equations. For a finite system the correction term falls off at least as fast as 1/r{sup 4} for large r.

  14. Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

    PubMed Central

    2013-01-01

    Background The aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection. Methods Multiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs). Results From a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened. Conclusions Administration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective. PMID:24350635

  15. Potential use of California lignite and other alternate fuel for enhanced oil recovery. Phase I and II. Final report. [As alternative fuels for steam generation in thermal EOR

    SciTech Connect

    Shelton, R.; Shimizu, A.; Briggs, A.

    1980-02-01

    The Nation's continued reliance on liquid fossil fuels and decreasing reserves of light oils gives increased impetus to improving the recovery of heavy oil. Thermal enhanced oil recovery EOR techniques, such as steam injection, have generally been the most effective for increasing heavy oil production. However, conventional steam generation consumes a large fraction of the produced oil. The substitution of alternate (solid) fuels would release much of this consumed oil to market. This two-part report focuses on two solid fuels available in California, the site of most thermal EOR - petroleum coke and lignite. Phase I, entitled Economic Analysis, shows detailed cost comparisons between the two candidate fuels and also with Western coal. The analysis includes fuels characterizations, process designs for several combustion systems, and a thorough evaluation of the technical and economic uncertainties. In Phase II, many technical parameters of petroleum coke combustion were measured in a pilot-plant fluidized bed. The results of the study showed that petroleum coke combustion for EOR is feasible and cost effective in a fluidized bed combustor.

  16. The "e" in cost-effectiveness analyses. A case study of omalizumab efficacy and effectiveness for cost-effectiveness analysis evidence.

    PubMed

    Campbell, Jonathan D; McQueen, R Brett; Briggs, Andrew

    2014-02-01

    This article is a call for increased use of real-world evidence in health technology assessment and related policy and decision making. There is currently a disconnect between evidence used to guide regulatory approval of therapies and evidence used to inform therapeutic coverage and reimbursement decisions. Public and private payers need to understand not only whether an intervention works but also whether it offers good value compared with licensed alternatives (not placebo) as they are used in the real-world practice and population (not in a controlled trial environment). Addressing such concerns requires evidence to be drawn from a wide range of study designs, but with consideration and weighting given to their relative strengths and weaknesses, as well as their position on the pragmatic-explanatory (i.e., effectiveness-efficacy) continuum. The potential impact of using different types of evidence to inform cost-effectiveness analysis (CEA) is discussed for omalizumab, comparing and contrasting a CEA model informed by an omalizumab efficacy trial to a CEA model drawing primarily on evidence from effectiveness observational studies of omalizumab. There was reasonable agreement between the two omalizumab CEA models, although the incremental cost-effectiveness ratio generated by the effectiveness observational study-driven model was more favorable for omalizumab. Health technology assessment bodies and payers must use their judgment to determine which components of efficacy-based and effectiveness-based CEA evidence are most closely aligned with their goals. For each CEA evidence component, perhaps the two E's form bounds of the truth as well as a fuller picture of the uncertainty surrounding the truth.

  17. Alternating current potential drop for measuring the case depth of hardened steel

    NASA Astrophysics Data System (ADS)

    Quddes, Mohammad R.; Ji, Yuan; Bowler, John R.

    2015-03-01

    Multi-frequency alternate current potential drop measurements have been made to estimate the case depth of case hardened steels using four point probes. The probes have four parallel sprung loaded pins in a line with a 1.5 mm separation between the contact points. A printed circuit board has been used to ensure the electrical connections to the pins are close to the surface of the material. This has the effect of reducing the mutual induction between driver and pick-up pins. The case depth is estimated from measurements at frequencies typically from 10 Hz to 10 kHz. The real part of the voltage phasor representing the AC potential drop is used to evaluate the case depth. The imaginary part includes the contribution due to mutual induction. To estimate the case depth of the hardened samples, the measured potential drop has been fitted to theoretical predictions. The substrate material properties of the hardened samples are extracted from multi-frequency potential drop measurements on non-harden samples. The estimated case hardened depths, deduced from potential drop measurements, are similar to those found from destructive measurements.

  18. Cost-effectiveness as a price control.

    PubMed

    Jena, Anupam B; Philipson, Tomas

    2007-01-01

    After a technology is developed, cost-effectiveness analysis can offer an economically sound approach to adoption decisions. Little attention has been paid, however, to the incentives these criteria induce for getting technologies to market in the first place. We argue that technology adoption procedures more fully take into account the key trade-off inherent in research and development: the decreased welfare of current patients as a result of higher prices versus the increased welfare of future patients as a result of the incentives for innovation that such prices provide. Empirical evidence from a case study of HIV/AIDS provides an illustration of our conclusions.

  19. Social network bridging potential and the use of complementary and alternative medicine in later life.

    PubMed

    Goldman, Alyssa W; Cornwell, Benjamin

    2015-09-01

    The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. PMID:26207353

  20. Social network bridging potential and the use of complementary and alternative medicine in later life.

    PubMed

    Goldman, Alyssa W; Cornwell, Benjamin

    2015-09-01

    The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage.

  1. Alternative antimicrobial compounds to control potential Lactobacillus contamination in bioethanol fermentations.

    PubMed

    Limayem, Alya; Hanning, Irene B; Muthaiyan, Arunachalam; Illeghems, Koen; Kim, Jin-Woo; Crandall, Philip G; O'Bryan, Corliss A; Ricke, Steven C

    2011-01-01

    Antibiotics are commonly used to control microbial contaminants in yeast-based bioethanol fermentation. Given the increase in antibiotic-resistant bacteria, alternative natural antimicrobials were evaluated against the potential contaminant, Lactobacillus. The effects of nisin, ϵ-polylysine, chitosan (CS) and lysozyme were screened against 5 Lactobacillus strains. A standard broth- microdilution method was used in 96-well plates to assess the minimal inhibitory concentration (MIC). L. delbrueckii subsp lactis ATCC479 exhibited maximal MICs with CS, ϵ-polylysine and nisin (1.87, 0.3125 and 0.05 mg/mL, respectively). Nisin reduced most Lactobacillus strains by 6 log CFU/mL after 48 hours with the exception of L. casei. Synergism occurred when ethylenediaminetetraacetic acid (EDTA) was added with nisin. An MIC of 0.4 mg/mL of nisin combined with the EDTA at an MIC of 1 mg/ml markedly suppressed L .casei by 6 log CFU/mL. In conclusion, alternative antimicrobials proved to be a potential candidate for controlling bacterial contamination in the fermentation process. Synergistic effect of nisin with EDTA successfully inhibited the nisin-resistant contaminant, L. casei. PMID:21879832

  2. Pharmacoinformatics approach for investigation of alternative potential hepatitis C virus nonstructural protein 5B inhibitors

    PubMed Central

    Mirza, Muhammad Usman; Ghori, Noor-Ul-Huda; Ikram, Nazia; Adil, Abdur Rehman; Manzoor, Sadia

    2015-01-01

    Hepatitis C virus (HCV) is one of the major viruses affecting the world today. It is a highly variable virus, having a rapid reproduction and evolution rate. The variability of genomes is due to hasty replication catalyzed by nonstructural protein 5B (NS5B) which is also a potential target site for the development of anti-HCV agents. Recently, the US Food and Drug Administration approved sofosbuvir as a novel oral NS5B inhibitor for the treatment of HCV. Unfortunately, it is much highlighted for its pricing issues. Hence, there is an urgent need to scrutinize alternate therapies against HCV that are available at affordable price and do not have associated side effects. Such a need is crucial especially in underdeveloped countries. The search for various new bioactive compounds from plants is a key part of pharmaceutical research. In the current study, we applied a pharmacoinformatics-based approach for the identification of active plant-derived compounds against NS5B. The results were compared to docking results of sofosbuvir. The lead compounds with high-binding ligands were further analyzed for pharmacokinetic and pharmacodynamic parameters based on in silico absorption, distribution, metabolism, excretion, and toxicity (ADMET) profile. The results showed the potential alternative lead compounds that can be developed into commercial drugs having high binding energy and promising ADMET properties. PMID:25848219

  3. SOCIAL NETWORK BRIDGING POTENTIAL AND THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN LATER LIFE *

    PubMed Central

    Goldman, Alyssa; Cornwell, Benjamin

    2015-01-01

    The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals’ social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. PMID:26207353

  4. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  5. Cost effective data acquisition for small developments

    SciTech Connect

    Johnson, J.D.

    1987-01-01

    A cost effective method for obtaining reservoir fata to define the depletion mechanism in the small Odin gas field is described. The addition of a simple work program to the drilling plan for the first development well provided basic reservoir and aquifer data, and the well completion scheme provided for continuing reservoir surveillance. Cost effective methods for reservoir data acquisition are particularly relevant for marginal developments. This discussion should be of interest for operators of gas fields where the depletion mechanism is not defined, and where early acquisition of additional data can provide an indication of the mechanism. A brief development history of Odin field illustrates the need for good reservoir data. Initially there was some uncertainty surrounding the amount of bottom water influx into the Odin gas sand and the resulting reservoir depletion mechanism. Conclusions about the expected type of reservoir depletion mechanism were drawn from data including conventional cores analysis, measured pressure gradients, fluid saturation logs, and production well tests. Production history is shown which confirms the conclusions made from the initial data acquisition.

  6. An assessment of potential impact of alternative fluorocarbons on tropospheric ozone

    NASA Technical Reports Server (NTRS)

    Niki, Hiromi

    1990-01-01

    While the chlorofuorocarbons (CFCs) such as CFC-11 (CFCl3) and CFC-12 (CF2Cl2) are chemically inert in the troposphere, the hydrogen-containing halocarbons being considered as their replacements can, to a large extent, be removed in the troposphere by the HO radical. These alternative halocarbons include the hydrochlorofluorocarbons (HCFCs) 123 (CF3CHCl2), 141b (CFCl2CH3), 142b (CF2ClCH3), 22 (CHF2Cl), and 124 (CF3CHFCl) and the hydrofluorocarbons (HCFs) 134a (CF3CH2F), 152a (CHF2CH3) and 125 (CF3CHF2). Listed are the rate constants (k) for the HO radical reaction of these compounds and their estimated chemical lifetimes in the troposphere. In this table, values of the lifetimes of these selected HCFCs and HCFs are seen to vary by more than a factor of more than ten ranging from 1.6 years for HFC 152a and HCFC 125 to as long as 28 years for HFC 125. Clearly, from the standpoint of avoiding or minimizing impact on stratospheric O3, those halocarbons with short tropospheric lifetimes are the desirable alternates. However, potential environmental consequences of their degradation in the troposphere should be assessed and taken into account in the selection process.

  7. Potential application of alternatively glycosylated serum MUC1 and MUC5AC in gastric cancer diagnosis.

    PubMed

    Xu, Ye; Zhang, Liang; Hu, Gengxi

    2009-01-01

    Post-transcription modification of proteins can be altered during carcinogenesis. In this study, quantitative sandwich enzyme immunoassays were utilized to explore the clinical diagnostic value of the alternatively glycosylated MUC1 and MUC5AC. Four pairs of antibodies were selected to construct quantitative sandwich enzyme immunoassay. Serum mucin levels of 104 primary gastric cancer patients and 120 healthy individuals were measured using the four antibody pairs. The detection sensitivities of each antibody pair against gastric cancers were 42.31%, 25.00%, 38.46% and 30.77% respectively, with a specificity of 90.00%, significantly higher than widely used tumor markers CEA (21.15%) and CA19-9 (18.27%). When monitoring in parallel with all of the four antibody pairs, the detection sensitivity increased to 75.00%, with the same 90.00% specificity. Immunoblotting of the serum samples using the anti-mucin antibodies revealed highly variable glycosylation patterns among gastric cancer patients. In addition, real-time PCR indicated the elevated mRNA levels of MUC1 and/or MUC5AC in gastric cancers. The cancer-specific epitopes were also detected in other alimentary canal epithelium cancers such as colonic, nasopharyngeal and esophageal cancers, but with much lower sensitivities. Our results suggested that alternatively glycosylated MUC1 and MUC5AC could be of significant potential as effective tumor markers in gastric cancer diagnosis.

  8. Potential impacts on air quality of the use of ethanol as an alternative fuel. Final report

    SciTech Connect

    Gaffney, J.S.; Marley, N.A.

    1994-09-01

    The use of ethanol/gasoline mixtures in motor vehicles has been proposed as an alternative fuel strategy that might improve air quality while minimizing US dependence on foreign oil. New enzymatic production methodologies are being explored to develop ethanol as a viable, economic fuel. In an attempt to reduce urban carbon monoxide (CO) and ozone levels, a number of cities are currently mandating the use of ethanol/gasoline blends. However, it is not at all clear that these blended fuels will help to abate urban pollution. In fact, the use of these fuels may lead to increased levels of other air pollutants, specifically aldehydes and peroxyacyl nitrates. Although these pollutants are not currently regulated, their potential health and environmental impacts must be considered when assessing the impacts of alternative fuels on air quality. Indeed, formaldehyde has been identified as an important air pollutant that is currently being considered for control strategies by the State of California. This report focuses on measurements taken in Albuquerque, New Mexico during the summer of 1993 and the winter of 1994 as an initial attempt to evaluate the air quality effects of ethanol/gasoline mixtures. The results of this study have direct implications for the use of such fuel mixtures as a means to reduce CO emissions and ozone in a number of major cities and to bring these urban centers into compliance with the Clean Air Act.

  9. Antimicrobial Peptides as Potential Alternatives to Antibiotics in Food Animal Industry

    PubMed Central

    Wang, Shuai; Zeng, Xiangfang; Yang, Qing; Qiao, Shiyan

    2016-01-01

    Over the last decade, the rapid emergence of multidrug-resistant pathogens has become a global concern, which has prompted the search for alternative antibacterial agents for use in food animals. Antimicrobial peptides (AMPs), produced by bacteria, insects, amphibians and mammals, as well as by chemical synthesis, are possible candidates for the design of new antimicrobial agents because of their natural antimicrobial properties and a low propensity for development of resistance by microorganisms. This manuscript reviews the current knowledge of the basic biology of AMPs and their applications in non-ruminant nutrition. Antimicrobial peptides not only have broad-spectrum activity against bacteria, fungi, and viruses but also have the ability to bypass the common resistance mechanisms that are placing standard antibiotics in jeopardy. In addition, AMPs have beneficial effects on growth performance, nutrient digestibility, intestinal morphology and gut microbiota in pigs and broilers. Therefore, AMPs have good potential as suitable alternatives to conventional antibiotics used in swine and poultry industries. PMID:27153059

  10. Antimicrobial Peptides as Potential Alternatives to Antibiotics in Food Animal Industry.

    PubMed

    Wang, Shuai; Zeng, Xiangfang; Yang, Qing; Qiao, Shiyan

    2016-01-01

    Over the last decade, the rapid emergence of multidrug-resistant pathogens has become a global concern, which has prompted the search for alternative antibacterial agents for use in food animals. Antimicrobial peptides (AMPs), produced by bacteria, insects, amphibians and mammals, as well as by chemical synthesis, are possible candidates for the design of new antimicrobial agents because of their natural antimicrobial properties and a low propensity for development of resistance by microorganisms. This manuscript reviews the current knowledge of the basic biology of AMPs and their applications in non-ruminant nutrition. Antimicrobial peptides not only have broad-spectrum activity against bacteria, fungi, and viruses but also have the ability to bypass the common resistance mechanisms that are placing standard antibiotics in jeopardy. In addition, AMPs have beneficial effects on growth performance, nutrient digestibility, intestinal morphology and gut microbiota in pigs and broilers. Therefore, AMPs have good potential as suitable alternatives to conventional antibiotics used in swine and poultry industries. PMID:27153059

  11. Cost effectiveness of stream-gaging program in Michigan

    USGS Publications Warehouse

    Holtschlag, D.J.

    1985-01-01

    Data uses and funding sources were identified for the 129 continuous gaging stations being operated in Michigan as of 1984. One gaging station was identified as having insufficient reason to continue its operation. Several stations were identified for reactivation, should funds become available, because of insufficiencies in the data network. Alternative methods of developing streamflow information based on routing and regression analyses were investigated for 10 stations. However, no station records were reproduced with sufficient accuracy to replace conventional gaging practices. A cost-effectiveness analysis of the data collection procedure for the ice-free season was conducted using a Kalman-filter analysis. To define missing record characteristics, cross-correlation coefficients and coefficients of variation were computed at stations on the basis of daily mean discharge. Discharge measurement data were used to describe the gage/discharge rating stability at each station. The results of the cost-effectiveness analysis for a 9-month ice-free season show that the current policy of visiting most stations on a fixed servicing schedule once every 6 weeks results in an average standard error of 12.1% for the current $718,100 budget. By adopting a flexible servicing schedule, the average standard error could be reduced to 11.1%. Alternatively, the budget could be reduced to $700,200 while maintaining the current level of accuracy. A minimum budget of $680,200 is needed to operate the 129-gaging-station program; a budget less than this would not permit proper service and maintenance of stations. At the minimum budget, the average standard error would be 14.4%. A budget of $789,900 (the maximum analyzed) would result in a decrease in the average standard error to 9.07%. Owing to continual changes in the composition of the network and the changes in the uncertainties of streamflow accuracy at individual stations, the cost-effectiveness analysis will need to be updated

  12. A simple separation method with a microfluidic channel based on alternating current potential modulation.

    PubMed

    Noh, Hui-Bog; Chandra, Pranjal; Kim, You-Jeong; Shim, Yoon-Bo

    2012-11-20

    A simple separation and detection system based on an electrochemical potential modulated microchannel (EPMM) device was developed for the first time. The application of alternating current (AC) potential to the microfluidic separation channel walls, which were composed of screen printed carbon electrodes, resulted in the oscillation and fluctuation of analytes and in the formation of a perfect flat flow front. These events resulted in an increase in the effective concentration and in the fine separation of samples. The performance of the EPMM device was examined through the analysis of endocrine disruptors (EDs) and heavy metal ions (HMIs) as model compounds. The analytical parameters that affected the separation and detection of EDs and HMIs were studied in terms of AC amplitude, AC frequency, flow rate, buffer concentration, pH, detection potential, and temperature. The separation efficiency was evaluated through measurements of the theoretical plate number (N), the retention time, and the half-peak width. Linear calibration plots for the detection of EDs and HMIs were obtained between 0.15 and 250.0 nM (detection limit 86.4 ± 2.9 pM) and between 0.01 and 10.0 nM (detection limit 9.5 ± 0.3 pM), respectively. The new device was successfully demonstrated with authentic and real samples. PMID:23075295

  13. Nanostructured systems containing babassu (Orbignya speciosa) oil as a potential alternative therapy for benign prostatic hyperplasia

    PubMed Central

    de Sousa, Valeria Pereira; Crean, Joanne; de Almeida Borges, Vinícius Raphael; Rodrigues, Carlos Rangel; Tajber, Lidia; Boylan, Fabio; Cabral, Lucio Mendes

    2013-01-01

    The oil of babassu tree nuts (Orbignya speciosa) is a potential alternative for treatment and prophylaxis of benign prostatic hyperplasia. Improved results can be obtained by drug vectorization to the hyperplastic tissue. The main objective of this work was the preparation and characterization of poly(lactic-co-glycolic acid) (PLGA) nanoparticle and clay nanosystems containing babassu oil (BBS). BBS was extracted from the kernels of babassu tree nuts and characterized by gas chromatography-mass spectrometry as well as 1H and 13C nuclear magnetic resonance. BBS-clay nanosystems were obtained by adding polyvinylpyrrolidone, Viscogel B8®, and BBS at a 2:1:1 mass ratio and characterized by X-ray diffraction, thermogravimetric analysis, infrared spectroscopy, and laser diffraction. The PLGA-BBS nanoparticles were prepared by the precipitation-solvent evaporation method. Mean diameter, polydispersity, zeta potential, and scanning electron microscopic images of the nanosystems were analyzed. Thermogravimetric analysis showed successful formation of the nanocomposite. PLGA nanoparticles containing BBS were obtained, with a suitable size that was confirmed by scanning electron microscopy. Both nanostructured systems showed active incorporation yields exceeding 90%. The two systems obtained represent a new and potentially efficient therapy for benign prostatic hyperplasia. PMID:23990721

  14. Analysis of Burnup and Economic Potential of Alternative Fuel Materials in Thermal Reactors

    SciTech Connect

    Oggianu, Stella Maris; No, Hee Cheon; Kazimi, Mujid S.

    2003-09-15

    A strategy is proposed for the assessment of nuclear fuel material economic potential use in future light water reactors (LWRs). In this methodology, both the required enrichment and the fuel performance limits are considered. In order to select the best fuel candidate, the optimal burnup that produces the lowest annual fuel cost within the burnup potential for a given fuel material and smear density ratio is determined.Several nuclear materials are presented as examples of the application of the methodology proposed in this paper. The alternative fuels considered include uranium dioxide (UO{sub 2}), uranium carbide (UC), uranium nitride (UN), metallic uranium (U-Zr alloy), combined thorium and uranium oxides (ThO{sub 2}/UO{sub 2}), and combined thorium and uranium metals (U/Th). For these examples, a typical LWR lattice geometry in a zirconium-based cladding was assumed. The uncertainties in the results presented are large due to the scarcity of experimental data regarding the behavior of the considered materials at high burnups. Also, chemical compatibility issues are to be considered separately.The same methodology can be applied in the future to evaluate the economic potential of other nuclear fuel materials including different cladding designs, dispersions of ceramics into ceramics, dispersions of ceramics into metals, and also for geometries other than the traditional circular fuel pin.

  15. Osthole: A Review on Its Bioactivities, Pharmacological Properties, and Potential as Alternative Medicine

    PubMed Central

    Zhang, Zhong-Rong; Leung, Wing Nang; Cheung, Ho Yee; Chan, Chun Wai

    2015-01-01

    This paper reviews the latest understanding of biological and pharmacological properties of osthole (7-methoxy-8-(3-methyl-2-butenyl)-2H-1-benzopyran-2-one), a natural product found in several medicinal plants such as Cnidium monnieri and Angelica pubescens. In vitro and in vivo experimental results have revealed that osthole demonstrates multiple pharmacological actions including neuroprotective, osteogenic, immunomodulatory, anticancer, hepatoprotective, cardiovascular protective, and antimicrobial activities. In addition, pharmacokinetic studies showed osthole uptake and utilization are fast and efficient in body. Moreover, the mechanisms of multiple pharmacological activities of osthole are very likely related to the modulatory effect on cyclic adenosine monophosphate (cAMP) and cyclic adenosine monophosphate (cGMP) level, though some mechanisms remain unclear. This review aims to summarize the pharmacological properties of osthole and give an overview of the underlying mechanisms, which showcase its potential as a multitarget alternative medicine. PMID:26246843

  16. A decision-theoretic framework for the application of cost-effectiveness analysis in regulatory processes.

    PubMed

    Baio, Gianluca; Russo, Pierluigi

    2009-01-01

    Cost-effectiveness analysis (CEA) represents the most important tool in the health economics literature to quantify and qualify the reasoning behind the optimal decision process in terms of the allocation of resources to a given health intervention. However, the practical application of CEA in the regulatory process is often limited by some critical barriers, and decisions in clinical practice are frequently influenced by factors that do not contribute to efficient resource allocation, leading to inappropriate drug prescription and utilization. Moreover, most of the time there is uncertainty about the real cost-effectiveness profile of an innovative intervention, with the consequence that it is usually impossible to obtain an immediate and perfect substitution of a product with another having a better cost-effectiveness ratio. The objective of this article is to propose a rational approach to CEA within regulatory processes, basing our analysis in a Bayesian decision-theoretic framework and proposing an extension of the application of well known tools (such as the expected value of information) to such cases. The regulator can use these tools to identify the economic value of reducing the uncertainty surrounding the cost-effectiveness profile of the several alternatives. This value can be compared with the one that is generated by the actual market share of the different treatment options: one that is the most cost effective and others in the same therapeutic category that, despite producing clinical benefits, are less cost effective.

  17. Use of alternative assays to identify and prioritize organophosphorus flame retardants for potential developmental and neurotoxicity.

    PubMed

    Behl, Mamta; Hsieh, Jui-Hua; Shafer, Timothy J; Mundy, William R; Rice, Julie R; Boyd, Windy A; Freedman, Jonathan H; Hunter, E Sidney; Jarema, Kimberly A; Padilla, Stephanie; Tice, Raymond R

    2015-01-01

    Due to their toxicity and persistence in the environment, brominated flame retardants (BFRs) are being phased out of commercial use, leading to the increased use of alternative chemicals such as the organophosphorus flame retardants (OPFRs). There is, however, limited information on the potential health effects of OPFRs. Due to the structural similarity of the OPFRs to organophosphorus insecticides, there is concern regarding developmental toxicity and neurotoxicity. In response, we evaluated a set of OPFRs (triphenyl phosphate [TPHP]), isopropylated phenyl phosphate [IPP], 2-ethylhexyl diphenyl phosphate [EHDP], tert-butylated phenyl diphenyl phosphate [BPDP], trimethyl phenyl phosphate [TMPP], isodecyl diphenyl phosphate [IDDP], (tris(1,3-dichloroisopropyl) phosphate [TDCIPP], and tris(2-chloroethyl)phosphate [TCEP]) in a battery of cell-based in vitro assays and alternative model organisms and compared the results to those obtained for two classical BFRs (3,3',5,5'-tetrabromobisphenol A [TBBPA] and 2,2'4,4'-brominated diphenyl ether [BDE-47]). The assays used evaluated the effects of chemicals on the differentiation of mouse embryonic stem cells, the proliferation and growth of human neural stem cells, rat neuronal growth and network activity, and development of nematode (Caenorhabditis elegans) and zebrafish (Danio rerio). All assays were performed in a concentration-response format, allowing for the determination of the point of departure (POD: the lowest concentration where a chemically-induced response exceeds background noise). The majority of OPFRs (8/9) were active in multiple assays in the range of 1-10 μM, most of which had comparable activity to the BFRs TBBPA and BDE-47. TCEP was negative in all assays. The results indicate that the replacement OPFRs, with the exception of TCEP, showed comparable activity to the two BFRs in the assays tested. Based on these results, more comprehensive studies are warranted to further characterize the potential hazard

  18. Mythology in the Making: Is the Open University Really Cost-Effective?

    ERIC Educational Resources Information Center

    Mace, John

    1978-01-01

    An alternative technique, cost-effectiveness analysis, is proposed as a more appropriate way of evaluating the Open University. A rudimentary application of the technique to the cost structure of OU indicates that it could result in a substantial reduction in OU's costs. (Author/LBH)

  19. A Guide to the Selection of Cost-Effective Wastewater Treatment Systems. Technical Report.

    ERIC Educational Resources Information Center

    Van Note, Robert H.; And Others

    The data within this publication provide guidelines for planners, engineers and decision-makers at all governmental levels to evaluate cost-effectiveness of alternative wastewater treatment proposals. The processes described include conventional and advanced treatment units as well as most sludge handling and processing units. Flow sheets, cost…

  20. Assembly of a Cost-Effective Anode Using Palladium Nanoparticles for Alkaline Fuel Cell Applications

    ERIC Educational Resources Information Center

    Feliciano-Ramos, Ileana; Casan~as-Montes, Barbara; García-Maldonado, María M.; Menendez, Christian L.; Mayol, Ana R.; Díaz-Vazquez, Liz M.; Cabrera, Carlos R.

    2015-01-01

    Nanotechnology allows the synthesis of nanoscale catalysts, which offer an efficient alternative for fuel cell applications. In this laboratory experiment, the student selects a cost-effective anode for fuel cells by comparing three different working electrodes. These are commercially available palladium (Pd) and glassy carbon (GC) electrodes, and…

  1. Using Pair Counseling to Improve the Cost-Effectiveness of College Career Counseling

    ERIC Educational Resources Information Center

    McClain, Mary-Catherine; Sampson, James P.

    2013-01-01

    As the demand for career counseling services grows, the need for accountability rises, and the availability of funding decreases, it becomes more critical that practitioners utilize cost-effective interventions and alternative forms of treatment. One option for improving access to all clients while concurrently reducing costs involves using…

  2. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 23 Highways 1 2012-04-01 2012-04-01 false Finding of cost effectiveness. 635.205 Section 635.205... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be found cost effective for a State transportation department or county to undertake a federally...

  3. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy...

  4. Cost-effectiveness of continuous erythropoietin receptor activator in anemia

    PubMed Central

    Schmid, Holger

    2014-01-01

    Background Erythropoiesis-stimulating agents (ESAs) are the mainstay of anemia therapy. Continuous erythropoietin receptor activator (CERA) is a highly effective, long-acting ESA developed for once-monthly dosing. A multitude of clinical studies has evaluated the safety and efficiency of this treatment option for patients with renal anemia. In times of permanent financial pressure on health care systems, the cost-effectiveness of CERA should be of particular importance for payers and clinicians. Objective To critically analyze, from the nephrologists’ point of view, the published literature focusing on the cost-effectiveness of CERA for anemia treatment. Methods The detailed literature search covered electronic databases including MEDLINE, PubMed, and Embase, as well as international conference abstract databases. Results Peer-reviewed literature analyzing the definite cost-effectiveness of CERA is scarce, and most of the available data originate from conference abstracts. Identified data are restricted to the treatment of anemia due to chronic kidney disease. Although the majority of studies suggest a considerable cost advantage for CERA, the published literature cannot easily be compared. While time and motion studies clearly indicate that a switch to CERA could minimize health care staff time in dialysis units, the results of studies comparing direct costs are more ambivalent, potentially reflecting the differences between health care systems and variability between centers. Conclusion Analyzed data are predominantly insufficient; they miss clear evidence and have to thus be interpreted with great caution. In this day and age of financial restraints, results from well-designed, head-to-head studies with clearly defined endpoints have to prove whether CERA therapy can achieve cost savings without compromising anemia management. PMID:25050070

  5. Intracameral cefuroxime and moxifloxacin used as endophthalmitis prophylaxis after cataract surgery: systematic review of effectiveness and cost-effectiveness.

    PubMed

    Linertová, Renata; Abreu-González, Rodrigo; García-Pérez, Lidia; Alonso-Plasencia, Marta; Cordovés-Dorta, Luis Mateo; Abreu-Reyes, José Augusto; Serrano-Aguilar, Pedro

    2014-01-01

    Postoperative endophthalmitis is one of the most serious potential complications of ocular lens surgery. Its incidence can be reduced by means of antibiotic prophylaxis. Although the prophylactic use of intracameral cefuroxime has been extended, other drugs, such as moxifloxacin, have arisen as alternatives. We performed a systematic literature review on the effectiveness and efficiency of intracameral cefuroxime and moxifloxacin for the prophylaxis of postoperative endophthalmitis after cataract surgery. Several bibliographic databases were searched up to October 2010 and were updated up to January 2013. Outcomes were the onset of endophthalmitis after surgery and the cost-effectiveness ratio of using both antibiotic prophylaxis alternatives. The following were included: a clinical trial reported in two papers, six observational studies, and an economic evaluation. All studies assessed cefuroxime compared with another antibiotic prophylaxis or no prophylaxis. The only randomized controlled trial performed by the European Society of Cataract and Refractive Surgery found that intracameral cefuroxime is significantly more effective than not using prophylaxis or the use of a topical antibiotic. The observational studies support these results. The economic evaluation compared different prophylaxis regimens and concluded that intracameral cefuroxime showed the best cost-effectiveness ratio. Both the observational studies and the economic evaluation have methodological limits that reduce their validity. This review confirmed that cefuroxime can prevent endophthalmitis after cataract surgery. Further randomized controlled trials, with large sample sizes, are required to compare different antibiotic prophylaxis regimens.

  6. Religious Broadcasting as an Alternative to TV: An Initial Assessment of Potential Utilization of the Christian Broadcasting Network Alternative.

    ERIC Educational Resources Information Center

    Gantz, Walter; Kowalewski, Paul

    Telephone interviews were conducted with 308 adults in a large eastern metropolitan area as part of a study to discover levels of satisfaction with present television programing; awareness of and exposure to religious broadcasts; motivations for exposure to "The 700 Club," a nationally syndicated religious program; and potential utilization of…

  7. The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales.

    PubMed

    Atkins, Katherine E; Shim, Eunha; Carroll, Stuart; Quilici, Sibilia; Galvani, Alison P

    2012-11-01

    Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £ 60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

  8. Alternative future analysis for assessing the potential impact of climate change on urban landscape dynamics.

    PubMed

    He, Chunyang; Zhao, Yuanyuan; Huang, Qingxu; Zhang, Qiaofeng; Zhang, Da

    2015-11-01

    Assessing the impact of climate change on urban landscape dynamics (ULD) is the foundation for adapting to climate change and maintaining urban landscape sustainability. This paper demonstrates an alternative future analysis by coupling a system dynamics (SD) and a cellular automata (CA) model. The potential impact of different climate change scenarios on ULD from 2009 to 2030 was simulated and evaluated in the Beijing-Tianjin-Tangshan megalopolis cluster area (BTT-MCA). The results suggested that the integrated model, which combines the advantages of the SD and CA model, has the strengths of spatial quantification and flexibility. Meanwhile, the results showed that the influence of climate change would become more severe over time. In 2030, the potential urban area affected by climate change will be 343.60-1260.66 km(2) (5.55 -20.37 % of the total urban area, projected by the no-climate-change-effect scenario). Therefore, the effects of climate change should not be neglected when designing and managing urban landscape.

  9. Microbial Peptidyl-Prolyl cis/trans Isomerases (PPIases): Virulence Factors and Potential Alternative Drug Targets

    PubMed Central

    2014-01-01

    SUMMARY Initially discovered in the context of immunomodulation, peptidyl-prolyl cis/trans isomerases (PPIases) were soon identified as enzymes catalyzing the rate-limiting protein folding step at peptidyl bonds preceding proline residues. Intense searches revealed that PPIases are a superfamily of proteins consisting of three structurally distinguishable families with representatives in every described species of prokaryote and eukaryote and, recently, even in some giant viruses. Despite the clear-cut enzymatic activity and ubiquitous distribution of PPIases, reports on solely PPIase-dependent biological roles remain scarce. Nevertheless, they have been found to be involved in a plethora of biological processes, such as gene expression, signal transduction, protein secretion, development, and tissue regeneration, underscoring their general importance. Hence, it is not surprising that PPIases have also been identified as virulence-associated proteins. The extent of contribution to virulence is highly variable and dependent on the pleiotropic roles of a single PPIase in the respective pathogen. The main objective of this review is to discuss this variety in virulence-related bacterial and protozoan PPIases as well as the involvement of host PPIases in infectious processes. Moreover, a special focus is given to Legionella pneumophila macrophage infectivity potentiator (Mip) and Mip-like PPIases of other pathogens, as the best-characterized virulence-related representatives of this family. Finally, the potential of PPIases as alternative drug targets and first tangible results are highlighted. PMID:25184565

  10. Chlorella zofingiensis as an Alternative Microalgal Producer of Astaxanthin: Biology and Industrial Potential

    PubMed Central

    Liu, Jin; Sun, Zheng; Gerken, Henri; Liu, Zheng; Jiang, Yue; Chen, Feng

    2014-01-01

    Astaxanthin (3,3′-dihydroxy-β,β-carotene-4,4′-dione), a high-value ketocarotenoid with a broad range of applications in food, feed, nutraceutical, and pharmaceutical industries, has been gaining great attention from science and the public in recent years. The green microalgae Haematococcus pluvialis and Chlorella zofingiensis represent the most promising producers of natural astaxanthin. Although H. pluvialis possesses the highest intracellular astaxanthin content and is now believed to be a good producer of astaxanthin, it has intrinsic shortcomings such as slow growth rate, low biomass yield, and a high light requirement. In contrast, C. zofingiensis grows fast phototrophically, heterotrophically and mixtrophically, is easy to be cultured and scaled up both indoors and outdoors, and can achieve ultrahigh cell densities. These robust biotechnological traits provide C. zofingiensis with high potential to be a better organism than H. pluvialis for mass astaxanthin production. This review aims to provide an overview of the biology and industrial potential of C. zofingiensis as an alternative astaxanthin producer. The path forward for further expansion of the astaxanthin production from C. zofingiensis with respect to both challenges and opportunities is also discussed. PMID:24918452

  11. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    SciTech Connect

    Tidball, Rick

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  12. Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements

    PubMed Central

    Contzen, Nadja; De Pasquale, Sandra; Mosler, Hans-Joachim

    2015-01-01

    Handwashing interventions are a priority in development and emergency aid programs. Evaluation of these interventions is essential to assess the effectiveness of programs; however, measuring handwashing is quite difficult. Although observations are considered valid, they are time-consuming and cost-ineffective; self-reports are highly efficient but considered invalid because desirable behaviour tends to be over-reported. Socially desirable responding has been claimed to be the main cause of inflated self-reports, but its underlying factors and mechanisms are understudied. The present study investigated socially desirable responding and additional potential explanatory factors for over-reported handwashing to identify indications for measures which mitigate over-reporting. Additionally, a script-based covert recall, an alternative interview question intended to mitigate recall errors and socially desirable responding, was developed and tested. Cross-sectional data collection was conducted in the Borena Zone, Ethiopia, through 2.5-hour observations and 1-hour interviews with the primary caregivers in households. A total sample of N = 554 was surveyed. Data were analysed with correlation and multiple regression analyses and dependent t-tests. Over-reporting of handwashing was associated with factors assumed to be involved in (1) socially desirable responding, (2) encoding and recall of information, and (3) dissonance processes. The latter two factor groups explained over-reported handwashing beyond socially desirable responding. The alternative interview question—script-based covert recall—reduced over-reporting compared to conventional self-reports. Although the difficulties involved in measuring handwashing by self-reports and observations are widely known, the present study is the first to investigate the factors which explain over-reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate

  13. Plant oils as feedstock alternatives to petroleum - A short survey of potential oil crop platforms.

    PubMed

    Carlsson, Anders S

    2009-06-01

    Our society is highly depending on petroleum for its activities. About 90% is used as an energy source for transportation and for generation of heat and electricity and the remaining as feedstocks in the chemical industry. However, petroleum is a finite source as well as causing several environmental problems such as rising carbon dioxide levels in the atmosphere. Petroleum therefore needs to be replaced by alternative and sustainable sources. Plant oils and oleochemicals derived from them represent such alternative sources, which can deliver a substantial part of what is needed to replace the petroleum used as feedstocks. Plant derived feedstock oils can be provided by two types of oil qualities, multi-purpose and technical oils. Multi-purpose oils represent oil qualities that contain common fatty acids and that can be used for both food and feedstock applications. Technical oil qualities contain unusual fatty acids with special properties gained from their unique molecular structure and these types of oils should only be used for feedstock applications. As a risk mitigation strategy in the selection of crops, technical oil qualities should therefore preferably be produced by oil crop platforms dedicated for industrial usage. This review presents a short survey of oil crop platforms to be considered for either multi-purpose or technical oils production. Included among the former platforms are some of the major oil crops in cultivation such as oil palm, soybean and rapeseed. Among the later are those that could be developed into dedicated industrial platforms such as crambe, flax, cotton and Brassica carinata. The survey finishes off by highlighting the potential of substantial increase in plant oil production by developing metabolic flux platforms, which are starch crops converted into oil crops.

  14. Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements.

    PubMed

    Contzen, Nadja; De Pasquale, Sandra; Mosler, Hans-Joachim

    2015-01-01

    Handwashing interventions are a priority in development and emergency aid programs. Evaluation of these interventions is essential to assess the effectiveness of programs; however, measuring handwashing is quite difficult. Although observations are considered valid, they are time-consuming and cost-ineffective; self-reports are highly efficient but considered invalid because desirable behaviour tends to be over-reported. Socially desirable responding has been claimed to be the main cause of inflated self-reports, but its underlying factors and mechanisms are understudied. The present study investigated socially desirable responding and additional potential explanatory factors for over-reported handwashing to identify indications for measures which mitigate over-reporting. Additionally, a script-based covert recall, an alternative interview question intended to mitigate recall errors and socially desirable responding, was developed and tested. Cross-sectional data collection was conducted in the Borena Zone, Ethiopia, through 2.5-hour observations and 1-hour interviews with the primary caregivers in households. A total sample of N = 554 was surveyed. Data were analysed with correlation and multiple regression analyses and dependent t-tests. Over-reporting of handwashing was associated with factors assumed to be involved in (1) socially desirable responding, (2) encoding and recall of information, and (3) dissonance processes. The latter two factor groups explained over-reported handwashing beyond socially desirable responding. The alternative interview question--script-based covert recall--reduced over-reporting compared to conventional self-reports. Although the difficulties involved in measuring handwashing by self-reports and observations are widely known, the present study is the first to investigate the factors which explain over-reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate

  15. Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness.

    PubMed

    Goldfeld, K S

    2014-03-30

    Cost-effectiveness analysis is an important tool that can be applied to the evaluation of a health treatment or policy. When the observed costs and outcomes result from a nonrandomized treatment, making causal inference about the effects of the treatment requires special care. The challenges are compounded when the observation period is truncated for some of the study subjects. This paper presents a method of unbiased estimation of cost-effectiveness using observational study data that is not fully observed. The method-twice-weighted multiple interval estimation of a marginal structural model-was developed in order to analyze the cost-effectiveness of treatment protocols for advanced dementia residents living nursing homes when they become acutely ill. A key feature of this estimation approach is that it facilitates a sensitivity analysis that identifies the potential effects of unmeasured confounding on the conclusions concerning cost-effectiveness.

  16. Cost-effective bifacial dye-sensitized solar cells with transparent iron selenide counter electrodes. An avenue of enhancing rear-side electricity generation capability

    NASA Astrophysics Data System (ADS)

    Liu, Juan; Tang, Qunwei; He, Benlin; Yu, Liangmin

    2015-02-01

    Alloy materials have established themselves as alternative electrocatalysts for electrochemical devices because of their cost-effectiveness, high conductivity, good electrocatalytic activity, and reasonable stability. Aiming at reducing fabrication cost without sacrificing power conversion efficiency of dye-sensitized solar cells (DSSCs), we report the feasibility of designing transparent and cost-effective Fe-Se alloy counter electrodes for bifacial DSSCs. Due to the rapid charge transfer ability and electrocatalytic activity, maximum front and rear efficiencies of 7.64% and 4.95% are measured for the DSSC with FeSe alloy electrode in comparison with 6.97% and 3.56% from Pt-based solar cell. The impressive results along with simple synthesis highlight the potential application of Fe-Se alloys in robust bifacial DSSCs.

  17. Can Aging in Place Be Cost Effective? A Systematic Review

    PubMed Central

    Graybill, Erin M.; McMeekin, Peter; Wildman, John

    2014-01-01

    Purpose of the Study To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to ‘age in place’ and highlight what further research is needed to inform decisions regarding aging in place. Design People aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement. Methods Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. Results Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. Implications The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn. PMID:25058505

  18. The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis

    PubMed Central

    Manca, Andrea; Claxton, Karl; Sculpher, Mark J.

    2014-01-01

    This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. PMID:24944196

  19. The 2-year cost-effectiveness of 3 options to treat lumbar spinal stenosis patients.

    PubMed

    Udeh, Belinda L; Costandi, Shrif; Dalton, Jarrod E; Ghosh, Raktim; Yousef, Hani; Mekhail, Nagy

    2015-02-01

    Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild(®) ) is an alternative. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild(®) to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. The mild(®) strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost-effective ($125,985/QALY).

  20. ROV's: The key is cost effectiveness

    SciTech Connect

    Saunders, E.

    1986-10-01

    Although diver-support activities will continue to be required in terms of monitoring and assistance, low-cost, remotely operated vehicles (ROV's) will have an increasing presence in the oil industry and other fields provided there is ongoing improvement in management, preparation, and execution of work. Beyond the safety aspect, the key is cost effectiveness. It is the company's intention wherever possible, and within realistic constraints, to take the man out of the water either by direct ROV replacement of the diver or by assisting him. Shell's exploration and production operations are based in three main areas: the southern, central, and northern North Sea. These developed fields, which consist of 26 various structures (interconnected), are connected to the mainland by over 1,100 km of submarine pipeline. Maintenance and underwater engineering costs in northern operations alone exceed pounds40 million/year (about $60 million/year) where typical support is an estimated 700 ROV days/year. The utilization analysis indicates a major use in ''eyeball'' vehicles for diver monitoring, and a large percentage for pipeline survey with only a limited amount on structural work and other special applications. The ''Bondi initiative'' in the late 1970s was intended to remove the diver from the water by ROV replacement, but due to lack of development, the capability in many areas has not evolved.

  1. Cost effectiveness of recycling: A systems model

    SciTech Connect

    Tonjes, David J.; Mallikarjun, Sreekanth

    2013-11-15

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

  2. Cost effectiveness of recycling: a systems model.

    PubMed

    Tonjes, David J; Mallikarjun, Sreekanth

    2013-11-01

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

  3. Systematic review of cost effectiveness studies of telemedicine interventions

    PubMed Central

    Whitten, Pamela S; Mair, Frances S; Haycox, Alan; May, Carl R; Williams, Tracy L; Hellmich, Seth

    2002-01-01

    review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusionsThere is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery PMID:12065269

  4. Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria

    PubMed Central

    Habib, Abdulrazaq G.; Lamorde, Mohammed; Dalhat, Mahmood M.; Habib, Zaiyad G.; Kuznik, Andreas

    2015-01-01

    Background Snakebite envenoming is a major public health problem throughout the rural tropics. Antivenom is effective in reducing mortality and remains the mainstay of therapy. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria. Methodology Economic analysis was conducted from a public healthcare system perspective. Estimates of model inputs were obtained from the literature. Incremental Cost Effectiveness Ratios (ICERs) were quantified as deaths and Disability-Adjusted-Life-Years (DALY) averted from antivenom therapy. A decision analytic model was developed and analyzed with the following model base-case parameter estimates: type of snakes causing bites, antivenom effectiveness to prevent death, untreated mortality, risk of Early Adverse Reactions (EAR), mortality risk from EAR, mean age at bite and remaining life expectancy, and disability risk (amputation). End-user costs applied included: costs of diagnosing and monitoring envenoming, antivenom drug cost, supportive care, shipping/freezing antivenom, transportation to-and-from hospital and feeding costs while on admission, management of antivenom EAR and free alternative snakebite care for ineffective antivenom. Principal Findings We calculated a cost/death averted of ($2330.16) and cost/DALY averted of $99.61 discounted and $56.88 undiscounted. Varying antivenom effectiveness through the 95% confidence interval from 55% to 86% yield a cost/DALY averted of $137.02 to $86.61 respectively. Similarly, varying the prevalence of envenoming caused by carpet viper from 0% to 96% yield a cost/DALY averted of $254.18 to $78.25 respectively. More effective antivenoms and carpet viper envenoming rather than non-carpet viper envenoming were associated with lower cost/DALY averted. Conclusions/Significance Treatment of snakebite envenoming in Nigeria is cost-effective with a cost/death averted of $2330.16 and cost/DALY averted of $99.61 discounted, lower

  5. Modifying the gastrointestinal ecology in alternatively raised poultry and the potential for molecular and metabolomic assessment.

    PubMed

    Park, S H; Hanning, I; Perrota, A; Bench, B J; Alm, E; Ricke, S C

    2013-02-01

    Consumer demand for nonconventional poultry products continues to increase in the United States. In pasture flock and organic poultry production, probiotics and prebiotic feed additives have potential advantages because they are thought to promote intestinal health and may offer a replacement for current intervention strategies that are not considered acceptable for these production systems. Prebiotics have been demonstrated to produce effects on the gastrointestinal tract including modulation of microflora by promoting selective increases in beneficial bacteria concomitant with decreases in undesirable bacteria. In-depth assessment of microbial community changes during host growth and development as well as the establishment of beneficial microbial species by adding biologicals such as probiotics and prebiotics is important to achieve predictable and consistent improvements in chicken health and productivity. To analyze microflora shifts and metabolites produced by bacteria in the gut as well as host responses to biological additives, sophisticated molecular techniques are now available and are becoming more widely used. Polymerase chain reaction assays, denaturing gradient gel electrophoresis, and temperature gradient gel electrophoresis offer approaches for detecting microbial shifts in the gut. Likewise, the employment of microarrays and molecular analysis of gut tissues can reveal insight into gut physiological and responses to dietary and other changes. Recent application of 16S rDNA sequencing and analysis utilizing basic local alignment search tool (BLAST) and FASTA databases on poultry gut samples have the potential to provide a much more in-depth assessment of the gut microbiome. Utilizing ultra pressure liquid chromatography-mass spectroscopy profiling, metabolomic assessment of gut contents will also allow for parallel comparisons of changes in the gut contents with microbiome and physiological responses. Combining all these technologies will provide a

  6. Modifying the gastrointestinal ecology in alternatively raised poultry and the potential for molecular and metabolomic assessment.

    PubMed

    Park, S H; Hanning, I; Perrota, A; Bench, B J; Alm, E; Ricke, S C

    2013-02-01

    Consumer demand for nonconventional poultry products continues to increase in the United States. In pasture flock and organic poultry production, probiotics and prebiotic feed additives have potential advantages because they are thought to promote intestinal health and may offer a replacement for current intervention strategies that are not considered acceptable for these production systems. Prebiotics have been demonstrated to produce effects on the gastrointestinal tract including modulation of microflora by promoting selective increases in beneficial bacteria concomitant with decreases in undesirable bacteria. In-depth assessment of microbial community changes during host growth and development as well as the establishment of beneficial microbial species by adding biologicals such as probiotics and prebiotics is important to achieve predictable and consistent improvements in chicken health and productivity. To analyze microflora shifts and metabolites produced by bacteria in the gut as well as host responses to biological additives, sophisticated molecular techniques are now available and are becoming more widely used. Polymerase chain reaction assays, denaturing gradient gel electrophoresis, and temperature gradient gel electrophoresis offer approaches for detecting microbial shifts in the gut. Likewise, the employment of microarrays and molecular analysis of gut tissues can reveal insight into gut physiological and responses to dietary and other changes. Recent application of 16S rDNA sequencing and analysis utilizing basic local alignment search tool (BLAST) and FASTA databases on poultry gut samples have the potential to provide a much more in-depth assessment of the gut microbiome. Utilizing ultra pressure liquid chromatography-mass spectroscopy profiling, metabolomic assessment of gut contents will also allow for parallel comparisons of changes in the gut contents with microbiome and physiological responses. Combining all these technologies will provide a

  7. Evaluation of the odour reduction potential of alternative cover materials at a commercial landfill.

    PubMed

    Solan, P J; Dodd, V A; Curran, T P

    2010-02-01

    The availability of virgin soils and traditional landfill covers are not only costly and increasingly becoming scarce, but they also reduce the storage capacity of landfill. The problem can be overcome by the utilisation of certain suitable waste streams as alternative landfill covers. The objective of this study was to assess the suitability of Construction & Demolition fines (C&D), Commercial & Industrial fines (C&I) and woodchip (WC) as potential landfill cover materials in terms of odour control. Background odour analysis was conducted to determine if any residual odour was emitted from the cover types. It was deemed negligible for the three materials. The odour reduction performance of each of the materials was also examined on an area of an active landfill site. A range of intermediate cover compositions were also studied to assess their performance. Odour emissions were sampled using a Jiang hood and analysed. Results indicate that the 200 mm deep combination layer of C&D and wood chip used on-site is adequate for odour abatement. The application of daily cover was found to result in effective reduction allowing for the background odour of woodchip. PMID:19786346

  8. The Potential of the Internet for Alternative Caring Practices for Health

    PubMed Central

    Atkinson, Sarah; Ayers, Andrew

    2013-01-01

    The practices of health care in late modernity are informed by competing visions of the ideal human and the nature of care. Western societies typically characterise the ideal human as independent and self-reliant. The resultant welfare systems provide temporary havens away from the everyday, competitive spaces of capitalist societies, termed here the enclave model. Social scientists problematise this model on several grounds: the construction of pathologised and medicalised body forms; the neglect of caring practices that are gendered, invisible and primarily private; the de-politicisation of caring practices. Policy calls reject reference to care and its associations with dependency, make visible and value informal care work or invoke a caring citizenship as a policy goal not just a means. Into this field of contested notions of care enters a well-documented rise in access to, and consultation through, the internet in everyday lives for a vast range of issues. Health care encountered on-line reflects a similar range in form as that encountered off-line and much that is innovative, whilst clearly of benefit, does nothing to challenge the existing dominance of the enclave model of social care. However, certain groups of sites create spaces through which participants can both express and extract caring relationships that are otherwise unforthcoming. The paper argues that these sites afford potential to develop an alternative model of caring, to reframe questions of how to care about distant others and to demonstrate the centrality of caring relations to human life. PMID:20419518

  9. Ethanol-glycerin fixation with thymol conservation: a potential alternative to formaldehyde and phenol embalming.

    PubMed

    Hammer, Niels; Löffler, Sabine; Feja, Christine; Sandrock, Mara; Schmidt, Wolfgang; Bechmann, Ingo; Steinke, Hanno

    2012-01-01

    Anatomical fixation and conservation are required to prevent specimens from undergoing autolysis and decomposition. While fixation is the primary arrest of the structures responsible for autolysis and decomposition, conservation preserves the state of fixation. Although commonly used, formaldehyde has been classified as carcinogenic to humans. For this reason, an adequate substitute was developed. Ethanol-glycerin fixation and thymol conservation are described and compared with formaldehyde and phenol in this technical report. The setup, tissue qualities, financial aspects, and health concerns of this method are discussed. Ethanol-glycerin fixation and thymol conservation provide outstanding haptic and optic tissue qualities. Typical formaldehyde and phenol effects, such as skin, airway, and eye irritation, as well as carcinogenic effects, can be circumvented by using ethanol-glycerin and thymol instead. Ethanol-glycerin fixation is more expensive than formaldehyde and requires an explosion-proof facility. However, the absence of health effects and its convincing tissue qualities balance these higher costs. Therefore, ethanol-glycerin fixation and thymol conservation provide a potential alternative and complement established fixation techniques. The use of carcinogenic formaldehyde and toxic phenol can be effectively restricted through the use of the described method.

  10. Cost Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, Philip

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous United States. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  11. Release of Lungworm Larvae from Snails in the Environment: Potential for Alternative Transmission Pathways

    PubMed Central

    Giannelli, Alessio; Colella, Vito; Abramo, Francesca; do Nascimento Ramos, Rafael Antonio; Falsone, Luigi; Brianti, Emanuele; Varcasia, Antonio; Dantas-Torres, Filipe; Knaus, Martin; Fox, Mark T.; Otranto, Domenico

    2015-01-01

    Background Gastropod-borne parasites may cause debilitating clinical conditions in animals and humans following the consumption of infected intermediate or paratenic hosts. However, the ingestion of fresh vegetables contaminated by snail mucus and/or water has also been proposed as a source of the infection for some zoonotic metastrongyloids (e.g., Angiostrongylus cantonensis). In the meantime, the feline lungworms Aelurostrongylus abstrusus and Troglostrongylus brevior are increasingly spreading among cat populations, along with their gastropod intermediate hosts. The aim of this study was to assess the potential of alternative transmission pathways for A. abstrusus and T. brevior L3 via the mucus of infected Helix aspersa snails and the water where gastropods died. In addition, the histological examination of snail specimens provided information on the larval localization and inflammatory reactions in the intermediate host. Methodology/Principal Findings Twenty-four specimens of H. aspersa received ~500 L1 of A. abstrusus and T. brevior, and were assigned to six study groups. Snails were subjected to different mechanical and chemical stimuli throughout 20 days in order to elicit the production of mucus. At the end of the study, gastropods were submerged in tap water and the sediment was observed for lungworm larvae for three consecutive days. Finally, snails were artificially digested and recovered larvae were counted and morphologically and molecularly identified. The anatomical localization of A. abstrusus and T. brevior larvae within snail tissues was investigated by histology. L3 were detected in the snail mucus (i.e., 37 A. abstrusus and 19 T. brevior) and in the sediment of submerged specimens (172 A. abstrusus and 39 T. brevior). Following the artificial digestion of H. aspersa snails, a mean number of 127.8 A. abstrusus and 60.3 T. brevior larvae were recovered. The number of snail sections positive for A. abstrusus was higher than those for T. brevior

  12. Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.

    PubMed

    Fiedler, John L; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I; Jallier, Vincent; Guyondet, Christophe

    2013-12-01

    Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates ofmicronutrient deficiencies. Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods. Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternativefoodfortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results. Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions. Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose-response-based approach to estimating the number ofDALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.

  13. Mechanical impedance measurements for improved cost-effective process monitoring

    NASA Astrophysics Data System (ADS)

    Clopet, Caroline R.; Pullen, Deborah A.; Badcock, Rodney A.; Ralph, Brian; Fernando, Gerard F.; Mahon, Steve W.

    1999-06-01

    The aerospace industry has seen a considerably growth in composite usage over the past ten years, especially with the development of cost effective manufacturing techniques such as Resin Transfer Molding and Resin Infusion under Flexible Tooling. The relatively high cost of raw material and conservative processing schedules has limited their growth further in non-aerospace technologies. In-situ process monitoring has been explored for some time as a means to improving the cost efficiency of manufacturing with dielectric spectroscopy and optical fiber sensors being the two primary techniques developed to date. A new emerging technique is discussed here making use of piezoelectric wafers with the ability to sense not only aspects of resin flow but also to detect the change in properties of the resin as it cures. Experimental investigations to date have shown a correlation between mechanical impedance measurements and the mechanical properties of cured epoxy systems with potential for full process monitoring.

  14. Methods of cost-effectiveness analysis in the evaluation of new antipsychotics: implications for schizophrenia treatment.

    PubMed

    Neumann, P J

    1999-01-01

    Because health care payers are increasingly interested in learning whether new treatments offer value for money, there has been an abundance of research into the cost-effectiveness of pharmacologic therapies in the United States. In the past few years, a number of studies comparing the cost-effectiveness of the conventional neuroleptics with that of the atypical antipsychotics have been published. Cost-effectiveness analyses show the relationship between the resources used (costs) and the health benefits achieved (effects) for a health or medical intervention compared with an alternative strategy. Ideally, the analyses can help decision makers improve the health of the population by better allocating society's limited health care resources. However, the extent to which cost-effectiveness data are actually used in decision making is unclear. The analyses are sometimes viewed with skepticism, in part because studies differ in their methodological approaches. Recently, the U.S. Panel on Cost-Effectiveness in Health and Medicine offered recommendations for standard methodological practices, which may help improve the quality of studies and the acceptability of the approach in the future. The issue is particularly important in light of new legislation governing how the Food and Drug Administration will regulate promotional claims made by drug companies regarding health economic information. PMID:10073371

  15. Metronomic Chemotherapy in Anaplastic Thyroid Carcinoma: A Potentially Feasible Alternative to Therapeutic Nihilism

    PubMed Central

    Revannasiddaiah, Swaroop; Madabhavi, Irappa; Bodh, Anita; Thakur, Priyanka; Sharma, Mukesh

    2015-01-01

    Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies and prognostic outlook remains very dismal. Treatment most often is palliative in intent attempting to relieve the patients from local compressive symptoms in the neck. Radical surgery, radiotherapy (RT), and chemotherapy have not been tested in large prospective trials, and current evidence from retrospective series and small trials indicate only marginal survival benefits. Given the poor prognostic and therapeutic outlook, patients must be encouraged to be actively involved in the decision making process. We report the case of an elderly patient who had no response to palliative RT, and was treated with oral metronomic chemotherapy. The response to oral metronomic chemotherapy was dramatic, and the patient has enjoyed complete freedom from symptoms as well as radiologically exhibits a complete regression. Thus, we document the first ever use of a simple, cost-effective, and convenient oral metronomic chemotherapeutic regimen delivering a remarkable response in an elderly patient with ATC. PMID:26009682

  16. Metronomic chemotherapy in anaplastic thyroid carcinoma: a potentially feasible alternative to therapeutic nihilism.

    PubMed

    Revannasiddaiah, Swaroop; Madabhavi, Irappa; Bodh, Anita; Thakur, Priyanka; Sharma, Mukesh

    2015-01-01

    Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies and prognostic outlook remains very dismal. Treatment most often is palliative in intent attempting to relieve the patients from local compressive symptoms in the neck. Radical surgery, radiotherapy (RT), and chemotherapy have not been tested in large prospective trials, and current evidence from retrospective series and small trials indicate only marginal survival benefits. Given the poor prognostic and therapeutic outlook, patients must be encouraged to be actively involved in the decision making process. We report the case of an elderly patient who had no response to palliative RT, and was treated with oral metronomic chemotherapy. The response to oral metronomic chemotherapy was dramatic, and the patient has enjoyed complete freedom from symptoms as well as radiologically exhibits a complete regression. Thus, we document the first ever use of a simple, cost-effective, and convenient oral metronomic chemotherapeutic regimen delivering a remarkable response in an elderly patient with ATC. PMID:26009682

  17. How to develop renewable power in China? A cost-effective perspective.

    PubMed

    Cong, Rong-Gang; Shen, Shaochuan

    2014-01-01

    To address the problems of climate change and energy security, Chinese government strived to develop renewable power as an important alternative of conventional electricity. In this paper, the learning curve model is employed to describe the decreasing unit investment cost due to accumulated installed capacity; the technology diffusion model is used to analyze the potential of renewable power. Combined with the investment cost, the technology potential, and scenario analysis of China social development in the future, we develop the Renewable Power Optimization Model (RPOM) to analyze the optimal development paths of three sources of renewable power from 2009 to 2020 in a cost-effective way. Results show that (1) the optimal accumulated installed capacities of wind power, solar power, and biomass power will reach 169000, 20000, and 30000 MW in 2020; (2) the developments of renewable power show the intermittent feature; (3) the unit investment costs of wind power, solar power, and biomass power will be 4500, 11500, and 5700 Yuan/KW in 2020; (4) the discounting effect dominates the learning curve effect for solar and biomass powers; (5) the rise of on-grid ratio of renewable power will first promote the development of wind power and then solar power and biomass power.

  18. How to Develop Renewable Power in China? A Cost-Effective Perspective

    PubMed Central

    2014-01-01

    To address the problems of climate change and energy security, Chinese government strived to develop renewable power as an important alternative of conventional electricity. In this paper, the learning curve model is employed to describe the decreasing unit investment cost due to accumulated installed capacity; the technology diffusion model is used to analyze the potential of renewable power. Combined with the investment cost, the technology potential, and scenario analysis of China social development in the future, we develop the Renewable Power Optimization Model (RPOM) to analyze the optimal development paths of three sources of renewable power from 2009 to 2020 in a cost-effective way. Results show that (1) the optimal accumulated installed capacities of wind power, solar power, and biomass power will reach 169000, 20000, and 30000 MW in 2020; (2) the developments of renewable power show the intermittent feature; (3) the unit investment costs of wind power, solar power, and biomass power will be 4500, 11500, and 5700 Yuan/KW in 2020; (4) the discounting effect dominates the learning curve effect for solar and biomass powers; (5) the rise of on-grid ratio of renewable power will first promote the development of wind power and then solar power and biomass power. PMID:24578672

  19. Cost effectiveness of therapies for atrial fibrillation. A review.

    PubMed

    Teng, M P; Catherwood, L E; Melby, D P

    2000-10-01

    Atrial fibrillation is the most common supraventricular tachyarrhythmia encountered in clinical practice, affecting over 5% of persons over the age of 65 years. A common pathophysiological mechanism for arrhythmia development is atrial distention and fibrosis induced by hypertension, coronary artery disease or ventricular dysfunction. Less frequently, atrial fibrillation is caused by mitral stenosis or other provocative factors such as thyrotoxicosis, pericarditis or alcohol intoxication. Depending on the extent of associated cardiovascular disease, atrial fibrillation may produce haemodynamic compromise, or symptoms such as palpitations, fatigue, chest pain or dyspnoea. Arrhythmia-induced atrial stasis can precipitate clot formation and the potential for subsequent thromboembolism. Comprehensive management of atrial fibrillation requires a multifaceted approach directed at controlling symptoms, protecting the patient from ischaemic stroke or peripheral embolism and possible conversion to or maintenance of sinus rhythm. Numerous randomised trials have demonstrated the efficacy of warfarin--and less so aspirin (acetylsalicylic acid)--in reducing the risk of embolic events. Furthermore, therapeutic strategies exist that can favourably modify symptoms by restoring and maintaining sinus rhythm with cardioversion and antiarrhythmic prophylaxis. However, the risks and benefits of various treatments is highly dependent on patient-specific features, emphasising the need for an individualised approach. This article reviews the findings of cost-effectiveness studies published over the past decade that have evaluated different components of treatment strategies for atrial fibrillation. These studies demonstrate the economic attractiveness of acute management options, long term warfarin prophylaxis, telemetry-guided initiation of antiarrhythmic therapy, approaches to restore and maintain sinus rhythm, and the potential role of transoesophageal echocardiographic screening for

  20. Weak polygyny in California sea lions and the potential for alternative mating tactics.

    PubMed

    Flatz, Ramona; González-Suárez, Manuela; Young, Julie K; Hernández-Camacho, Claudia J; Immel, Aaron J; Gerber, Leah R

    2012-01-01

    Female aggregation and male territoriality are considered to be hallmarks of polygynous mating systems. The development of genetic parentage assignment has called into question the accuracy of behavioral traits in predicting true mating systems. In this study we use 14 microsatellite markers to explore the mating system of one of the most behaviorally polygynous species, the California sea lion (Zalophus californianus). We sampled a total of 158 female-pup pairs and 99 territorial males across two breeding rookeries (San Jorge and Los Islotes) in the Gulf of California, Mexico. Fathers could be identified for 30% of pups sampled at San Jorge across three breeding seasons and 15% of sampled pups at Los Islotes across two breeding seasons. Analysis of paternal relatedness between the pups for which no fathers were identified (sampled over four breeding seasons at San Jorge and two at Los Islotes) revealed that few pups were likely to share a father. Thirty-one percent of the sampled males on San Jorge and 15% of the sampled males on Los Islotes were assigned at least one paternity. With one exception, no male was identified as the father of more than two pups. Furthermore, at Los Islotes rookery there were significantly fewer pups assigned paternity than expected given the pool of sampled males (p<0.0001). Overall, we found considerably lower variation in male reproductive success than expected in a species that exhibits behavior associated with strongly polygynous mating. Low variation in male reproductive success may result from heightened mobility among receptive females in the Gulf of California, which reduces the ability of males to monopolize groups of females. Our results raise important questions regarding the adaptive role of territoriality and the potential for alternative mating tactics in this species.

  1. On the potential for alternative greenhouse gas equivalence metrics to influence sectoral mitigation patterns

    NASA Astrophysics Data System (ADS)

    Brennan, Mark E.; Zaitchik, Benjamin F.

    2013-03-01

    Equivalence metrics used to quantify the relative climate impacts of different atmospheric forcers serve an essential function in policy and economic discussions about global climate change. The 100-year global warming potential (GWP-100), the most established greenhouse gas (GHG) equivalence metric, is used within the Kyoto Protocol, and in most emissions inventory, trading and offset mechanisms, to assign the mitigation value of non-carbon dioxide greenhouse gases relative to carbon dioxide. In recent literature the GWP-100 and alternative metrics have been used to compare various anthropogenic climate forcers with respect to a wide range of environmental and economic goals. Building on this work, we examine how 16 different static and time-varying CO2-equivalence schemes might influence GHG mitigation across sectors and gases in a perfect and fluid global mitigation regime. This mitigation regime is guided by achieving a global mean radiative forcing (RF) of 5.7 Wm-2 in 2100 from 1765 levels through a mitigation policy of prescribed emissions reductions in each decade. It was found that static metrics defined on 20- instead of 100-year time horizons favor mitigation strategies that maximize the abatement of short-lived gases (e.g. methane), on average resulting in an RF from methane in 2100 of 0.5 Wm-2 instead of 1.1 Wm-2 from 100-year metrics. Similarly, metrics that consider integrated rather than end-point climate impacts imply mitigation strategies that maximize mitigation of shorter-lived GHGs, resulting in higher abatement of agriculture and waste emissions. Comparing extreme scenarios, these mitigation shifts across gases and sectors result in a nearly 30% difference in the representation of methane in global cumulative emissions reductions. This shift across gases and sectors to mitigate shorter-lived GHGs, in lieu of longer-lived GHGs like carbon dioxide, has implications for the long-term warming commitment due to 21st century emissions.

  2. Alternative energy sources

    NASA Astrophysics Data System (ADS)

    Todd, R. W.

    1982-04-01

    Renewable energy sources and their potential contribution for solving energy needs are presented. Centralized supply technologies include those alternative fuels derived from biomass using solar energy, (supplying 57% of the energy supply in some countries), and those using directly collected solar energy to manufacture a fuel. Fuel utilization effects can be doubled by using combined heat and power stations, and other major sources include wind, wave, tidal, and solar. In terms of local supply technology, wood burning appliances are becoming more popular, and methane is being used for heating and to fuel spark ignition engines. Geothermal low temperature heating exists worldwide at a capacity of 7.2 GW, supplying heat, particularly in Hungary, parts of the U.S.S.R., and Iceland, and a geothermal research program has been established in the United States. Sweden has a potential hydroelectric capacity of 600 MW, and the United States has a 100 GW capacity. Many of these technologies are already cost effective.

  3. Potential radiological impacts of upper-bound operational accidents during proposed waste disposal alternatives for Hanford defense waste

    SciTech Connect

    Mishima, J.; Sutter, S.L.; Hawley, K.A.; Jenkins, C.E.; Napier, B.A.

    1986-02-01

    The Geologic Disposal Alternative, the In-Place Stabilization and Disposal Alternative, and the Reference Disposal Alternative are being evaluated for disposal of Hanford defense high-level, transuranic, and tank wastes. Environmental impacts associated with disposal of these wastes according to the alternatives listed above include potential doses to the downwind population from operation during the application of the handling and processing techniques comprising each disposal alternative. Scenarios for operational accident and abnormal operational events are postulated, on the basis of the currently available information, for the application of the techniques employed for each waste class for each disposal alternative. From these scenarios, an upper-bound airborne release of radioactive material was postulated for each waste class and disposal alternative. Potential downwind radiologic impacts were calculated from these upper-bound events. In all three alternatives, the single postulated event with the largest calculated radiologic impact for any waste class is an explosion of a mixture of ferri/ferro cyanide precipitates during the mechanical retrieval or microwave drying of the salt cake in single shell waste tanks. The anticipated downwind dose (70-year dose commitment) to the maximally exposed individual is 3 rem with a total population dose of 7000 man-rem. The same individual would receive 7 rem from natural background radiation during the same time period, and the same population would receive 3,000,000 man-rem. Radiological impacts to the public from all other postulated accidents would be less than that from this accident; furthermore, the radiological impacts resulting from this accident would be less than one-half that from the natural background radiation dose.

  4. Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation

    PubMed Central

    Dorian, Paul; Kongnakorn, Thitima; Phatak, Hemant; Rublee, Dale A.; Kuznik, Andreas; Lanitis, Tereza; Liu, Larry Z.; Iloeje, Uchenna; Hernandez, Luis; Lip, Gregory Y.H.

    2014-01-01

    Aims Warfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than warfarin and aspirin in the ARISTOTLE and AVERROES studies, respectively, and causes less bleeding than warfarin. We evaluated the potential cost-effectiveness of apixaban against warfarin and aspirin from the perspective of the UK payer perspective. Results and methods A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model. Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs. Conclusions Based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively. PMID:24513791

  5. Teaching and Technology Transfer as Alternative Revenue Streams: A Primer on the Potential Legal Implications for UK Universities

    ERIC Educational Resources Information Center

    Van Hoorebeek, Mark; Marson, James

    2005-01-01

    Purpose: The purpose of this paper is to assess the financial and intellectual issues facing the university sector as many institutions in the UK pursue alternative revenue streams. As a consequence to the increasing financial pressures, university departments are increasingly exposed to new forms of potential litigation and also face the risk to…

  6. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  7. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  8. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  9. Cost-Effective Hyperspectral Transmissometers for Oceanographic Applications: Performance Analysis

    PubMed Central

    Ramírez-Pérez, Marta; Röttgers, Rüdiger; Torrecilla, Elena; Piera, Jaume

    2015-01-01

    The recent development of inexpensive, compact hyperspectral transmissometers broadens the research capabilities of oceanographic applications. These developments have been achieved by incorporating technologies such as micro-spectrometers as detectors as well as light emitting diodes (LEDs) as light sources. In this study, we evaluate the performance of the new commercial LED-based hyperspectral transmissometer VIPER (TriOS GmbH, Rastede, Germany), which combines different LEDs to emulate the visible light spectrum, aiming at the determination of attenuation coefficients in coastal environments. For this purpose, experimental uncertainties related to the instrument stability, the effect of ambient light and derived temperature, and salinity correction factors are analyzed. Our results identify some issues related to the thermal management of the LEDs and the contamination of ambient light. Furthermore, the performance of VIPER is validated against other transmissometers through simultaneous field measurements. It is demonstrated that VIPER provides a compact and cost-effective alternative for beam attenuation measurements in coastal waters, but it requires the consideration of several optimizations. PMID:26343652

  10. Cost effectiveness of the stream-gaging program in Louisiana

    USGS Publications Warehouse

    Herbert, R.A.; Carlson, D.D.

    1985-01-01

    This report documents the results of a study of the cost effectiveness of the stream-gaging program in Louisiana. Data uses and funding sources were identified for the 68 continuous-record stream gages currently (1984) in operation with a budget of $408,700. Three stream gages have uses specific to a short-term study with no need for continued data collection beyond the study. The remaining 65 stations should be maintained in the program for the foreseeable future. In addition to the current operation of continuous-record stations, a number of wells, flood-profile gages, crest-stage gages, and stage stations, are serviced on the continuous-record station routes; thus, increasing the current budget to $423,000. The average standard error of estimate for data collected at the stations is 34.6%. Standard errors computed in this study are one measure of streamflow errors, and can be used as guidelines in comparing the effectiveness of alternative networks. By using the routes and number of measurements prescribed by the ' Traveling Hydrographer Program, ' the standard error could be reduced to 31.5% with the current budget of $423,000. If the gaging resources are redistributed, the 34.6% overall level of accuracy at the 68 continuous-record sites and the servicing of the additional wells or gages could be maintained with a budget of approximately $410,000. (USGS)

  11. A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care

    PubMed Central

    Schoeny, Michael; Risser, Heather; Johnson, Tricia

    2016-01-01

    Introduction Up to 20% of children demonstrate behavior problems that interfere with relationship development and academic achievement. Parent participation in behavioral parent training programs has been shown to decrease child problem behaviors and promote positive parent-child relationships. However, attendance and parent involvement in face-to-face parent training remain low. Testing the implementation, efficacy, and cost of alternative delivery models is needed to (a) increase the reach and sustainability of parent training interventions and (b) address the barriers to parent participation and implementation of such programs, specifically in primary health care settings. The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of delivering the tablet-based ezParent program in pediatric primary care sites. Methods The implementation of the ezParent in four pediatric primary care sites will be evaluated using a descriptive design and cost-effectiveness analysis. The efficacy of the ezParent will be tested using a randomized controlled trial design with 312 parents of 2 to 5 year old children from pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained from all participants at baseline, and 3, 6, and 12 months post baseline. Discussion Integrating and evaluating the implementation of the ezParent in pediatric primary care is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care. PMID:27592122

  12. Costs and cost-effectiveness of periviable care.

    PubMed

    Caughey, Aaron B; Burchfield, David J

    2014-02-01

    With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates.

  13. Cost-effectiveness of vaccination against herpes zoster.

    PubMed

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

  14. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If... life cycle cost-effective without further analysis. (b) A Federal agency may presume that an investment in an energy or water conservation measure retrofit to an existing Federal building is not life...

  15. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart, “cost-effective” means that the State's cost of purchasing family coverage that includes coverage...

  16. The Cost Effectiveness of 22 Approaches for Raising Student Achievement

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2010-01-01

    Review of cost-effectiveness studies suggests that rapid assessment is more cost effective with regard to student achievement than comprehensive school reform (CSR), cross-age tutoring, computer-assisted instruction, a longer school day, increases in teacher education, teacher experience or teacher salaries, summer school, more rigorous math…

  17. Cost effectiveness of cardiovascular disease prevention strategies: a perspective on EU food based dietary guidelines.

    PubMed

    Brunner, E; Cohen, D; Toon, L

    2001-04-01

    For policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states? An overview of published studies of cost-effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available. Estimated costs per life year gained were as follows: population-based healthy eating Pound Sterling 14-560; smoking cessation Pound Sterling 300-790; nurse screening and life style advice Pound Sterling 900 (minimum); simvastatin (HMGCoA reductase inhibitor) Pound Sterling 6200-11,300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors. The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness

  18. Cost-Effectiveness of Cetuximab for Advanced Esophageal Squamous Cell Carcinoma

    PubMed Central

    Bruno, Marco J.; Polinder, Suzanne; Lorenzen, Sylvie; Lordick, Florian; Peppelenbosch, Maikel P.; Spaander, Manon C. W.

    2016-01-01

    Background Costly biologicals in palliative oncology are emerging at a rapid pace. For example, in patients with advanced esophageal squamous cell carcinoma addition of cetuximab to a palliative chemotherapy regimen appears to improve survival. However, it simultaneously results in higher costs. We aimed to determine the incremental cost-effectiveness ratio of adding cetuximab to first-line chemotherapeutic treatment of patients with advanced esophageal squamous cell carcinoma, based on data from a randomized controlled phase II trial. Methods A cost effectiveness analysis model was applied based on individual patient data. It included only direct medical costs from the health-care perspective. Quality-adjusted life-years and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by a Monte Carlo analysis. Results Adding cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma resulted in an the incremental cost-effectiveness ratio of €252,203 per quality-adjusted life-year. Sensitivity analysis shows that there is a chance of less than 0.001 that the incremental cost-effectiveness ratio will be less than a maximum willingness to pay threshold of €40,000 per quality-adjusted life-year, which is representative for the threshold used in The Netherlands and other developed countries. Conclusions Addition of cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma is not cost-effective when appraised according to currently accepted criteria. Cost-effectiveness analyses using outcome data from early clinical trials (i.c. a phase II trial) enable pharmaceutical companies and policy makers to gain early insight into whether a new drug meets the current eligibility standards for reimbursement and thereby potential admittance for use in regular clinical practice. PMID:27100871

  19. Potential of alternative sorbents for desulphurization: from laboratory tests to the full-scale combustion unit

    SciTech Connect

    Zbyszek Szeliga; Dagmar Juchelkova; Bohumir Cech; Pavel Kolat; Franz Winter; Adam J. Campen; Tomasz S. Wiltowski

    2008-09-15

    At present, natural limestone is used for the desulphurization of waste gases from the combustion of fossil fuels. However, it is important to save all primary resources, such as limestone, for the future. The researchers focused on finding alternative sorbents for the purpose of desulphurization in a dry additive method, which would become the alternative for natural limestone. This paper is primarily focused on desulphurization tests of selected substances. Tests were initially conducted on the laboratory scale, followed by pilot and full-scale combustion units. 15 refs., 9 figs., 5 tabs.

  20. Cost-effectiveness of conservation payment schemes for species with different range sizes.

    PubMed

    Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

    2016-08-01

    Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option. PMID:26918707

  1. Cost-effectiveness of conservation payment schemes for species with different range sizes.

    PubMed

    Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

    2016-08-01

    Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option.

  2. Cost-effectiveness of the stream-gaging program in Missouri

    USGS Publications Warehouse

    Waite, L.A.

    1987-01-01

    This report documents the results of an evaluation of the cost effectiveness of the 1986 stream-gaging program in Missouri. Alternative methods of developing streamflow information and cost-effective resource allocation were used to evaluate the Missouri program. Alternative methods were considered statewide, but the cost effective resource allocation study was restricted to the area covered by the Rolla field headquarters. The average standard error of estimate for records of instantaneous discharge was 17 percent; assuming the 1986 budget and operating schedule, it was shown that this overall degree of accuracy could be improved to 16 percent by altering the 1986 schedule of station visitations. A minimum budget of $203,870, with a corresponding average standard error of estimate 17 percent, is required to operate the 1986 program for the Rolla field headquarters; a budget of less than this would not permit proper service and maintenance of the stations or adequate definition of stage-discharge relations. The maximum budget analyzed was $418,870, which resulted in an average standard error of estimate of 14 percent. Improved instrumentation can have a positive effect on streamflow uncertainties by decreasing lost records. An earlier study of data uses found that data uses were sufficient to justify continued operation of all stations. One of the stations investigated, Current River at Doniphan (07068000) was suitable for the application of alternative methods for simulating discharge records. However, the station was continued because of data use requirements. (Author 's abstract)

  3. Wastewater Reuse for Agriculture: Development of a Regional Water Reuse Decision-Support Model (RWRM) for Cost-Effective Irrigation Sources.

    PubMed

    Tran, Quynh K; Schwabe, Kurt A; Jassby, David

    2016-09-01

    Water scarcity has become a critical problem in many semiarid and arid regions. The single largest water use in such regions is for crop irrigation, which typically relies on groundwater and surface water sources. With increasing stress on these traditional water sources, it is important to consider alternative irrigation sources for areas with limited freshwater resources. One potential irrigation water resource is treated wastewater for agricultural fields located near urban centers. In addition, treated wastewater can contribute an appreciable amount of necessary nutrients for plants. The suitability of reclaimed water for specific applications depends on water quality and usage requirements. The main factors that determine the suitability of recycled water for agricultural irrigation are salinity, heavy metals, and pathogens, which cause adverse effects on human, plants, and soils. In this paper, we develop a regional water reuse decision-support model (RWRM) using the general algebraic modeling system to analyze the cost-effectiveness of alternative treatment trains to generate irrigation water from reclaimed wastewater, with the irrigation water designed to meet crop requirements as well as California's wastewater reuse regulations (Title 22). Using a cost-minimization framework, least-cost solutions consisting of treatment processes and their intensities (blending ratios) are identified to produce alternative irrigation sources for citrus and turfgrass. Our analysis illustrates the benefits of employing an optimization framework and flexible treatment design to identify cost-effective blending opportunities that may produce high-quality irrigation water for a wide range of end uses. PMID:27499353

  4. Wastewater Reuse for Agriculture: Development of a Regional Water Reuse Decision-Support Model (RWRM) for Cost-Effective Irrigation Sources.

    PubMed

    Tran, Quynh K; Schwabe, Kurt A; Jassby, David

    2016-09-01

    Water scarcity has become a critical problem in many semiarid and arid regions. The single largest water use in such regions is for crop irrigation, which typically relies on groundwater and surface water sources. With increasing stress on these traditional water sources, it is important to consider alternative irrigation sources for areas with limited freshwater resources. One potential irrigation water resource is treated wastewater for agricultural fields located near urban centers. In addition, treated wastewater can contribute an appreciable amount of necessary nutrients for plants. The suitability of reclaimed water for specific applications depends on water quality and usage requirements. The main factors that determine the suitability of recycled water for agricultural irrigation are salinity, heavy metals, and pathogens, which cause adverse effects on human, plants, and soils. In this paper, we develop a regional water reuse decision-support model (RWRM) using the general algebraic modeling system to analyze the cost-effectiveness of alternative treatment trains to generate irrigation water from reclaimed wastewater, with the irrigation water designed to meet crop requirements as well as California's wastewater reuse regulations (Title 22). Using a cost-minimization framework, least-cost solutions consisting of treatment processes and their intensities (blending ratios) are identified to produce alternative irrigation sources for citrus and turfgrass. Our analysis illustrates the benefits of employing an optimization framework and flexible treatment design to identify cost-effective blending opportunities that may produce high-quality irrigation water for a wide range of end uses.

  5. A Study of the Effect of Alternative Programs on the Potential Dropout.

    ERIC Educational Resources Information Center

    Gloria, Cyril; Karr-Kidwell, PJ

    Educators are very concerned about the problem of students dropping out of school. The reasons for students dropping out vary from social to economic causes. Alternative programs or schools have been used since the 1960s to try to keep students in school. This study involved a literature review of research on the identification and remediation of…

  6. Acrolein as Potential Alternative to Methyl Bromide in California-Grown Calla Lilies

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cut flower and ornamental bulb industries rely heavily on a methyl bromide/chloropicrin (MB/Pic) mixture as a key pest management tool. The loss of methyl bromide (MB) will seriously affect the cut flower and bulb industry, and in the future, will require growers to use alternative fumigants. Theref...

  7. Guide for Identifying and Converting High-Potential Petroleum Brownfield Sites to Alternative Fuel Stations

    SciTech Connect

    Johnson, C.; Hettinger, D.; Mosey, G.

    2011-05-01

    Former gasoline stations that are now classified as brownfields can be good sites to sell alternative fuels because they are in locations that are convenient to vehicles and they may be seeking a new source of income. However, their success as alternative fueling stations is highly dependent on location-specific criteria. First, this report outlines what these criteria are, how to prioritize them, and then applies that assessment framework to five of the most popular alternative fuels--electricity, natural gas, hydrogen, ethanol, and biodiesel. The second part of this report delves into the criteria and tools used to assess an alternative fuel retail site at the local level. It does this through two case studies of converting former gasoline stations in the Seattle-Eugene area into electric charge stations. The third part of this report addresses steps to be taken after the specific site has been selected. This includes choosing and installing the recharging equipment, which includes steps to take in the permitting process and key players to include.

  8. Cost-effective solar heating system

    SciTech Connect

    Kyrias, G.M.

    1981-09-08

    The collector includes two planar panels separated by a thin spacer. The spacer includes a closed border within the edge of the collector and a number of separate strips within the border. The strips are disposed parallel to each other and are spaced in from the border, the spaces between the border and adjacent ends of successive strips alternating between a larger space and a smaller space, so that the path of least resistance through the collector is a serpentine passage. The smaller spaces prevent air and water from being trapped when the panel is filled and drained. A flow-restricting orifice is coupled to each collector to permit the collectors to be supplied at high pressure but without excessive flow. The supply pressure is much greater than the hydrostatic pressure head differences between the collectors so that when the collectors are connected in parallel in an open system, differences in flow rate due to elevation differences between the panels are minimized. The panels used in the collector are composed of glass cloth included in a cured polyester resin or epoxy resin. The strips and border of the separator are composed of a polyester resin or epoxy resin filled with silica particles and applied to the panels through a template.

  9. Applying a Simple Model of Cost Effectiveness Study of HPV Vaccine for Iran

    PubMed Central

    Khatibi, Mohsen; Rasekh, Hamid Reza

    2015-01-01

    HPV vaccine has been recently added to the Iran Drug List, so decision makers need information beyond that available from RCTs to recommend funding for this vaccination. Modeling and economic studies have addressed some of those information needs. We reviewed cost effectiveness studies to find a suitable model for Iranian population to determine the potential cost effectiveness of HPV vaccine program based on domestic available epidemiologic data. Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination program with routine cervical cancer screening. A total of 64 studies were included in this review. Although the studies used different model structures, baseline parameters and assumptions (either a Markov, Hybrid, or Dynamic model). Most of the proposed cost effectiveness models need to model the probability of HPV acquisition, the possible progression from HPV infection to CIN I, CIN II, CIN III and cervical cancer, the probability of HPV transmission which are not available in Iranian epidemiologic data. Based on the available epidemiologic data in Iran, the simplified and it requires substantially fewer assumptions than the other more complex Markov and hybrid models, therefore we decided to use this model for the evaluation of cost effectiveness of HPV vaccine in Iran. PMID:25901173

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

    PubMed

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

    2013-07-01

    An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios. PMID:23834790

  11. The potential of standards-based agriculture biology as an alternative to traditional biology in California

    NASA Astrophysics Data System (ADS)

    Sellu, George Sahr

    schools. Thoron & Meyer (2011) suggested that research into the contribution of integrated science courses toward higher test scores yielded mixed results. This finding may have been due in part to the fact that integrated science courses only incorporate select topics into agriculture education courses. In California, however, agriculture educators have developed standards-based courses such as Agriculture Biology (AgBio) that cover the same content standards as core traditional courses such as traditional biology. Students in both AgBio and traditional biology take the same standardized biology test. This is the first time there has been an opportunity for a fair comparison and a uniform metric for an agriscience course such as AgBio to be directly compared to traditional biology. This study will examine whether there are differences between AgBio and traditional biology with regard to standardized test scores in biology. Furthermore, the study examines differences in perception between teachers and students regarding teaching and learning activities associated with higher achievement in science. The findings of the study could provide a basis for presenting AgBio as a potential alternative to traditional biology. The findings of this study suggest that there are no differences between AgBio and traditional biology students with regard to standardized biology test scores. Additionally, the findings indicate that co-curricular activities in AgBio could contribute higher student achievement in biology. However, further research is required to identify specific activities in AgBio that contribute to higher achievement in science.

  12. Cost-effectiveness of a Primary Care Depression Intervention

    PubMed Central

    Pyne, Jeffrey M; Rost, Kathryn M; Zhang, Mingliang; Williams, D Keith; Smith, Jeffrey; Fortney, John

    2003-01-01

    OBJECTIVE To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation. PMID:12823650

  13. Photovoltaics for municipal planners. Cost-effective municipal applications of photovoltaics for electric power

    SciTech Connect

    Not Available

    1993-04-01

    This booklet is intended for city and county government personnel, as well as community organizations, who deal with supplying, regulating, or recommending electric power resources. Specifically, this document deals with photovoltaic (PV) power, or power from solar cells, which is currently the most cost-effective energy source for electricity requirements that are relatively small, located in isolated areas, or difficult to serve with conventional technology. Recently, PV has been documented to be more cost-effective than conventional alternatives (such as line extensions or engine generators) in dozens of applications within the service territories of electric, gas, and communications utilities. Here, we document numerous cost-effective urban applications, chosen by planners and utilities because they were the most cost-effective option or because they were appropriate for environmental or logistical reasons. These applications occur within various municipal departments, including utility, parks and recreation, traffic engineering, transportation, and planning, and they include lighting applications, communications equipment, corrosion protection, irrigation control equipment, remote monitoring, and even portable power supplies for emergency situations.

  14. Cost-effectiveness analysis: problems and promise for evaluating medical technology

    NASA Astrophysics Data System (ADS)

    Juday, Timothy R.

    1994-12-01

    Although using limited financial resources in the most beneficial way, in principle, a laudable goal, actually developing standards for measuring the cost-effectiveness of medical technologies and incorporating them into the coverage process is a much more difficult proposition. Important methodological difficulties include determining how to compare a technology to its leading alternative, defining costs, incorporating patient preferences, and defining health outcomes. In addition, more practical questions must be addressed. These questions include: who does the analysis? who makes the decisions? which technologies to evaluate? what resources are required? what is the political and legal environment? how much is a health outcome worth? The ultimate question that must be answered is what is a health outcome worth? Cost-effectiveness analysis cannot answer this question; it only enables comparison of cost-effectiveness ratios across technologies. In order to determine whether a technology should be covered, society or individual insurers must determine how much they are willing to pay for the health benefits. Conducting cost-effectiveness analysis will not remove the need to make difficult resource allocation decisions; however, explicitly examining the tradeoffs involved in these decisions should help to improve the process.

  15. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

    PubMed Central

    Penno, Erin C.; Baird, Sarah J.; Crump, John A.

    2015-01-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context. PMID:26175032

  16. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

    PubMed

    Penno, Erin C; Baird, Sarah J; Crump, John A

    2015-10-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

  17. Cost-effectiveness of different strategies to manage patients with sciatica.

    PubMed

    Fitzsimmons, Deborah; Phillips, Ceri J; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire

    2014-07-01

    The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.

  18. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

    PubMed

    Penno, Erin C; Baird, Sarah J; Crump, John A

    2015-10-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context. PMID:26175032

  19. Parametric evaluation of the cost effectiveness of Shuttle payload vibroacoustic test plans

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

    Consideration is given to alternate vibroacoustic test plans for sortie and free flyer Shuttle payloads. Statistical decision models for nine test plans provide a viable method of evaluating the cost effectiveness of alternate vibroacoustic test plans and the associated test levels. The methodology is a major step toward the development of a useful tool for the quantitative tailoring of vibroacoustic test programs to sortie and free flyer payloads. A broader application of the methodology is now possible by the use of the OCTAVE computer code.

  20. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    PubMed Central

    2011-01-01

    Background Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. We aimed to investigate which factors had a major impact on cost-effectiveness and were primarily responsible for the large differences in previously estimated cost-effectiveness ratios. Methods Based on updated data on health outcomes and cost estimates, we re-assessed the cost-effectiveness of routine paediatric rotavirus vaccination within the National Immunization Program for the Netherlands. Two consensus meetings were organised with national and international experts in the field to achieve consensus and resolve potential controversies. Results It was estimated that rotavirus vaccination in the Netherlands could avert 34,214 cases of rotavirus gastroenteritis in children aged less than 5 years. Notably, 2,779 hospitalisations were averted of which 315 were extensions of existing hospital stays due to nosocomial rotavirus infection. With a threshold varying from 20K€ - 50K€ per QALY and according to the base-case scenario, the full vaccination costs per child leading to cost-effectiveness was €57.76 -€77.71. Results were sensitive to the inclusion of potential vaccine induced herd protection, QALY losses and number of deaths associated with rotavirus gastroenteritis. Conclusions Our economic analysis indicates that inclusion of rotavirus vaccination in the Dutch National Immunization Program might be cost-effective depending on the cost of the vaccine and the impact of rotavirus gastroenteritis on children's quality of life. PMID:21663620

  1. A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States

    PubMed Central

    Walker, Brandon S.; Nelson, Richard E.; Jackson, Brian R.; Grenache, David G.; Ashwood, Edward R.; Schmidt, Robert L.

    2015-01-01

    Background Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS. Study Design Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer. Results From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective. Conclusions From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS. PMID:26133556

  2. Fourier law in the alternate-mass hard-core potential chain.

    PubMed

    Li, Baowen; Casati, Giulio; Wang, Jiao; Prosen, Tomaz

    2004-06-25

    We study energy transport in a one-dimensional model of elastically colliding particles with alternate masses m and M. In order to prevent total momentum conservation, we confine particles with mass M inside a cell of finite size. We provide convincing numerical evidence for the validity of Fourier law of heat conduction in spite of the lack of exponential dynamical instability. Comparison with previous results on similar models shows the relevance of the role played by total momentum conservation.

  3. Rheostat Re-Wired: Alternative Hypotheses for the Control of Thioredoxin Reduction Potentials

    PubMed Central

    Bewley, Kathryn D.; Dey, Mishtu; Bjork, Rebekah E.; Mitra, Sangha; Chobot, Sarah E.; Drennan, Catherine L.; Elliott, Sean J.

    2015-01-01

    Thioredoxins are small soluble proteins that contain a redox-active disulfide (CXXC). These disulfides are tuned to oxidizing or reducing potentials depending on the function of the thioredoxin within the cell. The mechanism by which the potential is tuned has been controversial, with two main hypotheses: first, that redox potential (Em) is specifically governed by a molecular ‘rheostat’—the XX amino acids, which influence the Cys pKa values, and thereby, Em; and second, the overall thermodynamics of protein folding stability regulates the potential. Here, we use protein film voltammetry (PFV) to measure the pH dependence of the redox potentials of a series of wild-type and mutant archaeal Trxs, PFV and glutathionine-equilibrium to corroborate the measured potentials, the fluorescence probe BADAN to measure pKa values, guanidinium-based denaturation to measure protein unfolding, and X-ray crystallography to provide a structural basis for our functional analyses. We find that when these archaeal thioredoxins are probed directly using PFV, both the high and low potential thioredoxins display consistent 2H+:2e- coupling over a physiological pH range, in conflict with the conventional ‘rheostat’ model. Instead, folding measurements reveals an excellent correlation to reduction potentials, supporting the second hypothesis and revealing the molecular mechanism of reduction potential control in the ubiquitous Trx family. PMID:25874934

  4. Cost-effective electric vehicle charging infrastructure siting for Delhi

    NASA Astrophysics Data System (ADS)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6-7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ˜10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  5. Cost-effective electric vehicle charging infrastructure siting for Delhi

    NASA Astrophysics Data System (ADS)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6–7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ∼10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  6. Heterogeneity in cost-effectiveness of lifestyle counseling for metabolic syndrome risk groups -primary care patients in Sweden

    PubMed Central

    2013-01-01

    Background Clinical trials have indicated that lifestyle interventions for patients with lifestyle-related cardiovascular and diabetes risk factors (the metabolic syndrome) are cost-effective. However, patient characteristics in primary care practice vary considerably, i.e. they exhibit heterogeneity in risk factors. The cost-effectiveness of lifestyle interventions is likely to differ over heterogeneous patient groups. Methods Patients (62 men, 80 women) in the Kalmar Metabolic Syndrome Program (KMSP) in primary care (Kalmar regional healthcare area, Sweden) were divided into three groups reflecting different profiles of metabolic risk factors (low, middle and high risk) and gender. A Markov model was used to predict future cardiovascular disease and diabetes, including complications (until age 85 years or death), with health effects measured as QALYs and costs from a societal perspective in Euro (EUR) 2012, discounted 3%. Simulations with risk factor levels at start and at 12 months follow-up were performed for each group, with an assumed 4-year sustainability of intervention effects. Results The program was estimated cost-saving for middle and high risk men, while the incremental cost vs. do-nothing varied between EUR 3,500 – 18,000 per QALY for other groups. There is heterogeneity in the cost-effectiveness over the risk groups but this does not affect the overall conclusion on the cost-effectiveness of the KMSP. Even the highest ICER (for high risk women) is considered moderately cost-effective in Sweden. The base case result was not sensitive to alternative data and methodology but considerably affected by sustainability assumptions. Alternative risk stratifications did not change the overall conclusion that KMSP is cost-effective. However, simple grouping with average risk factor levels over gender groups overestimate the cost-effectiveness. Conclusions Lifestyle counseling to prevent metabolic diseases is cost-effective in Swedish standard primary care

  7. Cost effects of hospital mergers in Portugal.

    PubMed

    Azevedo, Helda; Mateus, Céu

    2014-12-01

    The Portuguese hospital sector has been restructured by wide-ranging hospital mergers, following a conviction among policy makers that bigger hospitals lead to lower average costs. Since the effects of mergers have not been systematically evaluated, the purpose of this article is to contribute to this area of knowledge by assessing potential economies of scale to explore and compare these results with realized cost savings after mergers. Considering the period 2003-2009, we estimate the translog cost function to examine economies of scale in the years preceding restructuring. Additionally, we use the difference-in-differences approach to evaluate hospital centres (HC) that occurred between 2004 and 2007, comparing the years after and before mergers. Our findings suggest that economies of scale are present in the pre-merger configuration with an optimum hospital size of around 230 beds. However, the mergers between two or more hospitals led to statistically significant post-merger cost increases, of about 8 %. This result indicates that some HC become too large to explore economies of scale and suggests the difficulty of achieving efficiencies through combining operations and service specialization.

  8. Cost effects of hospital mergers in Portugal.

    PubMed

    Azevedo, Helda; Mateus, Céu

    2014-12-01

    The Portuguese hospital sector has been restructured by wide-ranging hospital mergers, following a conviction among policy makers that bigger hospitals lead to lower average costs. Since the effects of mergers have not been systematically evaluated, the purpose of this article is to contribute to this area of knowledge by assessing potential economies of scale to explore and compare these results with realized cost savings after mergers. Considering the period 2003-2009, we estimate the translog cost function to examine economies of scale in the years preceding restructuring. Additionally, we use the difference-in-differences approach to evaluate hospital centres (HC) that occurred between 2004 and 2007, comparing the years after and before mergers. Our findings suggest that economies of scale are present in the pre-merger configuration with an optimum hospital size of around 230 beds. However, the mergers between two or more hospitals led to statistically significant post-merger cost increases, of about 8 %. This result indicates that some HC become too large to explore economies of scale and suggests the difficulty of achieving efficiencies through combining operations and service specialization. PMID:24379130

  9. Cost-effective forensic image enhancement

    NASA Astrophysics Data System (ADS)

    Dalrymple, Brian E.

    1998-12-01

    In 1977, a paper was presented at the SPIE conference in Reston, Virginia, detailing the computer enhancement of the Zapruder film. The forensic value of this examination in a major homicide investigation was apparent to the viewer. Equally clear was the potential for extracting evidence which is beyond the reach of conventional detection techniques. The cost of this technology in 1976, however, was prohibitive, and well beyond the means of most police agencies. Twenty-two years later, a highly efficient means of image enhancement is easily within the grasp of most police agencies, not only for homicides but for any case application. A PC workstation combined with an enhancement software package allows a forensic investigator to fully exploit digital technology. The goal of this approach is the optimization of the signal to noise ratio in images. Obstructive backgrounds may be diminished or eliminated while weak signals are optimized by the use of algorithms including Fast Fourier Transform, Histogram Equalization and Image Subtraction. An added benefit is the speed with which these processes are completed and the results known. The efficacy of forensic image enhancement is illustrated through case applications.

  10. Applications of Cost Effectiveness to Counseling Center Retention Programs.

    ERIC Educational Resources Information Center

    Weiss, Steven J.; Giddan, Norman S.

    1986-01-01

    Provides a framework for considering cost-benefit analysis and cost-effectiveness analysis of college counseling centers and retention activities. Results indicated that careful evaluation techniques can improve the efficiency and effectiveness of student retention programs. (Author/BL)

  11. Gas permeability of biochar-amended clay: potential alternative landfill final cover material.

    PubMed

    Wong, James Tsz Fung; Chen, Zhongkui; Ng, Charles Wang Wai; Wong, Ming Hung

    2016-04-01

    Compacted biochar-amended clay (BAC) has been proposed as an alternative landfill final cover material in this study. Biochar has long been proposed to promote crop growth, mitigate odor emission, and promote methane oxidation in field soils. However, previous studies showed that soil-gas permeability was increased upon biochar application, which will promote landfill gas emission. The objective of the present study is to investigate the possibility of using compacted BAC as an alternative material in landfill final cover by evaluating its gas permeability. BAC samples were prepared by mixing 425-μm-sieved peanut shell biochar with kaolin clay in different ratios (0, 5, 10, and 15 %, w/w) and compacting at different degrees of compactions (DOC) (80, 85, and 90 %) with an optimum water content of 35 %. The gas permeability of the BACs was measured by flexible wall gas permeameter and the microstructure of the BACs was analyzed by SEM with energy-dispersive x-ray spectroscopy (EDX). The results show that the effects of biochar content on BAC gas permeability is highly dependent on the DOC. At high DOC (90 %), the gas permeability of BAC decreases with increasing biochar content due to the combined effect of the clay aggregation and the inhibition of biochar in the gas flow. However, at low DOC (80 %), biochar incorporation has no effects on gas permeability because it no longer acts as a filling material to the retard gas flow. The results from the present study imply that compacted BAC can be used as an alternative final cover material with decreased gas permeability when compared with clay.

  12. Gas permeability of biochar-amended clay: potential alternative landfill final cover material.

    PubMed

    Wong, James Tsz Fung; Chen, Zhongkui; Ng, Charles Wang Wai; Wong, Ming Hung

    2016-04-01

    Compacted biochar-amended clay (BAC) has been proposed as an alternative landfill final cover material in this study. Biochar has long been proposed to promote crop growth, mitigate odor emission, and promote methane oxidation in field soils. However, previous studies showed that soil-gas permeability was increased upon biochar application, which will promote landfill gas emission. The objective of the present study is to investigate the possibility of using compacted BAC as an alternative material in landfill final cover by evaluating its gas permeability. BAC samples were prepared by mixing 425-μm-sieved peanut shell biochar with kaolin clay in different ratios (0, 5, 10, and 15 %, w/w) and compacting at different degrees of compactions (DOC) (80, 85, and 90 %) with an optimum water content of 35 %. The gas permeability of the BACs was measured by flexible wall gas permeameter and the microstructure of the BACs was analyzed by SEM with energy-dispersive x-ray spectroscopy (EDX). The results show that the effects of biochar content on BAC gas permeability is highly dependent on the DOC. At high DOC (90 %), the gas permeability of BAC decreases with increasing biochar content due to the combined effect of the clay aggregation and the inhibition of biochar in the gas flow. However, at low DOC (80 %), biochar incorporation has no effects on gas permeability because it no longer acts as a filling material to the retard gas flow. The results from the present study imply that compacted BAC can be used as an alternative final cover material with decreased gas permeability when compared with clay. PMID:26092359

  13. Evaluating potential changes in salmonid rearing capacity from alternative sets of rehabilitation actions in the Trinity River, California

    NASA Astrophysics Data System (ADS)

    Beechie, T. J.; Pess, G. R.; Imaki, H.; Martin, A.; Alvarez, J.; Goodman, D.

    2013-12-01

    River restoration plans often propose numerous rehabilitation actions to address key habitat impairments for salmonids. However, restoration plans rarely propose alternative sets of actions or attempt to quantify the potential benefits to targeted biota. In this paper we use geomorphic and biological analyses to estimate restoration potential for each of 37 reaches in a 64-km section of Trinity River, California from the North Fork Trinity River to Lewiston Dam (the focus of habitat rehabilitation efforts under the Trinity River Restoration Program). We first predicted the channel pattern that might develop based in each reach on slope-discharge criteria, and then used these potential patterns along with floodplain width to estimate the maximum sinuosity that restoration actions could likely achieve, as well as a maximum side-channel length that might be created in each reach. For each scenario, we then used existing stream habitat and juvenile salmonid data from previous studies in the Trinity River and other watersheds to determine current and restored carrying capacity. Potential increases in Chinook and steelhead carrying capacity range from 39% for a relatively realistic estimate of increasing habitat quality (more low velocity areas with cover) to 67% for a more optimistic scenario that increases both sinuosity and habitat quality. Only the most optimistic scenario that increases habitat quality, increases sinuosity, and constructs tens of kilometers of side channels more than doubles potential juvenile salmonid production (140% increase). These quantitative predictions provide a frame of reference for evaluating alternative restoration options, and for setting measurable restoration goals.

  14. Potential Use of Lime as Nitric Acid Source for Alternative Electrolyte Fuel-Cell Method

    NASA Astrophysics Data System (ADS)

    Christianto, V.; Smarandache, Florentin

    2011-04-01

    Despite growing popularity for the use of biofuel and other similar methods to generate renewable energy sources from natural plantation in recent years, there is also growing concern over its disadvantage, i.e. that the energy use of edible plants may cause unwanted effects, because the plantation price tends to increase following the oil price. Therefore an alternative solution to this problem is to find `natural plantation' which have no direct link to `food chain' (for basic foods, such as palm oil etc.).

  15. Cost effectiveness of a pentavalent rotavirus vaccine in Oman

    PubMed Central

    2014-01-01

    Background Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman Methods A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. Results A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. Conclusions Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal

  16. Antimicrobial stewardship programs - cost-minimizing or cost-effective?

    PubMed

    You, Joyce

    2015-02-01

    Antimicrobial stewardship programs (ASPs) are aimed to improve patient care and health care outcomes. It is encouraging to find ASP interventions to be cost-saving in many cost-minimization analyses in literature. Nevertheless, the cost-effectiveness of ASP interventions, measured in cost per quality-adjusted life-years, is less well-established. This Editorial aims to explore the barriers in assessing clinical effectiveness of ASPs and provide suggestions to conduct cost-effectiveness analysis of ASPs. PMID:25331093

  17. Cost effectiveness of in situ bioremediation at Savannah River

    SciTech Connect

    Saaty, R.P.; Showalter, W.E.; Booth, S.R.

    1995-09-01

    In situ bioremediation (ISBR) is an innovative new remediation technology for the removal of chlorinated solvents from contaminated soils and groundwater. The principal contaminant at the Savannah River Integrated Demonstration is tricloroethylene (TCE) a volatile organic compound (VOC). A 384-day test run at Savannah River, sponsored by the US Department of Energy (DOE), Office of Technology Development (EM-50), furnished information about the performance and applications of ISBR. In situ bioremediation, as tested, is based on two distinct processes occurring simultaneously; the physical process of in situ air stripping and the biological process of bioremediation. Both processes have the potential to remediate some amount of contamination. A quantity of VOCs, directly measured from the extracted airstream, was removed from the test area by the physical process of air stripping. The biological process is difficult to examine. However, the results of several tests performed at the SRID and independent numerical modeling determined that the biological process remediated an additional 40% above the physical process. Given these data, the cost effectiveness of this new technology can be evaluated.

  18. Phycoremediation: key issues for cost-effective nutrient removal processes.

    PubMed

    Olguín, Eugenia J

    2003-12-01

    Phycoremediation applied to the removal of nutrients from animal wastewater and other high organic content wastewater is a field with a great potential and demand considering that surface and underground water bodies in several regions of the world are suffering of eutrophication. However, the development of more efficient nutrient removal algal systems requires further research in key areas. Algae growth rate controls directly and indirectly the nitrogen and phosphorus removal efficiency. Thus, maximum algae productivity is required for effective nutrient removal and must be considered as a key area of research. Likewise, low harvesting costs are also required for a cost-effective nutrient removal system. The use of filamentous microalgae with a high autoflocculation capacity and the use of immobilized cells have been investigated in this respect. Another key area of research is the use of algae strains with special attributes such as tolerance to extreme temperature, chemical composition with predominance of high added value products, a quick sedimentation behavior, or a capacity for growing mixotrophically. Finally, to combine most of the achievements from key areas and to design integrated recycling systems (IRS) should be an ultimate and rewarding goal. PMID:14623045

  19. Climate targets and cost-effective climate stabilization pathways

    NASA Astrophysics Data System (ADS)

    Held, H.

    2015-08-01

    Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

  20. Cost-effectiveness analysis of using antiretroviral drug resistance testing.

    PubMed

    Lauria, Francesco Nicola; Angeletti, Claudio

    2003-01-01

    Human immunodeficiency virus (HIV)-infected patients failing highly active antiretroviral therapy (HAART) have a substantially lower chance of clinical success than naive patients given their first antiretroviral therapy. This suggests that HAART failure is a determinant for an increase in the cost of treatment. A review of the literature regarding cost and impact of antiretroviral drug-resistance testing was performed. Examination of existing methods to execute a cost-effectiveness analysis on the use of these tests in clinical practice was also undertaken. The cost of treatment failure in HIV-infected patients has been quantified in several retrospective studies. The cost of care for patients with virological suppression was significantly lower than those with a single virological failure. Moreover, the latter group had lower costs than patients with multiple failures. The result of the cost-effective analysis based on a specific model application using genotypic resistance assays to guide the choice of a subsequent therapy in HIV disease, is cost-effective under a wide range of assumptions regarding effectiveness and costs. The available studies on the cost-effective evaluation of genotypic tests are limited, and the respective studies supply important indications on cost-effective evaluations. Despite its demonstrated benefits, antiretroviral drug resistance testing presents features and limitations that also restrict the cost-effectiveness analysis. PMID:15000585

  1. The cost-effectiveness of shopping to a predetermined grocery list to reduce overweight and obesity

    PubMed Central

    Au, N; Marsden, G; Mortimer, D; Lorgelly, P K

    2013-01-01

    Background: Pre-commitment strategies can encourage participants to commit to a healthy food plan and have been suggested as a potential strategy for weight loss. However, it is unclear whether such strategies are cost-effective. Objective: To analyse whether pre-commitment interventions that facilitate healthier diets are a cost-effective approach to tackle obesity. Methods: Effectiveness evidence was obtained from a systematic review of the literature. For interventions demonstrating a clinically significant change in weight, a Markov model was employed to simulate the long-term health and economic consequences. The review supported modelling just one intervention: grocery shopping to a predetermined list combined with standard behavioural therapy (SBT). SBT alone and do nothing were used as comparators. The target population was overweight or obese adult women. A lifetime horizon for health effects (expressed as quality-adjusted life years (QALYs)) and costs from the perspective of the UK health sector were used to calculate incremental cost-effectiveness ratios (ICERs). Results: In the base case analysis, the pre-commitment strategy of shopping to a list was found to be more effective and cost saving when compared against SBT, and cost-effective when compared against ‘do nothing' (ICER=£166 per QALY gained). A sensitivity analysis indicated that shopping to a list remained dominant or cost-effective under various scenarios. Conclusion: Our findings suggest grocery shopping to a predetermined list combined with SBT is a cost-effective means for reducing obesity and its related health conditions. PMID:23797384

  2. Cost-Effectiveness of Interventions to Promote Fruit and Vegetable Consumption

    PubMed Central

    Cobiac, Linda J.; Vos, Theo; Veerman, J. Lennert

    2010-01-01

    Background Fruits and vegetables are an essential part of the human diet, but many people do not consume the recommended serves to prevent cardiovascular disease and cancer. In this research, we evaluate the cost-effectiveness of interventions to promote fruit and vegetable consumption to determine which interventions are good value for money, and by how much current strategies can reduce the population disease burden. Methods/Principal Findings In a review of published literature, we identified 23 interventions for promoting fruit and vegetable intake in the healthy adult population that have sufficient evidence for cost-effectiveness analysis. For each intervention, we model the health impacts in disability-adjusted life years (DALYs), the costs of intervention and the potential cost-savings from averting disease treatment, to determine cost-effectiveness of each intervention over the lifetime of the population, from an Australian health sector perspective. Interventions that rely on dietary counselling, telephone contact, worksite promotion or other methods to encourage change in dietary behaviour are not highly effective or cost-effective. Only five out of 23 interventions are less than an A$50,000 per disability-adjusted life year cost-effectiveness threshold, and even the most effective intervention can avert only 5% of the disease burden attributed to insufficient fruit and vegetable intake. Conclusions/Significance We recommend more investment in evaluating interventions that address the whole population, such as changing policies influencing price or availability of fruits and vegetables, to see if these approaches can provide more effective and cost-effective incentives for improving fruit and vegetable intake. PMID:21152389

  3. Cost-Effectiveness Analysis of Six Strategies to Treat Recurrent Clostridium difficile Infection

    PubMed Central

    Lapointe-Shaw, Lauren; Tran, Kim L.; Coyte, Peter C.; Hancock-Howard, Rebecca L.; Powis, Jeff; Poutanen, Susan M.; Hota, Susy

    2016-01-01

    Objective To assess the cost-effectiveness of six treatment strategies for patients diagnosed with recurrent Clostridium difficile infection (CDI) in Canada: 1. oral metronidazole; 2. oral vancomycin; 3.oral fidaxomicin; 4. fecal transplantation by enema; 5. fecal transplantation by nasogastric tube; and 6. fecal transplantation by colonoscopy. Perspective Public insurer for all hospital and physician services. Setting Ontario, Canada. Methods A decision analytic model was used to model costs and lifetime health effects of each strategy for a typical patient experiencing up to three recurrences, over 18 weeks. Recurrence data and utilities were obtained from published sources. Cost data was obtained from published sources and hospitals in Toronto, Canada. The willingness-to-pay threshold was $50,000/QALY gained. Results Fecal transplantation by colonoscopy dominated all other strategies in the base case, as it was less costly and more effective than all alternatives. After accounting for uncertainty in all model parameters, there was an 87% probability that fecal transplantation by colonoscopy was the most beneficial strategy. If colonoscopy was not available, fecal transplantation by enema was cost-effective at $1,708 per QALY gained, compared to metronidazole. In addition, fecal transplantation by enema was the preferred strategy if the probability of recurrence following this strategy was below 8.7%. If fecal transplantation by any means was unavailable, fidaxomicin was cost-effective at an additional cost of $25,968 per QALY gained, compared to metronidazole. Conclusion Fecal transplantation by colonoscopy (or enema, if colonoscopy is unavailable) is cost-effective for treating recurrent CDI in Canada. Where fecal transplantation is not available, fidaxomicin is also cost-effective. PMID:26901316

  4. Cost-effectiveness of sofosbuvir for the treatment of chronic hepatitis C-infected patients.

    PubMed

    Cure, S; Guerra, I; Dusheiko, G

    2015-11-01

    The efficacy of treatment for hepatitis C genotype 1 infection has significantly improved with the introduction of first-generation protease inhibitors. However, there remains a need for effective treatments for patients infected with other genotypes, for nonresponders and patients unsuitable for interferon. Sofosbuvir is the first nucleotide polymerase inhibitor with pan-genotypic activity. Sofosbuvir-based regimens have resulted in >90% sustained virological response across treatment-naïve genotype 1-6 patients in five phase III clinical trials of sofosbuvir administered with ribavirin or pegylated interferon and ribavirin. This analysis evaluates the cost-effectiveness of sofosbuvir within the current licensed indication, for genotype 1-6 in the UK. A Markov model followed a cohort of 10 000 patients over lifetime, with approximately 20% initiating treatment for compensated cirrhosis. Sofosbuvir-regimens were compared to telaprevir, boceprevir, pegylated interferon and ribavirin, or no treatment. Costs and outcomes were discounted at 3.5%. The cost perspective utilized costs applicable to the National Health Service in the UK. Sofosbuvir proved to be cost-effective in most patient populations with incremental cost-effectiveness ratios (ICERs) at £11 836/QALY and £7292/QALY against telaprevir and boceprevir, respectively. In genotype 3, sofosbuvir had a weighted ICER of £18 761/QALY. Sofosbuvir-based regimens are a cost-effective option for the majority of hepatitis C-infected patients in the United Kingdom although the incremental cost-effectiveness varies by genotype and regimen. Sofosbuvir and ribavirin is an alternative regimen for patients unsuitable for interferon.

  5. Cost-Effectiveness Analysis of Screening for KRAS and BRAF Mutations in Metastatic Colorectal Cancer

    PubMed Central

    2012-01-01

    Background In 2009, the American Society of Clinical Oncology recommended that patients with metastatic colorectal cancer (mCRC) who are candidates for anti-epidermal growth factor receptor (EGFR) therapy have their tumors tested for KRAS mutations because tumors with such mutations do not respond to anti-EGFR therapy. Limiting anti-EGFR therapy to those without KRAS mutations will reserve treatment for those likely to benefit while avoiding unnecessary costs and harm to those who would not. Similarly, tumors with BRAF genetic mutations may not respond to anti-EGFR therapy, though this is less clear. Economic analyses of mutation testing have not fully explored the roles of alternative therapies and resection of metastases. Methods This paper is based on a decision analytic framework that forms the basis of a cost-effectiveness analysis of screening for KRAS and BRAF mutations in mCRC in the context of treatment with cetuximab. A cohort of 50 000 patients with mCRC is simulated 10 000 times, with attributes randomly assigned on the basis of distributions from randomized controlled trials. Results Screening for both KRAS and BRAF mutations compared with the base strategy (of no anti-EGFR therapy) increases expected overall survival by 0.034 years at a cost of $22 033, yielding an incremental cost-effectiveness ratio of approximately $650 000 per additional year of life. Compared with anti-EGFR therapy without screening, adding KRAS testing saves approximately $7500 per patient; adding BRAF testing saves another $1023, with little reduction in expected survival. Conclusions Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year. PMID:23197490

  6. Cost-effectiveness Analysis of Cetuximab in Treatment of Metastatic Colorectal Cancer in Iranian Pharmaceutical Market

    PubMed Central

    Davari, Majid; Ashrafi, Farzaneh; Maracy, Mohammadreza; Aslani, Abolfazl; Tabatabaei, Mohammadreza

    2015-01-01

    Background: Cetuximab is a monoclonal antibody which acts against the epidermal growth-factor receptor. Randomized controlled trials show that the addition of cetuximab to folinic acid, 5-flourouracil, irinotecan (FOLFIRI), folinic acid, 5-flourouracil, oxaliplatin (FOLFOX) and capecitabin + oxaliplatin (CAPOX) regimens, as the first-line treatment for metastatic colorectal cancer (CRC), increases the overall survival (OS) and progression-free survival (PFS) compared to FOLFIRI, FOLFOX and CAPOX regimens alone. The aim of this study was to analyze the cost-effectiveness of different treatment programs for managing metastatic CRC with and without cetuximab in the first-line treatment of unresectable metastatic CRC in Iran. Methods: A systematic search of the literature was performed in PubMed, Centre for Reviews and Dissemination Databases and Cochrane Library to assess the effectiveness of the drug in the context of PFS, OS and the adverse events. The incremental cost-effectiveness ratio of each treatment program was calculated. An extensive sensitivity analysis was conducted on the results regarding the effectiveness. Results: The addition of cetuximab to FOLFIRI, FOLFOX and CAPOX programs increased PFS by 0.1, 0.042 and 0.042 years, respectively. Similarly, the addition of cetuximab to FOLFIRI, FOLFOX and CAPOX increased OS by 0.325, 0.442 and 0.442 years and also cost $212825, $202484 and $204198 individually. Whereas, based on the World Health Organisation (WHO) suggested threshold for cost-effectiveness analysis, even FOLFOX + cetuximab was very higher than the threshold in Iran (37.4 times higher). Conclusions: The FOLFOX regimen + cetuximab provides lower costs per additional life years gained (more cost-effective) compared with its alternatives in the treatment of patients with unresectable metastatic CRC. However, according to the WHO indicator, none of the cetuximab regimens could be considered as cost effective for the Iranian health care market. PMID

  7. Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

    PubMed Central

    de Carvalho, T. M.; Auvinen, A.; Zappa, M.; Nelen, V.; Kwiatkowski, M.; Villers, A.; Páez, A.; Moss, S. M.; Tammela, T. L. J.; Recker, F.; Denis, L.; Carlsson, S.V.; Wever, E. M.; Bangma, C. H.; Schröder, F. H.; Roobol, M. J.; Hugosson, J.; de Koning, H. J.

    2015-01-01

    Background: The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs. Methods: Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests. Results: Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained. Conclusion: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis. PMID:25505238

  8. Autologous haematopoietic stem cell transplantation for secondary progressive multiple sclerosis: an exploratory cost-effectiveness analysis.

    PubMed

    Tappenden, P; Saccardi, R; Confavreux, C; Sharrack, B; Muraro, P A; Mancardi, G L; Kozak, T; Farge-Bancel, D; Madan, J; Rafia, R; Akehurst, R; Snowden, J

    2010-06-01

    Treatment options for secondary progressive multiple sclerosis (SPMS) are limited. Mitoxantrone is routinely used to stabilize disease progression; however, evolving evidence suggests clinical benefit from intensive treatment with autologous haematopoietic stem cell transplantation (HSCT). Given differences in cost and outcomes, preliminary cost-effectiveness studies are warranted if this approach is to be developed for more widespread application in SPMS. We developed a decision-analytic Markov model to explore the potential cost-effectiveness of autologous HSCT versus mitoxantrone in SPMS, using patient-level data from registry sources. The model evaluates the lifetime costs and health outcomes associated with disability progression and relapse. Sensitivity analyses were undertaken to examine the uncertainty surrounding cost-effectiveness outcomes. In the absence of randomised controlled trial (RCT) evidence, conditions for comparative analysis were not ideal. Under optimistic assumptions, HSCT is estimated to cost below pound3000 per quality adjusted life year gained. However, when a strict 6-month sustained progression rule is adopted, HSCT may be less effective and more expensive than mitoxantrone. The model results were sensitive to reducing procedural costs and HSCT-related mortality. We conclude that HSCT could potentially achieve an acceptable level of cost-effectiveness. However, caution should be exercised as large, high-quality RCTs comparing HSCT versus mitoxantrone are necessary to validate these findings.

  9. Cell-Context Dependent TCF/LEF Expression and Function: Alternative Tales of Repression, De-Repression and Activation Potentials

    PubMed Central

    Mao, Catherine D; Byers, Stephen W.

    2012-01-01

    Wnt signaling controls cell specification and fate during development and adult tissue homeostasis by converging on a small family of DNA binding factors, the T-cell factor/lymphoid enhancer factor (TCF/LEF) family. In response to Wnt signals, TCF/LEF members undergo a transcriptional switch from repression to activation mediated in part by nuclear β-catenin binding and recruitment of co-activator complexes. In mammals, the specificity and fine tuning of this transcriptional switch is also achieved by the cell-context-dependent expression of four members (TCF7, TCF7L1, TCF7L2, and LEF1) and numerous variants, which display differential DNA binding affinity and specificity, repression strength, activation potential, and regulators. TCF7/LEF1 variants are generated by alternative promoters, alternative exon cassettes, and alternative donor/acceptor splicing sites, allowing combinatorial insertion/exclusion of modular functional and regulatory domains. In this review we present mounting evidence for the interdependency of TCF7/LEF1 variant expression and functions with cell lineage and cell state. We also illustrate how the p53 and nuclear receptor family of transcription factors, known to control cell fate and to inhibit Wnt signaling, may participate in the fine tuning of TCF7/LEF1 repression/activation potentials. PMID:22111711

  10. Economic potential of alternative land and natural resource uses at the Nevada Test Site, Nye County, Nevada

    SciTech Connect

    Richard-Haggard, K.

    1983-03-01

    The economic potentials of several alternative land uses at the Nevada Test Site (NTS) are estimated. Alternatives considered include mining, agriculture, grazing, and hunting. There are two known tungsten ore bodies located in the Oak Spring mining district. The economic potential of the reserves is estimated to be $42,840. It is also possible that there are other economic mineral resources on the NTS whose values are yet unknown. There are an estimated 5000 ha of agricultural land on the Test Site; the cash value of alfalfa grown on this acreage is approximately $564,030. The economic potential of grazing at the Test Site lies somewhere in the range of $10,340 to $41,220. The assumed annual worth of mule deer to hunters is $90,440. The gross potential of hunting at the NTS is probably somewhat higher if trophy species, game birds and fur-bearing animals are also considered. It should be noted that the above values indicate gross worth; no costs are included in the estimates.

  11. Volatile organic compounds (VOCs) in surface coating materials: Their compositions and potential as an alternative fuel.

    PubMed

    Dinh, Trieu-Vuong; Choi, In-Young; Son, Youn-Suk; Song, Kyu-Yong; Sunwoo, Young; Kim, Jo-Chun

    2016-03-01

    A sampling system was designed to determine the composition ratios of VOCs emitted from 31 surface coating materials (SCMs). Representative architectural, automotive, and marine SCMs in Korea were investigated. Toluene, ethylbenzene, and xylene were the predominant VOCs. The VOC levels (wt%) from automotive SCMs were significantly higher than those from architectural and marine paints. It was found that target SCMs comprised mainly VOCs with 6-10 carbon atoms in molecules, which could be adsorbed by activated carbon. The saturated activated carbon which had already adsorbed toluene, ethylbenzene, and m-xylene was combusted. The saturated activated carbon was more combustible than new activated carbon because it comprised inflammable VOCs. Therefore, it could be an alternative fuel when using in a "fuelization system". To use the activated carbon as a fuel, a control technology of VOCs from a coating process was also designed and introduced.

  12. Cost-effectiveness analysis: adding value to assessment of animal health welfare and production.

    PubMed

    Babo Martins, S; Rushton, J

    2014-12-01

    Cost-effectiveness analysis (CEA) has been extensively used in economic assessments in fields related to animal health, namely in human health where it provides a decision-making framework for choices about the allocation of healthcare resources. Conversely, in animal health, cost-benefit analysis has been the preferred tool for economic analysis. In this paper, the use of CEA in related areas and the role of this technique in assessments of animal health, welfare and production are reviewed. Cost-effectiveness analysis can add further value to these assessments, particularly in programmes targeting animal welfare or animal diseases with an impact on human health, where outcomes are best valued in natural effects rather than in monetary units. Importantly, CEA can be performed during programme implementation stages to assess alternative courses of action in real time.

  13. Cost-effectiveness of the US Geological Survey stream-gaging program in Arkansas

    USGS Publications Warehouse

    Darling, M.E.; Lamb, T.E.

    1984-01-01

    This report documents the results of the cost-effectiveness of the stream-gaging program in Arkansas. Data uses and funding sources were identified for the daily-discharge stations. All daily-discharge stations were found to be in one or more data use categories, and none were candidates for alternate methods which would result in discontinuation or conversion to a partial record station. The cost for operation of daily-discharge stations and routing costs to partial record stations, crest gages, pollution control stations as well as seven recording ground-water stations was evaluated in the Kalman-Filtering Cost-Effective Resource allocation (K-CERA) analysis. This operation under current practices requires a budget of $292,150. The average standard error of estimate of streamflow record for the Arkansas District was analyzed at 33 percent.

  14. Pulsed Excimer Laser Processing for Cost-Effective Solar Cells

    NASA Technical Reports Server (NTRS)

    Wong, D.

    1985-01-01

    Residual lattice damage by 5 keV ion implantation and surface flaws induced by wafer cleaning are proven to affect the V sub oc more adversely for laser annealed cells than conventional thermal diffusion. However, an alternative, molecular implantation of molecular species holds potential. The first experimental results are encouraging. The lack of a commercially available mass analyzed implantation with low energy, high fluence ions is constraining.

  15. Oseltamivir Treatment for Children with Influenza-Like Illness in China: A Cost-Effectiveness Analysis

    PubMed Central

    Shen, Kunling; Xiong, Tengbin; Tan, Seng Chuen; Wu, Jiuhong

    2016-01-01

    Background Influenza is a common viral respiratory infection that causes epidemics and pandemics in the human population. Oseltamivir is a neuraminidase inhibitor—a new class of antiviral therapy for influenza. Although its efficacy and safety have been established, there is uncertainty regarding whether influenza-like illness (ILI) in children is best managed by oseltamivir at the onset of illness, and its cost-effectiveness in children has not been studied in China. Objective To evaluate the cost-effectiveness of post rapid influenza diagnostic test (RIDT) treatment with oseltamivir and empiric treatment with oseltamivir comparing with no antiviral therapy against influenza for children with ILI. Methods We developed a decision-analytic model based on previously published evidence to simulate and evaluate 1-year potential clinical and economic outcomes associated with three managing strategies for children presenting with symptoms of influenza. Model inputs were derived from literature and expert opinion of clinical practice and research in China. Outcome measures included costs and quality-adjusted life year (QALY). All the interventions were compared with incremental cost-effectiveness ratios (ICER). Results In base case analysis, empiric treatment with oseltamivir consistently produced the greatest gains in QALY. When compared with no antiviral therapy, the empiric treatment with oseltamivir strategy is very cost effective with an ICER of RMB 4,438. When compared with the post RIDT treatment with oseltamivir, the empiric treatment with oseltamivir strategy is dominant. Probabilistic sensitivity analysis projected that there is a 100% probability that empiric oseltamivir treatment would be considered as a very cost-effective strategy compared to the no antiviral therapy, according to the WHO recommendations for cost-effectiveness thresholds. The same was concluded with 99% probability for empiric oseltamivir treatment being a very cost-effective strategy

  16. Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

    PubMed Central

    Marseille, Elliot; Jiwani, Aliya; Raut, Abhishek; Verguet, Stéphane; Walson, Judd; Kahn, James G

    2014-01-01

    Objective This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases. Methods We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars. Primary and secondary outcomes The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted. Results Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness. Conclusions IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC

  17. An alternating-direction-implicit algorithm for the unsteady potential equation in conservation form

    NASA Technical Reports Server (NTRS)

    Chipman, R. R.

    1980-01-01

    An implicit finite difference scheme for an efficient computation of unsteady potential flow about airfoils is presented. The formulation uses density and velocity potential as dependent variables, and is cast in conservation form to assure the theoretically correct determination of shockwave location and speed. To enable boundary conditions to be imposed directly on the airfoil surface, a time varying sheared rectilinear coordinate transformation is employed. Calculated time history solutions on a pulsating airfoil are compared with the results of another unsteady transonic code. It is concluded that the method has excellent numerical stability and gives accurate solutions with sharply resolved shocks.

  18. Cost-Effectiveness Analysis of Community Active Case Finding and Household Contact Investigation for Tuberculosis Case Detection in Urban Africa

    PubMed Central

    Sekandi, Juliet N.; Dobbin, Kevin; Oloya, James; Okwera, Alphonse; Whalen, Christopher C.; Corso, Phaedra S.

    2015-01-01

    Introduction Case detection by passive case finding (PCF) strategy alone is inadequate for detecting all tuberculosis (TB) cases in high burden settings especially Sub-Saharan Africa. Alternative case detection strategies such as community Active Case Finding (ACF) and Household Contact Investigations (HCI) are effective but empirical evidence of their cost-effectiveness is sparse. The objective of this study was to determine whether adding ACF or HCI compared with standard PCF alone represent cost-effective alternative TB case detection strategies in urban Africa. Methods A static decision modeling framework was used to examine the costs and effectiveness of three TB case detection strategies: PCF alone, PCF+ACF, and PCF+HCI. Probability and cost estimates were obtained from National TB program data, primary studies conducted in Uganda, published literature and expert opinions. The analysis was performed from the societal and provider perspectives over a 1.5 year time-frame. The main effectiveness measure was the number of true TB cases detected and the outcome was incremental cost-effectiveness ratios (ICERs) expressed as cost in 2013 US$ per additional true TB case detected. Results Compared to PCF alone, the PCF+HCI strategy was cost-effective at US$443.62 per additional TB case detected. However, PCF+ACF was not cost-effective at US$1492.95 per additional TB case detected. Sensitivity analyses showed that PCF+ACF would be cost-effective if the prevalence of chronic cough in the population screened by ACF increased 10-fold from 4% to 40% and if the program costs for ACF were reduced by 50%. Conclusions Under our baseline assumptions, the addition of HCI to an existing PCF program presented a more cost-effective strategy than the addition of ACF in the context of an African city. Therefore, implementation of household contact investigations as a part of the recommended TB control strategy should be prioritized. PMID:25658592

  19. Screening strategies for active tuberculosis: focus on cost-effectiveness

    PubMed Central

    Dobler, Claudia Caroline

    2016-01-01

    In recent years, there has been renewed interest in screening for active tuberculosis (TB), also called active case-finding (ACF), as a possible means to achieve control of the global TB epidemic. ACF aims to increase the detection of TB, in order to diagnose and treat patients with TB earlier than if they had been diagnosed and treated only at the time when they sought health care because of symptoms. This will reduce or avoid secondary transmission of TB to other people, with the long-term goal of reducing the incidence of TB. Here, the history of screening for active TB, current screening practices, and the role of TB-diagnostic tools are summarized and the literature on cost-effectiveness of screening for active TB reviewed. Cost-effectiveness analyses indicate that community-wide ACF can be cost-effective in settings with a high incidence of TB. ACF among close TB contacts is cost-effective in settings with a low as well as a high incidence of TB. The evidence for cost-effectiveness of screening among HIV-infected persons is not as strong as for TB contacts, but the reviewed studies suggest that the intervention can be cost-effective depending on the background prevalence of TB and test volume. None of the cost-effectiveness analyses were informed by data from randomized controlled trials. As the results of randomized controlled trials evaluating different ACF strategies will become available in future, we will hopefully gain a better understanding of the role that ACF can play in achieving global TB control. PMID:27418848

  20. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    NASA Astrophysics Data System (ADS)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  1. An Alternative View of the Climate Warming Mitigation Potential of U.S. Temperate Forests

    EPA Science Inventory

    Many U.S. federal and non-governmental agencies promote forestation as a means to mitigate climate warming because of the carbon sequestration potential of forests. This biogeochemical-oriented carbon sequestration policy is somewhat inconsistent with a decade or more of researc...

  2. An alternative approach to the Boltzmann distribution through the chemical potential

    NASA Astrophysics Data System (ADS)

    D'Anna, Michele; Job, Georg

    2016-05-01

    The Boltzmann distribution is one of the most significant results of classical physics. Despite its importance and its wide range of application, at high school level it is mostly presented without any derivation or link to some basic ideas. In this contribution we present an approach based on the chemical potential that allows to derive it directly from the basic idea of thermodynamical equilibrium.

  3. Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients.

    PubMed

    Dal, Negro Roberto; Eandi, M; Pradelli, L; Iannazzo, S

    2007-01-01

    Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs. PMID:18044689

  4. Identifying Cost-Effective Residential Energy Efficiency Opportunities for the Kauai Island Utility Cooperative

    SciTech Connect

    Busche, S.; Hockett, S.

    2010-06-01

    This analysis is an update to the 2005 Energy Efficiency Potential Study completed by KEMA for the Kauai Island Utility Cooperative (KIUC) and identifies potential energy efficiency opportunities in the residential sector on Kauai (KEMA 2005). The Total Resource Cost (TRC) test is used to determine which of the energy efficiency measures analyzed in the KEMA report are cost effective for KIUC to include in a residential energy efficiency program. This report finds that there remains potential energy efficiency savings that could be cost-effectively incentivized through a utility residential demand-side management program on Kauai if implemented in such a way that the program costs per measure are consistent with the current residential program costs.

  5. Air Quality and Population Exposure in Urban Areas: Potential Co-Benefits of Alternative Strategies

    NASA Astrophysics Data System (ADS)

    Mikolajczyk, U.; Suppan, P.; Forkel, R.; Williams, M.

    2014-12-01

    Even though much progress has been achieved through dedicated approaches to improving air quality in many European cities, there are various threats which still remain unchanged. According to the World Health Organization, outdoor air pollution was linked to 3.7 million deaths in year 2012. As climate changes, the frequency of days with harmful levels of air pollutants may significantly increase causing exacerbation of cardiovascular and respiratory diseases. The aim of this study is to conduct health impact assessment by utilizing regionally and spatially specific data in order to assess the influence of alternative emission strategies on human health. In the first stage of this investigation, a modeling study was carried out using the Weather Research and Forecasting (WRF) model coupled with Chemistry (WRF/Chem; Grell et al., 2005) to estimate ambient concentrations of air pollutants. The model set-up included a nesting approach, where three domains with horizontal resolution of 18 km, 6 km and 2 km were defined. The investigation area included the city of Munich (1.5 million inhabitants). The model performance has been evaluated against available air quality observations from the monitoring database "AirBase". The chemical species including O3, NO, NO2 and PM10 simulated by WRF/Chem compare favorably with the observations. The model performs especially well in resolving the observed O3 concentrations. In the ongoing study, different emission reduction scenarios are compared to a baseline 2009 scenario based on Germany's National Emissions Inventory. To investigate health effects associated with air pollution concentrations a local-scale health impact assessment (HIA) will be conducted. Concentration-response functions (CRFs) link the change in mortality rates to the change in concentrations of air pollutants. CRFs are applied to population-weighted mean concentrations to estimate relative risks and hence estimate numbers of attributable deaths and associated

  6. Promoting functional foods as acceptable alternatives to doping: potential for information-based social marketing approach

    PubMed Central

    2010-01-01

    Background Substances with performance enhancing properties appear on a continuum, ranging from prohibited performance enhancing drugs (PED) through dietary supplements to functional foods (FF). Anti-doping messages designed to dissuade athletes from using PEDs have been typically based on moralising sport competition and/or employing scare campaigns with focus on the negative consequences. Campaigns offering comparable and acceptable alternatives are nonexistent, nor are athletes helped in finding these for themselves. It is timely that social marketing strategies for anti-doping prevention and intervention incorporate media messages that complement the existing approaches by promoting comparable and acceptable alternatives to doping. To facilitate this process, the aim of this study was to ascertain whether a single exposure knowledge-based information intervention led to increased knowledge and subsequently result in changes in beliefs and automatic associations regarding performance enhancements. Methods In a repeated measure design, 115 male recreational gym users were recruited and provided with a brief information pamphlet on nitrite/nitrate and erythropoietin as a comparison. Measures of knowledge, beliefs and automatic associations were taken before and after the intervention with at least 24 hours between the two assessments. The psychological tests included explicit measures of beliefs and cognitive attitudes toward FF and PED using a self-reported questionnaire and computerised assessments of automatic associations using the modified and shortened version of the Implicit Association Test. Results The information based intervention significantly increased knowledge (p < 0.001), changed explicit beliefs in specific FF (p < 0.001) and shifted the automatic association of FF with health to performance (p < 0.001). Explicitly expressed beliefs and automatic associations appear to be independent. Conclusion Evidence was found that even a single exposure to a

  7. The Use of Complementary and Alternative Medicine Supplements of Potential Concern during Breast Cancer Chemotherapy.

    PubMed

    Sweet, Erin; Dowd, Fred; Zhou, May; Standish, Leanna J; Andersen, M Robyn

    2016-01-01

    Objective. While many Complementary and Alternative Medicines (CAM) are unlikely to interact negatively with conventional oncology treatment, some ingestible CAM substances have biological activities that may reduce the effectiveness of chemotherapy or radiation. This study surveyed women with breast cancer in order to document the extent to which women with breast cancer use these CAM substances of concern concurrently with conventional treatments. Methods. A total of 398 women completed a survey describing their use of CAM at various time points in their cancer treatment. This report focuses on a subsample of 250 women receiving chemotherapy or radiation who reported using specific one or more of several chemotherapies. Results. Of those participating, 104 (43.7%) of those receiving chemotherapy (n = 238) and 45 (32.3%) of those receiving radiation (139; 58.4% of all patients) reported using one or more CAM substances that could be cause for concern when taken concurrently. Conclusion. Research is needed to understand the real risks associated with CAM and conventional polypharmacy. If risks associated with CAM conventional polypharmacy use prove to be substantial then improved systems to assure all women get advice regarding herb and supplement use during breast cancer treatment appear to be needed. PMID:27528880

  8. Marked Antigiardial Activity of Yucca baccata Extracts: A Potential Natural Alternative for Treating Protozoan Infections

    PubMed Central

    Quihui-Cota, Luis; León-Trujillo, Rocio; Astiazarán-García, Humberto; Esparza-Romero, Julián; Robles, María del Refugio; Robles-Zepeda, Ramón E.; Canett, Rafael; Sánchez-Escalante, Jesús

    2014-01-01

    Human Giardiosis is a public health problem in Mexico, where the national prevalence was estimated to be up to 68%. Misuse of antiprotozoal drugs may result in low effectiveness and undesirable side effects. Research on natural products is a good strategy for discovering more effective antiparasitic compounds. This study evaluated the antigiardial activity of extracts of Yucca baccata, which is native to northwestern Mexico. Forty-two gerbils (females) were weighed and orally inoculated with 5 × 106 Giardia trophozoites. Two gerbils were selected at random to confirm infection. Forty living gerbils were randomly allocated into 5 treatment groups (8 per group). Gerbils were randomly assigned to be treated with 24.4 mg/mL, 12.2 mg/mL, and 6.1 mg/mL of extracts, metronidazole (2 mg/mL) or PBS, which were intragastrically administered once per day for 3 days. Nine gerbils died during the study course. On day 10 postinfection, gerbils were euthanized and trophozoites were quantified. Yucca extracts reduced, albeit not significantly, the trophozoite counts in the duodenum segment. Only the high-extract concentration significantly reduced the trophozoite counts in the proximal segment and it was similar to that of metronidazole. Extracts of Y. baccata may represent an effective and natural therapeutic alternative for human giardiosis. PMID:25250335

  9. The Use of Complementary and Alternative Medicine Supplements of Potential Concern during Breast Cancer Chemotherapy

    PubMed Central

    Dowd, Fred; Zhou, May; Standish, Leanna J.; Andersen, M. Robyn

    2016-01-01

    Objective. While many Complementary and Alternative Medicines (CAM) are unlikely to interact negatively with conventional oncology treatment, some ingestible CAM substances have biological activities that may reduce the effectiveness of chemotherapy or radiation. This study surveyed women with breast cancer in order to document the extent to which women with breast cancer use these CAM substances of concern concurrently with conventional treatments. Methods. A total of 398 women completed a survey describing their use of CAM at various time points in their cancer treatment. This report focuses on a subsample of 250 women receiving chemotherapy or radiation who reported using specific one or more of several chemotherapies. Results. Of those participating, 104 (43.7%) of those receiving chemotherapy (n = 238) and 45 (32.3%) of those receiving radiation (139; 58.4% of all patients) reported using one or more CAM substances that could be cause for concern when taken concurrently. Conclusion. Research is needed to understand the real risks associated with CAM and conventional polypharmacy. If risks associated with CAM conventional polypharmacy use prove to be substantial then improved systems to assure all women get advice regarding herb and supplement use during breast cancer treatment appear to be needed. PMID:27528880

  10. Concluding comments: maximizing good patient care and minimizing potential liability when considering complementary and alternative medicine.

    PubMed

    Gilmour, Joan; Harrison, Christine; Vohra, Sunita

    2011-11-01

    Our goal for this supplemental issue of Pediatrics was to consider what practitioners, parents, patients, institutions, and policy-makers need to take into account to make good decisions about using complementary and alternative medicine (CAM) to treat children and to develop guidelines for appropriate use. We began by explaining underlying concepts and principles in ethical, legal, and clinical reasoning and then used case scenarios to explore how they apply and identify gaps that remain in practice and policy. In this concluding article, we review our major findings, summarize our recommendations, and suggest further research. We focus on several key areas: practitioner and patient/parent relationships; decision-making; dispute resolution; standards of practice; hospital/health facility policies; patient safety; education; and research. Ethical principles, standards, and rules applicable when making decisions about conventional care for children apply to decision-making about CAM as well. The same is true of legal reasoning. Although CAM use has seldom led to litigation, general legal principles relied on in cases involving conventional medical care provide the starting point for analysis. Similarly, with respect to clinical decision-making, clinicians are guided by clinical judgment and the best interests of their patient. Whether a therapy is CAM or conventional, clinicians must weigh the relative risks and benefits of therapeutic options and take into account their patient's values, beliefs, and preferences. Consequently, many of our observations apply to conventional and CAM care and to both adult and pediatric patients. PMID:22045865

  11. The cost-effectiveness of exercise referral schemes

    PubMed Central

    2011-01-01

    Background Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting. Methods A decision analytic model was developed to estimate the cost-effectiveness of ERS from a UK NHS perspective. The costs and outcomes of ERS were modelled over the patient's lifetime. Data were derived from a systematic review of the literature on the clinical and cost-effectiveness of ERS, and on parameter inputs in the modelling framework. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses investigated the impact of varying ERS cost and effectiveness assumptions. Sub-group analyses explored the cost-effectiveness of ERS in sedentary people with an underlying condition. Results Compared with usual care, the mean incremental lifetime cost per patient for ERS was £169 and the mean incremental QALY was 0.008, generating a base-case incremental cost-effectiveness ratio (ICER) for ERS at £20,876 per QALY in sedentary individuals without a diagnosed medical condition. There was a 51% probability that ERS was cost-effective at £20,000 per QALY and 88% probability that ERS was cost-effective at £30,000 per QALY. In sub-group analyses, cost per QALY for ERS in sedentary obese individuals was £14,618, and in sedentary hypertensives and sedentary individuals with depression the estimated cost per QALY was £12,834 and £8,414 respectively. Incremental lifetime costs and benefits associated with ERS were small, reflecting the preventative public health context of the intervention, with this resulting in estimates of cost-effectiveness that are

  12. Alternative feeding strategies and potential disease transmission in Wisconsin white-tailed deer

    USGS Publications Warehouse

    Thompson, A.K.; Samuel, M.D.; VanDeelen, T.R.

    2008-01-01

    We conducted experimental feeding using 3 feeding methods (pile, spread, trough) and 2 quantities (rationed, ad libitum) of shelled corn to compare deer activity and behavior with control sites and evaluate potential direct and indirect transmission of infectious disease in white-tailed deer (Odocoileus virginianus) in central Wisconsin, USA. Deer use was higher at 2 of the feeding sites than at natural feeding areas (P ??? 0.02). Deer spent a higher proportion of time (P < 0.01) feeding at pile (49%) and spread (61%) treatments than at natural feeding areas (36%). We found higher deer use for rationed than ad libitum feeding quantities and feeding intensity was greatest at rationed piles and lowest at ad libitum spreads. We also observed closer pairwise distances (???0.3 m) among deer when corn was provided in a trough relative to spread (P=0.03). Supplemental feeding poses risks for both direct and indirect disease transmission due to higher deer concentration and more intensive use relative to control areas. Concentrated feeding and contact among deer at feeding sites can also increase risk for disease transmission. Our results indicated that restrictions on feeding quantity would not mitigate the potential for disease transmission None of the feeding strategies we evaluated substantially reduced the potential risk for disease transmission and banning supplemental feeding to reduce transmission is warranted.

  13. Cost-effectiveness and Pricing of Antibacterial Drugs

    PubMed Central

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. PMID:25521641

  14. Groundwater remediation and the cost effectiveness of phytoremediation.

    PubMed

    Compernolle, T; Van Passel, S; Weyens, N; Vangronsveld, J; Lebbe, L; Thewys, T

    2012-10-01

    In 1999, phytoremediation was applied at the site of a Belgian car factory to contain two BTEX plumes. This case study evaluates the cost effectiveness of phytoremediation compared to other remediation options, applying a tailored approach for economic evaluation. Generally, when phytoremediation is addressed as being cost effective, the cost effectiveness is only determined on an average basis. This study however, demonstrates that an incremental analysis may provide a more nuanced conclusion. When the cost effectiveness is calculated on an average basis, in this particular case, the no containment strategy (natural attenuation) has the lowest cost per unit mass removed and hence, should be preferred. However, when the cost effectiveness is determined incrementally, no containment should only be preferred if the value of removing an extra gram of contaminant mass is lower than 320 euros. Otherwise, a permeable reactive barrier should be adopted. A similar analysis is provided for the effect determined on the basis of remediation time. Phytoremediation is preferred compared to 'no containment' if reaching the objective one year earlier is worth 7 000 euros.

  15. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials.

    PubMed

    Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Yamauchi, Keita

    2016-06-01

    A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future

  16. Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore

    PubMed Central

    Carrasco, Luis R.; Lee, Linda K.; Lee, Vernon J.; Ooi, Eng Eong; Shepard, Donald S.; Thein, Tun L.; Gan, Victor; Cook, Alex R.; Lye, David; Ng, Lee Ching; Leo, Yee Sin

    2011-01-01

    Background Dengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. Methods and Findings We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. Conclusions Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially. PMID:22206028

  17. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials.

    PubMed

    Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Yamauchi, Keita

    2016-06-01

    A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future

  18. Effects of hypoxia or low PH on the alternation of canine ventricular action potentials following an abrupt increase in driving rate.

    PubMed

    Hirata, Y; Toyama, J; Yamada, K

    1980-02-01

    Effects of hypoxia or low extracellular pH on the alternation of ventricular action potentials occurring after an abrupt increase in driving rate (rate change induced alternation--RCI alternation) were studied using standard microelectrode methods in canine papillary muscle preparations. Under the control conditions the alternation always occurred after a rate change from 10 to 100 beats . min-1 or 60 to 200 beats . min-1, but it diminished rapidly during the faster rates. Under the hypoxic condition the degree of the RCI alternation gradually increased to the peak 20 to 60 min after the onset of the hypoxic perfusion and then decreased. The hypoxic perfusion caused an increase in beat-to-beat laternating change of the action potential configuration and a marked persistence of the phenomenon. In the initial stage of reoxygenation after 2 hours of the hypoxic perfusion, the RCI alternation transiently increased again. During hypoxia in six out of 15 preparations an unusual alternation of action potentials with an inverted phase occasionally occurred after the rate change from 60 to 200 beats . min-1. Acidic perfusion (pH = 6.0) had similar effects on the RCI alternation. It also caused an increase in beat-to-beat alternating change in the action potential configuration and a prolongation of the phenomenon. In the period when the RCI alternation was markedly increased, a steady-state alternation of action potentials spontaneously occurred at a constant drive rate under hypoxia or low pH. The mechanisms responsible for the RCI alternation of action potentials and the possible role of the phenomenon in the genesis of cardiac arrhythmias in the ischaemic heart are discussed.

  19. Thromboerythrocytes. In vitro studies of a potential autologous, semi-artificial alternative to platelet transfusions.

    PubMed

    Coller, B S; Springer, K T; Beer, J H; Mohandas, N; Scudder, L E; Norton, K J; West, S M

    1992-02-01

    In an attempt to overcome the limitations and drawbacks of using fresh platelets for transfusion therapy of thrombocytopenic patients, we have performed in vitro experiments on an autologous, semi-artificial alternative to platelet transfusions. Based on our previous studies of the interactions of unactivated and activated platelets with beads coated with peptides of various lengths, all of which contained the arginine-glycine-aspartic acid (RGD) cell recognition sequence, the peptide Ac-CGGRGDF-NH2 was chosen for covalent coupling to erythrocytes. A heterobifunctional crosslinking reagent (N-maleimido-6-aminocaproyl ester of 1-hydroxy-2-nitrobenzene-4-sulfonic acid) was used to crosslink via the peptide's free sulfhydryl group and the erythrocyte's surface amino groups. Approximately 0.5-1.5 x 10(6) peptide molecules bound per erythrocyte after 2 h of incubation, and most of the peptides appeared to crosslink to glycophorin A. The resulting cells, termed thromboerythrocytes, interacted selectively with activated platelets to form mixed aggregates. Studies with fluid phase RGD peptides and monoclonal antibodies indicated that the RGD peptides on the thromboerythrocytes interacted with the GPIIb/IIIa receptors on activated platelets. Thromboerythrocytes could also bind to platelets adherent to collagen. There was minimal erythrocyte hemolysis during the formation of thromboerythrocytes and studies of thromboerythrocyte osmotic fragility and cellular deformability showed no significant changes from control erythrocytes. Whereas there is a 20:1 ratio of erythrocytes to platelets in the circulation of normal individuals, the erythrocytes from as little as 50 ml of blood could be transformed into the equivalent of 2 U of platelets by numbers (equivalent to 18 U of platelets by mass), and reinfused into the same individual within several hours. These data encourage us to proceed to in vivo studies to assess the hemostatic efficacy of thromboerythrocytes in

  20. Investigation into Alternative Sugars as Potential Carriers for Dry Powder Formulation of Budesonide

    PubMed Central

    Momin, Mohammed-Nurul; Hedayati, Atoosa; Nokhodchi, Ali

    2011-01-01

    Introduction Dry powder inhaler (DPI) formulations are so far being used for pulmonary drug delivery, mainly for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Currently most of DPI formulations rely on lactose as a carrier in the drug powder blend. However, due to reducing sugar function of lactose which makes it incompatible with some drugs such as budesonide, it is realistic to investigate for alternative sugars that would overcome the concerned drawback but still have the positive aspects of lactose. Methods The study was conducted by characterizing carriers for their physico-chemical properties and preparing drug/carrier blends with concentration of 5% and 10% drug with the carrier. The mixing uniformity (homogeneity) of Budesonide in the blends was analyzed using spectrophotometer. The blend was then filled into NB7/2 Airmax inhaler device and the deposition profiles of the drug were determined using multi stage liquid impinger (MSLI) after aerosolization at 4 kPa via the inhaler. The morphology of the carriers conducted using the scanning electron microscope. Results The results determined that the mean fine particle fraction (FPF) of 5% and 10% blends of mannitol was 61%, possibly due to fine elongated particles. Dextrose exhibited excellent flowability. Scanning electron microscope illustrated mannitol with fine elongated particles and dextrose presenting larger and coarse particles. It was found out that type of carriers, particle size distribution, and morphology would influence the FPF of budesonide. Conclusion It may be concluded that mannitol could be suitable as a carrier on the basis of its pharmaceutical performance and successful achievement of FPF whereas the more hygroscopic sugars such as sorbitol or xylitol showed poor dispersibility leading to lower FPF. PMID:23678414

  1. Alternatives to conventional diesel fuel-some potential implications of California's TAC decision on diesel particulate.

    SciTech Connect

    Eberhardt, J. J.; Rote, D. M.; Saricks, C. L.; Stodolsky, F.

    1999-08-10

    Limitations on the use of petroleum-based diesel fuel in California could occur pursuant to the 1998 declaration by California's Air Resources Board (CARB) that the particulate matter component of diesel exhaust is a carcinogen, therefore a toxic air contaminant (TAC) subject to provisions of the state's Proposition 65. It is the declared intention of CARB not to ban or restrict diesel fuel, per se, at this time. Assuming no total ban, Argonne National Laboratory (ANL) explored two feasible ''mid-course'' strategies. (1) Increased penetration of natural gas and greater gasoline use in the transportation fuels market, to the extent that some compression-ignition (CI) applications revert to spark-ignition (SI) engines. (2) New specifications requiring diesel fuel reformulation based on exhaust products of individual diesel fuel constituents. Each of these alternatives results in some degree of (conventional) diesel displacement. In the first case, diesel fuel is assumed admissible for ignition assistance as a pilot fuel in natural gas (NG)-powered heavy-duty vehicles, and gasoline demand in California increases by 32.2 million liters per day overall, about 21 percent above projected 2010 baseline demand. Natural gas demand increases by 13.6 million diesel liter equivalents per day, about 7 percent above projected (total) consumption level. In the second case, compression-ignition engines utilize substitutes for petroleum-based diesel having similar ignition and performance properties. For each case we estimated localized air emission plus generalized greenhouse gas and energy changes. Economic implications of vehicle and engine replacement were not evaluated.

  2. Bis-indolic compounds as potential new therapeutic alternatives for tularaemia.

    PubMed

    Caspar, Yvan; Sutera, Vivien; Boisset, Sandrine; Denis, Jean-Noël; Maurin, Max

    2014-01-01

    Francisella tularensis is the etiological agent of tularaemia and a CDC class A biological threat agent. Few antibiotic classes are currently useful in treating tularaemia, including the aminoglycosides gentamicin and streptomycin, fluoroquinolones, and tetracyclines. However, treatment failures and relapses remain frequent and F. tularensis strains resistant to antibiotics have been easily selected in vitro. In this study, we evaluated the activity of new synthetic bis-indole derivatives against this pathogen. Minimum inhibitory concentrations (MICs) of four compounds (dcm01 to dcm04) were determined for the reference strains F. tularensis subsp. holarctica LVS NCTC10857, F. tularensis subsp. novicida CIP56.12 and F. philomiragia ATCC25015, and for 41 clinical strains of F. tularensis subsp. holarctica isolated in France. Minimal bactericidal concentrations (MBCs) were determined for the dcm02 and dcm04 compounds for the LVS and two clinical strains. Killing curves were also determined for the same three strains exposed to dcm04. All tested bis-indole compounds were bacteriostatic against F. tularensis subsp. holarctica strains, with a MIC90 of 8 μg/mL for dcm01, dcm02, and dcm03, and 2 μg/mL for dcm04. Only one strain was resistant to both dcm01 and dcm03, with MICs > 32 μg/mL. In contrast, F. tularensis subsp. novicida was resistant to all derivatives and F. philomiragia was only susceptible to dcm02 and dcm04, with MICs of 16 and 4 μg/mL, respectively. MBC and killing curve experiments revealed significant bactericidal activity (i.e., 3-log reduction of the bacterial inoculum) of the dcm02 and dcm04 compounds only for the LVS strain. In conclusion, we have identified novel synthetic bis-indole compounds that are active against F. tularensis subsp. holarctica. They may be drug candidates for the development of new therapeutic alternatives for tularaemia treatment. Their further characterization is needed, especially identification of their bacterial targets.

  3. The cost-effectiveness of a school-based smoking prevention program in India.

    PubMed

    Brown, H Shelton; Stigler, Melissa; Perry, Cheryl; Dhavan, Poonam; Arora, Monika; Reddy, K Srinath

    2013-06-01

    Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50,000 for a life-year. PMID:22271928

  4. The cost offsets and cost-effectiveness associated with pegylated drugs: a review of the literature.

    PubMed

    Becker, Russell; Dembek, Carole; White, Leigh Ann; Garrison, Louis P

    2012-12-01

    Pegylation (PEG) is used as both a drug-delivery and a drug-modification technology in ten drugs approved by the US FDA. Benefits of PEG drugs can include increased plasma half-life, longer absorption, improved tumor targeting and less antigenicity and immunogenicity. Clinical benefits of PEG drugs over non-PEG drugs may include reduced administration, improved efficacy, improved tolerability, and decreased severity and incidence of adverse events. This study reviews 37 economic literature publications featuring PEG drugs versus non-PEG versions. PEG drugs showed some reductions in overall costs resulting from various offsets including fewer administrations, lower adverse event treatment costs, reduced disease complication costs or reduced inpatient/outpatient costs. Of the 18 cost-effectiveness studies reviewed, 17 of them found PEG drugs to be cost effective versus the non-PEG drugs. Cost offsets and cost-effectiveness of PEG drugs have been demonstrated in multiple studies across various therapies, indications and country settings, and the results have been found to be stable when key parameters were varied in analyses. Further studies are needed to assess the potential for cost savings and cost-effectiveness for new PEG therapies in development.

  5. Estimation of life-years gained and cost effectiveness based on cause-specific mortality.

    PubMed

    Kim, Lois G; Thompson, Simon G

    2011-07-01

    Cost-effectiveness analysis is usually based on life-years gained estimated from all-cause mortality. When an intervention affects only a few causes of death accounting for a small fraction of all deaths, this approach may lack precision. We develop a novel technique for cost-effectiveness analysis when life-years gained are estimated from cause-specific mortality, allowing for competing causes of death. In the context of randomised trial data, we adjust for other-cause mortality combined across randomised groups. This method yields a greater precision than analysis based on total mortality, and we show application to life-years gained, quality-adjusted life-years gained, incremental costs, and cost effectiveness. In multi-state health economic models, however, mortality from competing causes is commonly derived from national statistics and is assumed to be known and equal across intervention groups. In such models, our method based on cause-specific mortality and standard methods using total mortality give essentially identical estimates and precision. The methods are applied to a randomised trial and a health economic model, both of screening for abdominal aortic aneurysm. A gain in precision for cost-effectiveness estimates is clearly helpful for decision making, but it is important to ensure that 'cause-specific mortality' is defined to include all causes of death potentially affected by the intervention.

  6. Synergistic potentiation of D-fraction with vitamin C as possible alternative approach for cancer therapy.

    PubMed

    Konno, Sensuke

    2009-01-01

    Maitake D-fraction or PDF is the bioactive extract of maitake mushroom (Grifola frondosa) and its active constituent is the protein-bound polysaccharide (proteoglucan), or more specifically known as beta-glucan. PDF has been extensively studied and a number of its medicinal potentials/properties have been unveiled and demonstrated. Those include various physiological benefits ranging from immunomodulatory and antitumor activities to treatment for hypertension, diabetes, hypercholesterolemia, viral infections (hepatitis B and human immunodeficiency virus), and obesity. Particularly, two major biological activities of PDF, immunomodulatory and antitumor activities, have been the main target for scientific and clinical research. To demonstrate and confirm such biological activities, numerous studies have been performed in vitro and in vivo or in clinical settings. These studies showed that PDF was indeed capable of modulating immunologic and hematologic parameters, inhibiting or regressing the cancer cell growth, and even improving quality of life of cancer patients. Synergistic potentiation of PDF with vitamin C demonstrated in vitro is rather interesting and may have clinical implication, because such combination therapy appears to help improve the efficacy of currently ongoing cancer therapies. Recently, intravenous administration of vitamin C has been often used to increase its physiological concentration and this useful procedure may further make this combination therapy feasible. Therefore, PDF may have great potential, either being used solely or combined with other agents, for cancer therapy. Such relevant and detailed studies will be described and discussed herein with a special focus on the combination of PDF and vitamin C as a viable therapeutic option.

  7. A conceptual framework for the evaluation of cost-effectiveness of projects to reduce GHG emissions and sequester carbon

    SciTech Connect

    Sathaye, J.; Norgaard, R.; Makundi, W.

    1993-07-01

    This paper proposes a conceptual framework for evaluating the cost of projects to reduce atmospheric greenhouse gases (GHGs). The evaluation of cost-effectiveness should account for both the timing of carbon emissions and the damage caused by the atmospheric stock of carbon. We develop a conceptual basis to estimate the cost-effectiveness of projects in terms of the cost of reducing atmospheric carbon (CRAC) and other GHGs. CRAC accounts for the economic discount rate, alternative functional forms of the shadow price, the residence period of carbon in the atmosphere, and the multiple monetary benefits of projects. The last item is of particular importance to the developing countries.

  8. Potential of Complementary and Alternative Medicine in Preventive Management of Novel H1N1 Flu (Swine Flu) Pandemic: Thwarting Potential Disasters in the Bud

    PubMed Central

    Arora, Rajesh; Chawla, R.; Marwah, Rohit; Arora, P.; Sharma, R. K.; Kaushik, Vinod; Goel, R.; Kaur, A.; Silambarasan, M.; Tripathi, R. P.; Bhardwaj, J. R.

    2011-01-01

    The emergence of novel H1N1 has posed a situation that warrants urgent global attention. Though antiviral drugs are available in mainstream medicine for treating symptoms of swine flu, currently there is no preventive medicine available. Even when available, they would be in short supply and ineffective in a pandemic situation, for treating the masses worldwide. Besides the development of drug resistance, emergence of mutant strains of the virus, emergence of a more virulent strain, prohibitive costs of available drugs, time lag between vaccine developments, and mass casualties would pose difficult problems. In view of this, complementary and alternative medicine (CAM) offers a plethora of interesting preventive possibilities in patients. Herbs exhibit a diverse array of biological activities and can be effectively harnessed for managing pandemic flu. Potentially active herbs can serve as effective anti influenza agents. The role of CAM for managing novel H1N1 flu and the mode of action of these botanicals is presented here in an evidence-based approach that can be followed to establish their potential use in the management of influenza pandemics. The complementary and alternative medicine approach deliberated in the paper should also be useful in treating the patients with serious influenza in non pandemic situations. PMID:20976081

  9. Cost effective dynamic design and test requirements for Shuttle payloads

    NASA Technical Reports Server (NTRS)

    Stahle, C. V.; Gongloff, H. R.; Bangs, W. F.

    1975-01-01

    The results of a study examining current spacecraft dynamic design and test requirements for the cost effective design and development of Shuttle payloads are presented. Dynamic environments, payload configurations, design/test requirements, test levels, assembly level of testing, simulation methods, prototype role, load limiting, test facilities, and flight measurements are discussed as they relate to the development of a cost effective design and test philosophy for Shuttle Spacelab payloads. It is concluded that changes to current design/test practices will minimize long range payload costs. However, changes to current practices need be quantitatively evaluated before an orderly progression to more cost effective methods can be achieved without undue risk of mission failures. Of major importance is optimization of test levels and plans for payloads and payload subsystems which will result in minimum project costs.

  10. Cost-effective conservation planning: lessons from economics.

    PubMed

    Duke, Joshua M; Dundas, Steven J; Messer, Kent D

    2013-08-15

    Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage.

  11. A Layered Decision Model for Cost-Effective System Security

    SciTech Connect

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  12. Evaluating cost-effectiveness using episodes of care.

    PubMed

    Lasdon, G S; Sigmann, P

    1977-03-01

    To test the feasibility of defining episodes of care as a cost-effectiveness measure, a pilot study was carried out in conjunction with an ongoing quality assessment program which involved abstracting prospective data from charts of patients treated for hypertension in the Primary Care Clinic of Hahnemann Medical College and Hospital. For comparison, data were abstracted retrospectively on hypertensive patients treated by faculty general internists in a fee-for-service private practice. The 12-month course of each patient was divided into controlled and uncontrolled episodes for which visit frequency rate and mean laboratory test utilization was calculated. Patient cost for each type of episode in each setting was calculated using standard charges. Results indicate that the episode definition is feasible and provides a measure for comparing the cost-effectiveness of different delivery systems treating the same health care problem. Factors omitted from the study that could affect cost-effectiveness are also discussed.

  13. Cost effective waste management through composting in Africa

    SciTech Connect

    Couth, R.; Trois, C.

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer The financial/social/institutional sustainability of waste management in Africa is analysed. Black-Right-Pointing-Pointer This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. Black-Right-Pointing-Pointer This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  14. Perspectives on Non-Animal Alternatives for Assessing Sensitization Potential in Allergic Contact Dermatitis.

    PubMed

    Sharma, Nripen S; Jindal, Rohit; Mitra, Bhaskar; Lee, Serom; Li, Lulu; Maguire, Tim J; Schloss, Rene; Yarmush, Martin L

    2012-03-01

    Skin sensitization remains a major environmental and occupational health hazard. Animal models have been used as the gold standard method of choice for estimating chemical sensitization potential. However, a growing international drive and consensus for minimizing animal usage have prompted the development of in vitro methods to assess chemical sensitivity. In this paper, we examine existing approaches including in silico models, cell and tissue based assays for distinguishing between sensitizers and irritants. The in silico approaches that have been discussed include Quantitative Structure Activity Relationships (QSAR) and QSAR based expert models that correlate chemical molecular structure with biological activity and mechanism based read-across models that incorporate compound electrophilicity. The cell and tissue based assays rely on an assortment of mono and co-culture cell systems in conjunction with 3D skin models. Given the complexity of allergen induced immune responses, and the limited ability of existing systems to capture the entire gamut of cellular and molecular events associated with these responses, we also introduce a microfabricated platform that can capture all the key steps involved in allergic contact sensitivity. Finally, we describe the development of an integrated testing strategy comprised of two or three tier systems for evaluating sensitization potential of chemicals.

  15. Potential of fructooligosaccharide prebiotics in alternative and nonconventional poultry production systems.

    PubMed

    Ricke, S C

    2015-06-01

    Fructooligosaccharide and inulin prebiotics are carbohydrate-based polymers derived from natural sources that can be utilized by certain gastrointestinal tract bacteria but not by the host animal. They are attractive as feed additives for nonconventional poultry production systems because they select for beneficial microorganisms that are thought to promote nutritional benefits to the bird and potentially limit foodborne pathogen establishment. There have been numerous studies conducted with prebiotic supplements to assess their impact in humans, animals, and conventionally raised poultry but only limited research has been conducted with birds grown under nonconventional production conditions. Much remains unknown about the specific mechanism(s) associated with their impact on the host as well as the gastrointestinal tract microflora. Utilization of several recently developed approaches such as microbiome and metabolomic analyses should offer more insight on how dietary prebiotic additives influence the development of the gastrointestinal tract microbiota and these subsequent changes correspond with alterations in a bird's physiology as it matures. As more detailed and precise studies are done with nonconventional poultry, it is likely that structurally distinct prebiotics will influence not only the gastrointestinal tract microbiota differently, but potentially interact directly and/or indirectly with the bird host in distinguishable patterns as well. These functions will be important to delineate if further applications are to be developed for specific prebiotics in nonconventional poultry production systems.

  16. An alternative Fc gamma-receptor ligand: potential role in T-cell development.

    PubMed Central

    Sandor, M; Galon, J; Takacs, L; Tatsumi, Y; Mueller, A L; Sautes, C; Lynch, R G

    1994-01-01

    Fetal pre-T cells express low-affinity receptors for IgG (Fc gamma R) at a developmental stage prior to the rearrangement and expression of immunoglobulin genes. The present studies investigated the possible functional significance of Fc gamma R on fetal pre-T cells. Between 13 and 17 days of fetal development a subpopulation of T-cell receptor-, Thy-1+ thymocytes express for gamma R. The same cells contain mRNA for several forms of Fc gamma R (Fc gamma RII beta 1, beta 2, and Fc gamma RIII). Concurrently, a Pgp-1-, Thy-1-, surface-immunoglobulin- fetal thymic cell binds recombinant soluble Fc gamma R. In principle this cell can interact with the pre-T cells through this counter-receptor. To test this possibility anti-Fc gamma RII/III antibody (2.4G2) was injected into pregnant mice and then into their offspring for 6 wk postpartum. The injected antibody induced a slight increase in the proportion of CD4 or CD8 single-positive, alpha/beta T cells in the thymus. However, in fetal thymic cultures in the presence of 2.4G2 or the recombinant soluble Fc gamma R there was an accelerated differentiation of thymocytes to single-positive, CD3-bright, heat-stable antigen-dull, alpha/beta T cells. These experiments show that Fc gamma Rs are present on pre-T cells during early fetal thymic development, and that a non-IgG ligand of the Fc gamma R is expressed concurrently on Thy- fetal thymocytes. Furthermore, the presumed interaction of Fc gamma R and the alternative ligand(s) influences T-cell development. IgG binding could be an adapted function of Fc gamma Rs, and, as shown for many members of the Ig super family, these receptors may have originally served as cell-cell recognition/interaction molecules required for hematopoietic development. Images Fig. 2 PMID:7809135

  17. Cost-effectiveness of Extended Cessation Treatment for Older Smokers

    PubMed Central

    Barnett, Paul G.; Wong, Wynnie; Jeffers, Abra; Munoz, Ricardo; Humfleet, Gary; Hall, Sharon

    2014-01-01

    Aims To examine the cost-effectiveness of extended smoking cessation treatment in older smokers. Design Participants who completed a 12 week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. Setting A free-standing smoking cessation clinic in the United States. Participants 402 smokers aged 50 years and older were recruited from the community. Measurements The trial measured biochemically-verified abstinence from cigarettes after 24 months and the quantity of smoking cessation services used. Trial findings were combined with literature on changes in smoking status and the age and gender adjusted effect of smoking on health care cost, mortality, and qualify of life over the long-term in a Markov model of cost-effectiveness over a lifetime horizon. Findings The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost (p =.012, CI $21-$212). At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (p <.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6,324 per Quality Adjusted Life Year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of –$331 – $2,081; the 0.150 additional QALYs had a confidence interval of 0.035- 0.280, and that the intervention was cost-effective against a $50,000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective. Conclusions Adding extended cognitive behavior therapy to standard smoking cessation treatment can be cost-effective. PMID:24329972

  18. Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis.

    PubMed

    Scuffham, P A; McIntyre, P B

    2004-07-29

    Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established.

  19. Alternate approaches for pediatric type 1 diabetes drug development and potential regulatory approval: a perspective.

    PubMed

    Turner, J Rick; Close, Kelly L; Fleming, G Alexander; Wherrett, Diane K; DiMeglio, Linda A

    2015-10-01

    The incidence and prevalence of pediatric type 1 diabetes are increasing globally, including in the U.S. While the increasing number of cases of pediatric diabetes makes expeditious availability of new medical products and therapies for diabetes care essential, there have been many barriers encountered in bringing some drugs and devices to pediatric patients who may benefit. Newer insulins have been studied and approved for use in children. However, hurdles exist in the inclusion of children in studies of therapies aimed at preventing β-cell loss in those with new-onset diabetes and those at risk for type 1 diabetes. This Perspective focuses on potential solutions to the challenges experienced in bringing new drugs for pediatric type 1 diabetes to marketing approval. Given their central importance as the users of medical products, patient perspectives are included along with scientific and regulatory considerations.

  20. Proteasome Impairment Induces Recovery of Mitochondrial Membrane Potential and an Alternative Pathway of Mitochondrial Fusion

    PubMed Central

    Shirozu, Ryohei; Yashiroda, Hideki

    2015-01-01

    Mitochondria are vital and highly dynamic organelles that continuously fuse and divide to maintain mitochondrial quality. Mitochondrial dysfunction impairs cellular integrity and is known to be associated with various human diseases. However, the mechanism by which the quality of mitochondria is maintained remains largely unexplored. Here we show that impaired proteasome function recovers the growth of yeast cells lacking Fzo1, a pivotal protein for mitochondrial fusion. Decreased proteasome activity increased the mitochondrial oxidoreductase protein Mia40 and the ratio of the short isoform of mitochondrial intermembrane protein Mgm1 (s-Mgm1) to the long isoform (l-Mgm1). The increase in Mia40 restored mitochondrial membrane potential, while the increase in the s-Mgm1/l-Mgm1 ratio promoted mitochondrial fusion in an Fzo1-independent manner. Our findings demonstrate a new pathway for mitochondrial quality control that is induced by proteasome impairment. PMID:26552703

  1. Economics of urolithiasis: cost-effectiveness of therapies.

    PubMed

    Chandhoke, P S

    2001-07-01

    The cost of treating urolithiasis with extracorporeal shockwave lithotripsy and endoscopic surgery continues to be a significant burden on a nation's healthcare economy. Cost-effectiveness evaluations of various medical and surgical treatment options for urolithiasis is a practical method of developing rational allocation strategies for limited economic resources. In this review, the cost-effectiveness of shockwave lithotripsy and that of endoscopic surgery in the management of kidney and ureteral stones are compared. This is followed by a discussion of the cost of the medical management of urolithiasis in comparison with repeated surgical treatment.

  2. Cost effective use of liquid nitrogen in cryogenic wind tunnels

    NASA Technical Reports Server (NTRS)

    Mcintosh, Glen E.; Lombard, David S.; Martindale, David L.; Dunn, Robert P.

    1987-01-01

    A method of reliquefying from 12 to 19% of the nitrogen exhaust gas from a cryogenic wind tunnel has been developed. Technical feasibility and cost effectiveness of the system depends on performance of an innovative positive displacement expander which requires scale model testing to confirm design studies. The existing cryogenic system at the 0.3-m transonic cryogenic tunnel has been surveyed and extensive upgrades proposed. Upgrades are generally cost effective and may be implemented immediately since they are based on established technology.

  3. Spermicidal and contraceptive potential of desgalactotigonin: a prospective alternative of nonoxynol-9.

    PubMed

    Chakraborty, Debanjana; Maity, Arindam; Jha, Tarun; Mondal, Nirup Bikash

    2014-01-01

    Crude decoction of Chenopodium album seed showed spermicidal effect at MIC 2 mg/ml in earlier studies. Systematic isolation, characterization and evaluation revealed that the major metabolite Desgalactotigonin (DGT) is the most effective principle in both in vitro and in vivo studies. The in vitro studies comprises (a) rat and human sperm motility and immobilizing activity by Sander-Cramer assay; (b) sperm membrane integrity was observed by HOS test and electron microscopy; (c) microbial potential was examined in Lactobacillus broth culture, and (d) the hemolytic index was determined by using rat RBCs. The in vivo contraceptive efficacy was evaluated by intra uterine application of DGT in rat. Lipid peroxidation and induction of apoptosis by DGT on human spermatozoa were also studied. The minimum effective concentration (MEC) of DGT that induced instantaneous immobilization in vitro was 24.18 µM for rat and 58.03 µM for human spermatozoa. Microbial study indicated DGT to be friendly to Lactobacillus acidophilus. Implantation was prevented in DGT treated uterine horn while no hindrance occurred in the untreated contra lateral side. At the level of EC50, DGT induced apoptosis in human spermatozoa as determined by increased labeling with Annexin-V and decreased polarization of sperm mitochondria. Desgalactotigonin emerged 80 and 2×10(4) times more potent than the decoction and Nonoxynol-9 respectively. It possesses mechanism based detrimental action on both human and rat spermatozoa and spares lactobacilli and HeLa cells at MEC which proves its potential as a superior ingredient for the formulation of a contraceptive safer/compatible to vaginal microflora.

  4. Potential of chitosan from Mucor rouxxi UCP064 as alternative natural compound to inhibit Listeria monocytogenes.

    PubMed

    Bento, Roberta A; Stamford, Tânia L M; de Campos-Takaki, Galba M; Stamford, Thayza C M; de Souza, Evandro L

    2009-07-01

    Listeria monocytogenes is widely distributed in nature and the infection listeriosis is recognized as a potential threat for human health because of its mortality rate. The objective of this study was to evaluate the growth profile and chitosan production by Mucor rouxxi UCP 064 grown in yam bean (Pachyrhizus erosus L. Urban) medium. It was also to assess the anti-L. monocytogenes efficacy of the obtained chitosan. Higher values of biomass of M. rouxxi (16.9 g.L(-1)) and best yield of chitosan (62 mg.g(-1)) were found after 48 h of cultivation. Residual glucose and nitrogen in the growth media were 4.1 and 0.02 g.L(-1) after 96 h, respectively. Obtained chitosan presented 85 % of degree of deacetylation and 2.60 x 10(4) g.mol(-1) of viscosimetric molecular weight. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of chitosan against L. monocytogenes ATCC 7644 were, respectively, 2.5 and 5.0 mg.mL(-1). At 2.5 and 5.0 mg.mL(-1) chitosan caused cidal effect in a maximum time of 4 h. Bacterial count below 2 log cfu.mL(-1) were found from 2 h onwards and no recovery in bacterial growth was noted in the remainder period. These results show the biotechnological potential of yam bean medium for chitosan production by Mucor rouxxi and support the possible rational use of chitosan from fungi as natural antimicrobial to control L. monocytogenes. PMID:24031403

  5. Spermicidal and contraceptive potential of desgalactotigonin: a prospective alternative of nonoxynol-9.

    PubMed

    Chakraborty, Debanjana; Maity, Arindam; Jha, Tarun; Mondal, Nirup Bikash

    2014-01-01

    Crude decoction of Chenopodium album seed showed spermicidal effect at MIC 2 mg/ml in earlier studies. Systematic isolation, characterization and evaluation revealed that the major metabolite Desgalactotigonin (DGT) is the most effective principle in both in vitro and in vivo studies. The in vitro studies comprises (a) rat and human sperm motility and immobilizing activity by Sander-Cramer assay; (b) sperm membrane integrity was observed by HOS test and electron microscopy; (c) microbial potential was examined in Lactobacillus broth culture, and (d) the hemolytic index was determined by using rat RBCs. The in vivo contraceptive efficacy was evaluated by intra uterine application of DGT in rat. Lipid peroxidation and induction of apoptosis by DGT on human spermatozoa were also studied. The minimum effective concentration (MEC) of DGT that induced instantaneous immobilization in vitro was 24.18 µM for rat and 58.03 µM for human spermatozoa. Microbial study indicated DGT to be friendly to Lactobacillus acidophilus. Implantation was prevented in DGT treated uterine horn while no hindrance occurred in the untreated contra lateral side. At the level of EC50, DGT induced apoptosis in human spermatozoa as determined by increased labeling with Annexin-V and decreased polarization of sperm mitochondria. Desgalactotigonin emerged 80 and 2×10(4) times more potent than the decoction and Nonoxynol-9 respectively. It possesses mechanism based detrimental action on both human and rat spermatozoa and spares lactobacilli and HeLa cells at MEC which proves its potential as a superior ingredient for the formulation of a contraceptive safer/compatible to vaginal microflora. PMID:25243914

  6. Potential of chitosan from Mucor rouxxi UCP064 as alternative natural compound to inhibit Listeria monocytogenes

    PubMed Central

    Bento, Roberta A.; Stamford, Tânia L.M.; de Campos-Takaki, Galba M.; Stamford, Thayza C.M.; de Souza, Evandro L.

    2009-01-01

    Listeria monocytogenes is widely distributed in nature and the infection listeriosis is recognized as a potential threat for human health because of its mortality rate. The objective of this study was to evaluate the growth profile and chitosan production by Mucor rouxxi UCP 064 grown in yam bean (Pachyrhizus erosus L. Urban) medium. It was also to assess the anti-L. monocytogenes efficacy of the obtained chitosan. Higher values of biomass of M. rouxxi (16.9 g.L-1) and best yield of chitosan (62 mg.g-1) were found after 48 h of cultivation. Residual glucose and nitrogen in the growth media were 4.1 and 0.02 g.L-1 after 96 h, respectively. Obtained chitosan presented 85 % of degree of deacetylation and 2.60 x 104 g.mol-1 of viscosimetric molecular weight. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of chitosan against L. monocytogenes ATCC 7644 were, respectively, 2.5 and 5.0 mg.mL-1. At 2.5 and 5.0 mg.mL-1 chitosan caused cidal effect in a maximum time of 4 h. Bacterial count below 2 log cfu.mL-1 were found from 2 h onwards and no recovery in bacterial growth was noted in the remainder period. These results show the biotechnological potential of yam bean medium for chitosan production by Mucor rouxxi and support the possible rational use of chitosan from fungi as natural antimicrobial to control L. monocytogenes. PMID:24031403

  7. Spermicidal and Contraceptive Potential of Desgalactotigonin: A Prospective Alternative of Nonoxynol-9

    PubMed Central

    Chakraborty, Debanjana; Maity, Arindam; Jha, Tarun; Mondal, Nirup Bikash

    2014-01-01

    Crude decoction of Chenopodium album seed showed spermicidal effect at MIC 2 mg/ml in earlier studies. Systematic isolation, characterization and evaluation revealed that the major metabolite Desgalactotigonin (DGT) is the most effective principle in both in vitro and in vivo studies. The in vitro studies comprises (a) rat and human sperm motility and immobilizing activity by Sander-Cramer assay; (b) sperm membrane integrity was observed by HOS test and electron microscopy; (c) microbial potential was examined in Lactobacillus broth culture, and (d) the hemolytic index was determined by using rat RBCs. The in vivo contraceptive efficacy was evaluated by intra uterine application of DGT in rat. Lipid peroxidation and induction of apoptosis by DGT on human spermatozoa were also studied. The minimum effective concentration (MEC) of DGT that induced instantaneous immobilization in vitro was 24.18 µM for rat and 58.03 µM for human spermatozoa. Microbial study indicated DGT to be friendly to Lactobacillus acidophilus. Implantation was prevented in DGT treated uterine horn while no hindrance occurred in the untreated contra lateral side. At the level of EC50, DGT induced apoptosis in human spermatozoa as determined by increased labeling with Annexin-V and decreased polarization of sperm mitochondria. Desgalactotigonin emerged 80 and 2×104 times more potent than the decoction and Nonoxynol-9 respectively. It possesses mechanism based detrimental action on both human and rat spermatozoa and spares lactobacilli and HeLa cells at MEC which proves its potential as a superior ingredient for the formulation of a contraceptive safer/compatible to vaginal microflora. PMID:25243914

  8. The Potential of Solar as Alternative Energy Source for Socio-Economic Wellbeing in Rural Areas, Malaysia

    NASA Astrophysics Data System (ADS)

    Alam, Rashidah Zainal; Siwar, Chamhuri; Ludin, Norasikin Ahmad

    Malaysia's energy sector is highly dependent on fossil fuels as a primary energy source. Economic growth and socio-economic wellbeing also rely on the utilization of energy in daily life routine. Nevertheless, the increasing cost for electricity and declining fossil fuels resources causes various negative impacts to the people and environment especially in rural areas. This prompted Malaysia to shift towards alternative energy sources such as solar energy to ensure social, economic and environmental benefits. The solar energy is one of the potential renewable energy sources in tropical countries particularly in Malaysia. The paper attempts to analyze the benefits and advantages related to energy efficiency of solar for sustainable energy use and socio economic wellbeing in rural areas, Malaysia. The paper uses secondary sources of data such as policies, regulations and research reports from relevant ministries and agencies to attain the objectives. As a signatory country to the UN Convention on Climate Change and the Kyoto Protocol, Malaysia has taken initiatives for decreasing energy dependence on oil to reduce greenhouse gas emissions (GHG) for sustainable development. The paper shows solar energy becomes one of the promising alternative energy sources to alleviate energy poverty in Malaysia for rural areas. Finally, solar energy has increased socio-economic wellbeing and develops green potential and toward achieving energy efficiency in energy sector of Malaysia by preserving environment as well as reducing carbon emission.

  9. Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

    PubMed Central

    Riewpaiboon, Arthorn; Dondorp, Arjen M; von Seidlein, Lorenz; Mokuolu, Olugbenga A; Nansumba, Margaret; Gesase, Samwel; Kent, Alison; Mtove, George; Olaosebikan, Rasaq; Ngum, Wirichada Pan; Fanello, Caterina I; Hendriksen, Ilse; Day, Nicholas PJ; White, Nicholas J; Yeung, Shunmay

    2011-01-01

    Abstract Objective To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. Methods The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted. Findings The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, CI: 61.7–65.2) in the quinine arm and US$ 66.5 (95% CI: 63.7–69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively. Conclusion Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible. PMID:21734764

  10. Endogenous patient responses and the consistency principle in cost-effectiveness analysis.

    PubMed

    Liu, Liqun; Rettenmaier, Andrew J; Saving, Thomas R

    2012-01-01

    In addition to incurring direct treatment costs and generating direct health benefits that improve longevity and/or health-related quality of life, medical interventions often have further or "unrelated" financial and health impacts, raising the issue of what costs and effects should be included in calculating the cost-effectiveness ratio of an intervention. The "consistency principle" in medical cost-effectiveness analysis (CEA) requires that one include both the cost and the utility benefit of a change (in medical expenditures, consumption, or leisure) caused by an intervention or neither of them. By distinguishing between exogenous changes directly brought about by an intervention and endogenous patient responses to the exogenous changes, and within a lifetime utility maximization framework, this article addresses 2 questions related to the consistency principle: 1) how to choose among alternative internally consistent exclusion/inclusion rules, and 2) what to do with survival consumption costs and earnings. It finds that, for an endogenous change, excluding or including both the cost and the utility benefit of the change does not alter cost-effectiveness results. Further, in agreement with the consistency principle, welfare maximization implies that consumption costs and earnings during the extended life directly caused by an intervention should be included in CEA. PMID:22101019

  11. Cost effective analysis of recycled products for use in highway construction. Final report

    SciTech Connect

    Gupta, J.D.

    1998-04-01

    Over 4.5 billion of non-hazardous wastes are generated in the United States each year. Out of these wastes over 200 million tons of post consumer waste is generated. The disposal of post consumer waste is the responsibility of municipality and society. Four waste materials glass, plastic, rubber tires and paper and paperboard were selected for the detail study. A questionnaire survey was conducted for obtaining input from all state Department of Transportation (DOT) Recyclers and solid waste management facilities in the state of Ohio. Responses received from state DOT stated that they use various recycled materials in highway construction but do not conduct cost-effectiveness analysis of recycle waste materials. The cost of disposal of post consumer waste is increasing, which requires an alternate use for these waste materials. One possible use of these post consumer waste materials is in highway construction. An economic analysis is needed for their cost-effectiveness before using these materials in highway construction. Though these recycled waste materials are expensive compared to virgin material, consideration of the savings in terms of societal cost make these materials cost-effective and attractive to use in highway construction.

  12. Schizophrenia interventions in Vietnam: primary results from a cost-effectiveness study.

    PubMed

    Anh, Nguyen Quynh; Linh, Bui Ngoc; Ha, Nguyen Thu; Phanthunane, Pudtan; Huong, Nguyen Thanh

    2015-01-01

    Schizophrenia is a highly disabling mental health disorder that imposes a considerable economic burden on a health care system. This paper aimed to examine the cost and effectiveness of alternative pharmaceutical interventions and the effects of family intervention (FI) for schizophrenia from the government perspective in order to introduce the most cost-effective intervention applicable to Vietnam. A Markov model was developed to estimate costs and health outcome over patients' lifetimes when using typical and atypical antipsychotic drugs, alone or in combination with family intervention. Health outcome was measured in terms of disability-adjusted life years averted. Monte Carlo simulation was used for uncertainty analysis. According to our findings, interventions using typical or atypical drugs combined with FI were found to be the most effective and least costly compared to a 'do-nothing' scenario. Interventions using atypical drugs alone were estimated to be much less favourable due to a considerably higher cost. This is a very first attempt on cost-effectiveness analysis of interventions for schizophrenia in Vietnam, and recommendations are made for future research to determine the most cost-effective intervention.

  13. The effect of a prior investment on choice: the sunk cost effect.

    PubMed

    Magalhães, Paula; White, K Geoffrey

    2014-01-01

    We investigated the effect of prior investment on choice in pigeons, namely, the sunk cost effect, which is a tendency to continue an endeavor once a prior investment has been made, despite a better option being available. In a concurrent-chains procedure, pigeons chose between left and right keys in the choice phase leading to different work requirements in the outcome phase. Within each session, two components were signaled by red or green keys in the choice phase. Components were identical, except that in red components, the choice was preceded by a prior investment of 20 pecks on the left key, whereas in green components, the investment of 20 pecks was on the right key. Preference for the key with the prior investment was studied in a series of experiments in which we manipulated the absence or presence of the investment (Experiments 1a and 1b) and size of the investment (Experiments 2 and 3). We also investigated whether the bias observed was a result of carryover effects or of the sunk cost effect (Experiment 4). Overall, the results showed that choice was biased toward the alternative associated with the prior investment, consistent with the sunk cost effect, an effect that can be understood in terms of within-trial contrast and the delay-reduction hypothesis. PMID:24893106

  14. Cost-effectiveness of pazopanib in advanced soft tissue sarcoma in the United kingdom.

    PubMed

    Amdahl, Jordan; Manson, Stephanie C; Isbell, Robert; Chit, Ayman; Diaz, Jose; Lewis, Lily; Delea, Thomas E

    2014-01-01

    In the phase III PALETTE trial, pazopanib improved progression-free survival (PFS) compared with placebo in patients with advanced/metastatic soft tissue sarcomas (mSTS) who had received prior chemotherapy. We used a multistate model to estimate expected PFS, overall survival (OS), lifetime STS treatment costs, and quality-adjusted life-years (QALYs) for patients receiving pazopanib, placebo, trabectedin, ifosfamide, or gemcitabine plus docetaxel as second-line mSTS therapies. The cost-effectiveness of pazopanib was expressed as the incremental costs per QALY gained. Estimates of PFS/OS, adverse events, and utilities for pazopanib and placebo were from the PALETTE trial. Estimates of relative effectiveness of the other comparators were from an unadjusted indirect comparison versus pazopanib. Costs were from published sources. Pazopanib is estimated to increase QALYs by 0.128 and costs by £7,976 versus placebo; cost per QALY gained with pazopanib versus placebo is estimated to be £62,000. Compared with the other chemotherapies, pazopanib provides similar QALYs at a lower cost. Pazopanib may not be cost-effective versus placebo but may be cost-effective versus the most commonly used active treatments, although this conclusion is uncertain. Given the unmet need for effective treatments for mSTS, pazopanib may be an appropriate alternative to some currently used medications in the United Kingdom. PMID:25024640

  15. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico

    PubMed Central

    Bishai, David M.; Lőrincz, Attila; Shah, Keerti V.; Lazcano-Ponce, Eduardo; Hernández, Mauricio; Granados-García, Víctor; Pérez, Ruth; Salmerón, Jorge

    2010-01-01

    Objective To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. Methods A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. Results Screening women between the ages of 30–80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. Conclusions This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program. PMID:21170578

  16. Laparoscopic versus open colorectal resection for cancer and polyps: a cost-effectiveness study

    PubMed Central

    Jordan, Jake; Dowson, Henry; Gage, Heather; Jackson, Daniel; Rockall, Timothy

    2014-01-01

    Background Available evidence that compares outcomes from laparoscopic and open surgery for colorectal cancer shows no difference in disease free or survival time, or in health-related quality of life outcomes, but does not capture the short term benefits of laparoscopic methods in the early postoperative period. Aim To explore the cost-effectiveness of laparoscopic colorectal surgery, compared to open methods, using quality of life data gathered in the first 6 weeks after surgery. Methods Participants were recruited in 2006–2007 in a district general hospital in the south of England; those with a diagnosis of cancer or polyps were included in the analysis. Quality of life data were collected using EQ-5D, on alternate days after surgery for 4 weeks. Costs per patient, from a National Health Service perspective (in British pounds, 2006) comprised the sum of operative, hospital, and community costs. Missing data were filled using multiple imputation methods. The difference in mean quality adjusted life years and costs between surgery groups were estimated simultaneously using a multivariate regression model applied to 20 imputed datasets. The probability that laparoscopic surgery is cost-effective compared to open surgery for a given societal willingness-to-pay threshold is illustrated using a cost-effectiveness acceptability curve. Results The sample comprised 68 laparoscopic and 27 open surgery patients. At 28 days, the incremental cost per quality adjusted life year gained from laparoscopic surgery was £12,375. At a societal willingness-to-pay of £30,000, the probability that laparoscopic surgery is cost-effective, exceeds 65% (at £20,000 ≈60%). In sensitivity analyses, laparoscopic surgery remained cost-effective compared to open surgery, provided it results in a saving ≥£699 in hospital bed days and takes no more than 8 minutes longer to perform. Conclusion The study provides formal evidence of the cost-effectiveness of laparoscopic approaches and

  17. Alternative strategies: a better alternative.

    PubMed

    Doody, Dennis

    2010-05-01

    Alternatives can be defined as being any financial asset other than traditional stocks and bonds. They include marketable alternatives, private capital, and equity real estate. There are two primary reasons for investing in alternatives: the potential for greater return and the opportunity to diversify a portfolio. Although alternatives were challenged in the highly volatile environment that existed in 2008 and early 2009, they generally lived up to expectations.

  18. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    PubMed Central

    Hutubessy, Raymond; Chisholm, Dan; Edejer, Tessa Tan-Torres

    2003-01-01

    Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs) or the coverage, efficacy and adherence rates of interventions (effectiveness). The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor. PMID:14687420

  19. Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong – A decision analysis

    PubMed Central

    You, Joyce H S; Ming, Wai-Kit; Chan, Paul K S

    2015-01-01

    Trivalent influenza vaccine (TIV) selects one of the 2 co-circulating influenza B lineages whereas quadrivalent influenza vaccine (QIV) includes both lineages. We examined potential cost-effectiveness of QIV versus TIV from perspectives of healthcare provider and society of Hong Kong. A decision tree was designed to simulate the outcomes of QIV vs. TIV in 6 age groups: 0–4 years, 5–9 years, 10–14 years, 15–64 years, 65–79 y and ≥80 years. Direct cost alone, direct and indirect costs, and quality-adjusted life-years (QALYs) loss due to TIV-unmatched influenza B infection were simulated for each study arm. Outcome measure was incremental cost per QALY (ICER). In base-case analysis, QIV was more effective than TIV in all-age population with additional direct cost per QALY (ICER-direct cost) and additional total cost per QALY (ICER-total cost) of USD 22,603 and USD 12,558, respectively. Age-stratified analysis showed that QIV was cost-effective in age groups 6 months to 9 y and ≥80 years from provider's perspective, and it was cost-effective in all age group except 15–64 y from societal perspective. Percentage of TIV-unmatched influenza B in circulation and additional vaccine cost of QIV were key influential factors. From perspectives of healthcare provider and society, QIV was the preferred option in 52.77% and 66.94% of 10,000 Monte Carlo simulations, respectively. QIV appears to be cost-effective in Hong Kong population, except for age group 15–64 years, from societal perspective. From healthcare provider's perspective, QIV seems to be cost-effective in very young (6 months-9 years) and older (≥80 years) age groups. PMID:25714506

  20. Analysis of Potential Alternatives to Reduce NASA's Cost of Human Access to Space

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The purpose of this report is to analyze NASA's potential options for significantly reducing the cost of human access to space. The opinions expressed in this report are based on Hawthorne, Krauss & Associates' ("HKA") interaction with NASA and several of its key contractors over the past nine months. This report is not intended to be an exhaustive quantitative analysis of the various options available to NASA. Instead, its purpose is to outline key decision-related issues that the agency should consider prior to making a decision as to which option to pursue. This report attempts to bring a private-sector perspective to bear on the issue of reducing the cost of human access to space. HKA believes that the key to the NASA's success in reducing those costs over the long-term is the involvement of the private-sector incentives and disciplines--which is achieved only through the assumption of risk by the private sector, not through a traditional contractor relationship--is essential to achieve significant long-term cost reductions.

  1. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    PubMed

    Obolski, Uri; Hadany, Lilach; Abelson, Avigdor

    2016-01-01

    Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world's reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR) should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery-a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs. PMID:26966666

  2. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    PubMed Central

    Obolski, Uri; Hadany, Lilach

    2016-01-01

    Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world’s reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR) should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery—a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs. PMID:26966666

  3. Mosquito habitat and dengue risk potential in Kenya: alternative methods to traditional risk mapping techniques.

    PubMed

    Attaway, David F; Jacobsen, Kathryn H; Falconer, Allan; Manca, Germana; Rosenshein Bennett, Lauren; Waters, Nigel M

    2014-11-01

    Outbreaks, epidemics and endemic conditions make dengue a disease that has emerged as a major threat in tropical and sub-tropical countries over the past 30 years. Dengue fever creates a growing burden for public health systems and has the potential to affect over 40% of the world population. The problem being investigated is to identify the highest and lowest areas of dengue risk. This paper presents "Similarity Search", a geospatial analysis aimed at identifying these locations within Kenya. Similarity Search develops a risk map by combining environmental susceptibility analysis and geographical information systems, and then compares areas with dengue prevalence to all other locations. Kenya has had outbreaks of dengue during the past 3 years, and we identified areas with the highest susceptibility to dengue infection using bioclimatic variables, elevation and mosquito habitat as input to the model. Comparison of the modelled risk map with the reported dengue epidemic cases obtained from the open source reporting ProMED and Government news reports from 1982-2013 confirmed the high-risk locations that were used as the Similarity Search presence cells. Developing the risk model based upon the bioclimatic variables, elevation and mosquito habitat increased the efficiency and effectiveness of the dengue fever risk mapping process.

  4. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    PubMed

    Obolski, Uri; Hadany, Lilach; Abelson, Avigdor

    2016-01-01

    Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world's reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR) should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery-a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs.

  5. Cost-Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, P.; Parker, D.

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous U.S. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are as follows: to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  6. Alcohol drinking and mammary cancer: Pathogenesis and potential dietary preventive alternatives

    PubMed Central

    Castro, Gerardo Daniel; Castro, José A

    2014-01-01

    Alcohol consumption is associated with an increased risk of breast cancer, increasing linearly even with a moderate consumption and irrespectively of the type of alcoholic beverage. It shows no dependency from other risk factors like menopausal status, oral contraceptives, hormone replacement therapy, or genetic history of breast cancer. The precise mechanism for the effect of drinking alcohol in mammary cancer promotion is still far from being established. Studies by our laboratory suggest that acetaldehyde produced in situ and accumulated in mammary tissue because of poor detoxicating mechanisms might play a role in mutational and promotional events. Additional studies indicated the production of reactive oxygen species accompanied of decreases in vitamin E and GSH contents and of glutathione transferase activity. The resulting oxidative stress might also play a relevant role in several stages of the carcinogenic process. There are reported in literature studies showing that plasmatic levels of estrogens significantly increased after alcohol drinking and that the breast cancer risk is higher in receptor ER-positive individuals. Estrogens are known that they may produce breast cancer by actions on ER and also as chemical carcinogens, as a consequence of their oxidation leading to reactive metabolites. In this review we introduce our working hypothesis integrating the acetaldehyde and the oxidative stress effects with those involving increased estrogen levels. We also analyze potential preventive actions that might be accessible. There remains the fact that alcohol drinking is just one of the avoidable causes of breast cancer and that, at present, the suggested acceptable dose for prevention of this risk is of one drink per day. PMID:25300769

  7. Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays.

    PubMed

    Damm, Douglas D; Jones, David M

    2013-08-01

    In 2011, the American Dental Association Council on Scientific Affairs released an update by their expert panel on managing the care of patients receiving antiresorptive therapy for the prevention and treatment of osteoporosis. In this report, the panel found no study results that confirmed the effectiveness of drug holidays to prevent antiresorptive agent-induced osteonecrosis of the jaws without increasing the risks of low bone mass. The purpose of this article is to provide suggestions for a pattern of patient care for individuals who desire or require an invasive surgical procedure of the jaws, but who also have a skeleton that is at risk for osteoporotic fracture. The authors reviewed pertinent literature related to basic bone histology, the pharmacokinetics of the aminobisphosphonates (nBP), diagnostic criteria for osteopenia/osteoporosis, and clinical applications of the antiresorptive agents. The skeletal system demonstrates a mixture of resting surfaces (osteocytes, 85%), resorbing surfaces (osteoclasts, 2%), and forming surfaces (osteoblasts, 10%-12%). Deposition of nBP is not uniform, and is highly concentrated in areas of bone remodeling. A full understanding of bone remodeling and the pharmacokinetics of nBP allow for the modification of the antiresorptive therapy and the timing of the oral surgical procedure in a manner that minimizes the prevalence of osteonecrosis while at the same time continuing to protect the patient's skeleton from osteoporotic fracture. The lack of support for drug holidays by the ADA's expert panel is strongly consistent with the science behind bone remodeling and nBP pharmacokinetics. In spite of this, creative interdisciplinary patient care has the potential to dramatically reduce the prevalence of bisphosphonate-related osteonecrosis (BRON), while at the same time continuing to protect the skeleton of the osteoporotic patient. Creative interdisciplinary patient care may prove to be an effective intervention to reduce the

  8. Alcohol drinking and mammary cancer: Pathogenesis and potential dietary preventive alternatives.

    PubMed

    Castro, Gerardo Daniel; Castro, José A

    2014-10-10

    Alcohol consumption is associated with an increased risk of breast cancer, increasing linearly even with a moderate consumption and irrespectively of the type of alcoholic beverage. It shows no dependency from other risk factors like menopausal status, oral contraceptives, hormone replacement therapy, or genetic history of breast cancer. The precise mechanism for the effect of drinking alcohol in mammary cancer promotion is still far from being established. Studies by our laboratory suggest that acetaldehyde produced in situ and accumulated in mammary tissue because of poor detoxicating mechanisms might play a role in mutational and promotional events. Additional studies indicated the production of reactive oxygen species accompanied of decreases in vitamin E and GSH contents and of glutathione transferase activity. The resulting oxidative stress might also play a relevant role in several stages of the carcinogenic process. There are reported in literature studies showing that plasmatic levels of estrogens significantly increased after alcohol drinking and that the breast cancer risk is higher in receptor ER-positive individuals. Estrogens are known that they may produce breast cancer by actions on ER and also as chemical carcinogens, as a consequence of their oxidation leading to reactive metabolites. In this review we introduce our working hypothesis integrating the acetaldehyde and the oxidative stress effects with those involving increased estrogen levels. We also analyze potential preventive actions that might be accessible. There remains the fact that alcohol drinking is just one of the avoidable causes of breast cancer and that, at present, the suggested acceptable dose for prevention of this risk is of one drink per day.

  9. Economic savings versus health losses: The cost-effectiveness of generic antiretroviral therapy in the United States

    PubMed Central

    Walensky, Rochelle P.; Sax, Paul E.; Nakamura, Yoriko M.; Weinstein, Milton C.; Pei, Pamela P.; Freedberg, Kenneth A.; Paltiel, A. David; Schackman, Bruce R.

    2013-01-01

    Background US HIV treatment guidelines recommend branded once-daily, one-pill efavirenz/emtricitabine/tenofovir as preferred first-line antiretroviral treatment (ART). With the anticipated approval of generic efavirenz in 2012 in the US, the cost of a once-daily, three-pill alternative (generic efavirenz, generic lamivudine, tenofovir) will decrease, but adherence and virologic suppression may be reduced. Objectives To assess the clinical impact, costs, and cost-effectiveness of the generic-based three-pill regimen compared to the branded, co-formulated regimen. To project the potential national savings in the first year of a switch to generic-based ART. Design Mathematical simulation of HIV disease. Data Sources Published data from US clinical trials and observational cohorts. Target Population HIV-infected patients eligible to start on or switch to an efavirenz-based generic ART regimen. Time Horizon Lifetime, One-year Perspective US health system Interventions No ART (for comparison), Three-pill Generic ART, and Branded ART Outcome Measures Quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICER, $/quality-adjusted life expectancy [QALY]). Results of Base-Case Analysis Compared to No ART, Generic ART has an ICER of $21,100/QALY. Compared to Generic ART, Branded ART increases lifetime costs by $42,500, and per-person survival gains by 0.37 QALYs, for an ICER of $114,800/QALY. Estimated first-year savings, if all eligible US patients start on or switch to Generic ART, are $920 million. Results of Sensitivity Analysis Most plausible assumptions about Generic ART efficacy and costs lead to Branded ART ICERs >$100,000/QALY. Limitations The efficacy and price reduction associated with generics are unknown; estimates are intended to be conservative. Conclusions Compared to a slightly less effective generic-based regimen, the cost-effectiveness of first-line Branded ART exceeds $100,000/QALY. Generic-based ART in the US could yield

  10. Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients

    PubMed Central

    Miquel-Cases, Anna; Retèl, Valesca P.; Lederer, Bianca; von Minckwitz, Gunter; Steuten, Lotte M. G.; van Harten, Wim H.

    2016-01-01

    Purpose Guiding response to neoadjuvant chemotherapy (guided-NACT) allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial). Materials and Methods As effectiveness was shown in hormone-receptor positive (HR+) early breast cancers (EBC), our decision model compared the health-economic outcomes of treating a cohort of such women with guided-NACT to conventional-NACT using clinical input data from the GeparTrio trial. The expected cost-effectiveness and the uncertainty around this estimate were estimated via probabilistic cost-effectiveness analysis (CEA), from a Dutch societal perspective over a 5-year time-horizon. Results Our exploratory CEA predicted that guided-NACT as proposed by the GeparTrio, costs additional €110, but results in 0.014 QALYs gained per patient. This scenario of guided-NACT was considered cost-effective at any willingness to pay per additional QALY. At the prevailing Dutch willingness to pay threshold (€80.000/QALY) cost-effectiveness was expected with 78% certainty. Conclusion This exploratory CEA indicated that guided-NACT (as proposed by the GeparTrio trial) is likely cost-effective in treating HR+ EBC women. While prospective validation of the GeparTrio findings is advisable from a clinical perspective, early CEAs can be used to prioritize further research from a broader health economic perspective, by identifying which parameters contribute most to current decision uncertainty. Furthermore, their use can be extended to explore the expected cost-effectiveness of alternative guided-NACT scenarios that combine the use of promising imaging techniques together with personalized treatments. PMID:27124410

  11. Decision-making using absolute cardiovascular risk reduction and incremental cost-effectiveness ratios: a case study

    PubMed Central

    Ker, J A; Oosthuizen, H; Rheeder, P

    2008-01-01

    Summary Background Many clinical guidelines have adopted a multifactorial cardiovascular risk assessment to identify high-risk individuals for treatment. The Framingham risk chart is a widely used risk engine to calculate the absolute cardiovascular risk of an individual. Cost-effective analyses are typically used to evaluate therapeutic strategies, but it is more problematic for a clinician when faced with alternative therapeutic strategies to calculate cost effectiveness. Aim We used a single simulated-patient model to explore the effect of different drug treatments on the calculated absolute cardiovascular risk. Methods The Framingham risk score was calculated on a hypothetical patient, and drug treatment was initiated. After every drug introduced, the score was recalculated. Single-exit pricing of the various drugs in South Africa was used to calculate the cost of reducing predicted cardiovascular risk. Results The cost-effective ratio of an antihypertensive treatment strategy was calculated to be R21.35 per percentage of risk reduction. That of a statin treatment strategy was R22.93 per percentage of risk reduction. Using a high-dose statin, the cost-effective ratio was R12.81 per percentage of risk reduction. Combining the antihypertensive and statin strategy demonstrated a cost-effective ratio of R23.84 per percentage of risk reduction. A combination of several drugs enabled the hypothetical patient to reduce the risk to 14% at a cost-effective ratio of R17.18 per percentage of risk reduction. Conclusion This model demonstrates a method to compare different therapeutic strategies to reduce cardiovascular risk with their cost-effective ratios. PMID:18516355

  12. Cost effectiveness studies of environmental technologies: Volume 1

    SciTech Connect

    Silva, E.M.; Booth, S.R.

    1994-02-01

    This paper examines cost effectiveness studies of environmental technologies including the following: (1) In Situ Air Stripping, (2) Surface Towed Ordinance Locator System, (3) Ditch Witch Horizontal Boring Technology, (4) Direct Sampling Ion Trap Mass Spectrometer, (5) In Situ Vitrification, (6) Site Characterization and Analysis Penetrometer System, (7) In Situ Bioremediation, and (8) SEAMIST Membrane System Technology.

  13. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    ERIC Educational Resources Information Center

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  14. Neural mechanisms and personality correlates of the sunk cost effect.

    PubMed

    Fujino, Junya; Fujimoto, Shinsuke; Kodaka, Fumitoshi; Camerer, Colin F; Kawada, Ryosaku; Tsurumi, Kosuke; Tei, Shisei; Isobe, Masanori; Miyata, Jun; Sugihara, Genichi; Yamada, Makiko; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2016-01-01

    The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect. PMID:27611212

  15. [Cost-effectiveness analysis of professional oral hygiene].

    PubMed

    Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E

    2014-01-01

    Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.

  16. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Cost-effectiveness. 457.1015 Section 457.1015 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

  17. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

  18. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  19. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this...) Federal agencies performing LCC analysis on computers shall use either the Federal Buildings Life Cycle... building energy or water system with an energy or water conservation measure by retrofit to an...

  20. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this...) Federal agencies performing LCC analysis on computers shall use either the Federal Buildings Life Cycle... building energy or water system with an energy or water conservation measure by retrofit to an...

  1. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  2. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Presuming cost-effectiveness results. 436.13 Section 436.13 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS... the investment and other costs for an energy or water conservation measure considered for retrofit...

  3. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Presuming cost-effectiveness results. 436.13 Section 436.13 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS... the investment and other costs for an energy or water conservation measure considered for retrofit...

  4. Research Report: Cost-Effectiveness of Curriculum Revision.

    ERIC Educational Resources Information Center

    Mulder, M.; And Others

    1991-01-01

    Evaluation of the cost effectiveness of a revised curriculum using computer-based training (CBT) in the Dutch postal service found cost savings and satisfactory training results, implying that CBT is an effective strategy for complex work organizations training considerable numbers of employees. (SK)

  5. Cost-Effectiveness of Case Management in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Saleh, Shadi S.; Vaughn, Thomas; Levey, Samuel; Fuortes, Laurence; Uden-Holmen, Tanya; Hall, James A.

    2006-01-01

    Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management…

  6. The Political Arithmetic of Cost-Effectiveness Analysis.

    ERIC Educational Resources Information Center

    Levin, Henry M.; And Others

    1986-01-01

    Responding to a critique of their earlier article, authors Levin and Meister, joined by Glass, attempt to clarify some of the issues and to correct implicit misunderstandings in the critique, while detailing the application of cost-effectiveness to educational interventions. Twenty footnotes are appended. (IW)

  7. Systems Analysis for Program Planning and Cost Effectiveness. (An Application).

    ERIC Educational Resources Information Center

    van Gigch, John P.; Hill, Richard E.

    This paper describes an effort to implement a cost-effectiveness program using systems analysis in an elementary school district, the Rio Linda Union School District in California. The systems design cycle employed has three phases, policy-making evaluation, and action-implementation. During the first phase, the general philosophy or mission of…

  8. Cost-effectiveness of hysteroscopy screening for infertile women.

    PubMed

    Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M

    2013-06-01

    This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed.

  9. A Cost Effectiveness Model for Comparing Various Circulation Systems

    ERIC Educational Resources Information Center

    Burgess, Thomas K.

    1973-01-01

    Two models for circulation systems (manual and automated) costing are presented. Validation tests for the model assumptions are devised and explained. Use of the models for cost effectiveness comparison and for cost prediction are discussed and examples are given showing their application. (10 references) (Author/SJ)

  10. Cost-effectiveness of Anterior Implants versus Fixed Dental Prostheses

    PubMed Central

    Zitzmann, N.U.; Krastl, G.; Weiger, R.; Kühl, S.; Sendi, P.

    2013-01-01

    For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient’s perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs. PMID:24158338

  11. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... pursuant to § 455.20(u)(3). (2) The simple payback period of each renewable resource energy conservation... 10 Energy 3 2012-01-01 2012-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED...

  12. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... pursuant to § 455.20(u)(3). (2) The simple payback period of each renewable resource energy conservation... 10 Energy 3 2014-01-01 2014-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED...

  13. Cost-Effectiveness of Evaluating the New Technologies.

    ERIC Educational Resources Information Center

    Kastner, Theodore A.

    1997-01-01

    This commentary on a study comparing use of the brand name drug Depakene with generic valproic acid to control seizures in people with mental retardation focuses on issues of cost-effectiveness. It notes existing guidelines for pharmacoeconomic evaluation and suggests a possible model to include a threshold price (per quality-adjusted life year)…

  14. Neural mechanisms and personality correlates of the sunk cost effect

    PubMed Central

    Fujino, Junya; Fujimoto, Shinsuke; Kodaka, Fumitoshi; Camerer, Colin F.; Kawada, Ryosaku; Tsurumi, Kosuke; Tei, Shisei; Isobe, Masanori; Miyata, Jun; Sugihara, Genichi; Yamada, Makiko; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2016-01-01

    The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect. PMID:27611212

  15. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2014-01-01 2014-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  16. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2012-01-01 2012-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  17. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this...) Federal agencies performing LCC analysis on computers shall use either the Federal Buildings Life Cycle...-effective if— (1) Life cycle costs, as described by § 436.19, are estimated to be lower; or (2) Net...

  18. Energy Submetering: The Key to Cost-Effective Conservation.

    ERIC Educational Resources Information Center

    Turner, W. D.; McBride, John R.

    1999-01-01

    Examines the monitoring results from two large-scale metering and energy information projects: Texas LoanSTAR Program; and the Texas A & M Campus Project. Data suggest implementing an energy metering system is cost effective, particularly if the system can be coupled with skilled engineering applications such as energy cost allocation and building…

  19. The Cost Effectiveness of Hepatitis Immunization for US College Students

    ERIC Educational Resources Information Center

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  20. A Cost-Effectiveness Analysis of Early Literacy Interventions

    ERIC Educational Resources Information Center

    Simon, Jessica

    2011-01-01

    Success in early literacy activities is associated with improved educational outcomes, including reduced dropout risk, in-grade retention, and special education referrals. When considering programs that will work for a particular school and context; cost-effectiveness analysis may provide useful information for decision makers. The study…

  1. Cost-Effective School Alarm Systems. Security Topics Series.

    ERIC Educational Resources Information Center

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  2. Cost-effectiveness of anterior implants versus fixed dental prostheses.

    PubMed

    Zitzmann, N U; Krastl, G; Weiger, R; Kühl, S; Sendi, P

    2013-12-01

    For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient's perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.

  3. Cost-effectiveness analysis and insurance coverage: solving a puzzle.

    PubMed

    Pauly, Mark

    2015-05-01

    The conventional model for the use of cost-effectiveness analysis for health programs involves determining whether the cost per unit of effectiveness of the program is lower than some socially determined maximum acceptable cost per unit of effectiveness. If a program is better by this criterion, the policy implication is that it should be implemented by full coverage of its cost by insurance; if not, the program should not be implemented. This paper examines the unanswered question of how cost-effectiveness analysis should be performed and interpreted when insurance coverage may involve cost sharing. It explores the question of how cost sharing should be related to the magnitude of a cost-effectiveness ratio. A common view that cost sharing should vary inversely with program cost-effectiveness is shown to be incorrect. A key issue in correct analysis is whether there is heterogeneity in marginal effectiveness of care that cannot be perceived by the social planner but is known by the demander. It is possible that some programs that would fail the social efficiency test at full coverage will be acceptable with positive cost sharing. Combining individual and social preferences affects both the choice of programs and the extent of cost sharing.

  4. Flipping the Calculus Classroom: A Cost-Effective Approach

    ERIC Educational Resources Information Center

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  5. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    ERIC Educational Resources Information Center

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  6. Cost-Effectiveness Affirmative Reading Skills Program, 1984-85.

    ERIC Educational Resources Information Center

    Gallagher, Michael P.

    The 1984-85 cost-effects study represents the third annual analysis of the components of Cleveland's Affirmative Reading Skills Plan, which offers three instructional strands--developmental (regular reading/language arts), support (additional enrichment, corrective or remedial), and compensatory (instruction for students having reading scores in…

  7. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    SciTech Connect

    Gropp, William Douglas

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  8. Cost-effectiveness of a worksite hypertension treatment program.

    PubMed

    Logan, A G; Milne, B J; Achber, C; Campbell, W P; Haynes, R B

    1981-01-01

    The cost-effectiveness of treating hypertension at the patient's place of work was compared in a randomized controlled trial with care delivered in a community. The average total cost per patient for worksite care in this 12-month study was not significantly different from that for regular care ($242.86 +/- 6.94 vs $211.34 +/- 18.66, mean +/- SEM). The worksite health system cost was significantly more expensive ($197.36 +/- 4.99 vs $129.33 +/- 13.34, p less than 0.001) but the patient cost was significantly less ($45.40 +/- 3.23 vs $82.00 +/- 6.20, p less than 0.01). The mean reduction in diastolic blood pressure (BP) at the year-end assessment was significantly greater in the worksite group (12.1 +/- 0.6 vs 6.5 +/- 0.6 mm Hg, p less than 0.001). The incremental cost-effectiveness ratio of $5.63 per mm Hg for worksite care was less than the base cost-effectiveness ratio of $32.51 per mm Hg for regular care, indicating that the worksite program was substantially more cost-effective. Our findings support health policies that favor allocating resources to work-based hypertension treatment programs for the target group identified in this study. PMID:6783519

  9. Potential control of human immunodeficiency virus type 1 asp expression by alternative splicing in the upstream untranslated region.

    PubMed

    Barbagallo, Michael S; Birch, Katherine E; Deacon, Nicholas J; Mosse, Jennifer A

    2012-07-01

    The negative-sense asp open reading frame (ORF) positioned opposite to the human immunodeficiency virus type 1 (HIV-1) env gene encodes the 189 amino acid, membrane-associated ASP protein. Negative-sense transcription, regulated by long terminal repeat sequences, has been observed early in HIV-1 infection in vitro. All subtypes of HIV-1 were scanned to detect the negative-sense asp ORF and to identify potential regulatory sequences. A series of highly conserved upstream short open reading frames (sORFs) was identified. This potential control region from HIV-1(NL4-3), containing six sORFs, was cloned upstream of the reporter gene EGFP. Expression by transfection of HEK293 cells indicated that the introduction of this sORF region inhibits EGFP reporter expression; analysis of transcripts revealed no significant changes in levels of EGFP mRNA. Reverse transcriptase-polymerase chain reaction analysis (RT-PCR) further demonstrated that the upstream sORF region undergoes alternative splicing in vitro. The most abundant product is spliced to remove sORFs I to V, leaving only the in-frame sORF VI upstream of asp. Sequence analysis revealed the presence of typical splice donor- and acceptor-site motifs. Mutation of the highly conserved splice donor and acceptor sites modulates, but does not fully relieve, inhibition of EGFP production. The strong conservation of asp and its sORFs across all HIV-1 subtypes suggests that the asp gene product may have a role in the pathogenesis of HIV-1. Alternative splicing of the upstream sORF region provides a potential mechanism for controlling expression of the asp gene.

  10. Medicaid: Determining Cost-Effectiveness of Home and Community-Based Services. Report to the Administrator, Health Care Financing Administration, Department of Health and Human Services.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    To examine alternatives to nursing home care, states have been testing home and community-based services under the Medicaid program. Information on the operations of the state projects will be vital to designing cost-effective alternative services in the future. The General Accounting Office (GAO) reviewed state reports to see if accurate,…

  11. Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina.

    PubMed

    Giorgi, Mariano Anibal; Caroli, Christian; Giglio, Norberto Damian; Micone, Paula; Aiello, Eleonora; Vulcano, Cristina; Blanco, Julia; Donato, Bonnie; Quevedo, Joaquin Mould

    2015-12-01

    Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina.

  12. Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina.

    PubMed

    Giorgi, Mariano Anibal; Caroli, Christian; Giglio, Norberto Damian; Micone, Paula; Aiello, Eleonora; Vulcano, Cristina; Blanco, Julia; Donato, Bonnie; Quevedo, Joaquin Mould

    2015-12-01

    Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina. PMID:26112219

  13. Cost effectiveness analysis of larval therapy for leg ulcers

    PubMed Central

    Iglesias, Cynthia P; Bland, J Martin; Cullum, Nicky; Dumville, Jo C; Nelson, E Andrea; Torgerson, David J; Worthy, Gill

    2009-01-01

    Objective To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers. Design Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation. Population Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue. Interventions Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel. Main outcome measure The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis). Results The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, £96.70 (€109.61; $140.57) more per participant per year (95% confidence interval −£491.9 to £685.8) than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval −0.95 to 31.91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval −0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at £8826 per QALY gained and £40 per ulcer-free day. Considerable uncertainty surrounds the outcome estimates. Conclusions Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692. PMID:19304578

  14. The Cost-Effectiveness Analysis of Teleglaucoma Screening Device.

    PubMed

    Thomas, Sera; Hodge, William; Malvankar-Mehta, Monali

    2015-01-01

    Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective

  15. Cost-effectiveness of universal and platelet reactivity assay-driven antiplatelet therapy in acute coronary syndrome.

    PubMed

    Coleman, Craig I; Limone, Brendan L

    2013-08-01

    cost-effectiveness ratio <$50,000/quality-adjusted life-year in 26% and 4% of iterations compared with their respective PRA-driven regimens. The results were most sensitive to differences in agent costs and drug-specific relative risks of death. In conclusion, even with generic clopidogrel, PRA-driven selection of antiplatelet therapy appeared to be a cost-effective strategy with the potential to decrease the overall acute coronary syndrome-associated healthcare costs.

  16. Alternative Energy Saving Technology Analysis Report for Richland High School Renovation Project

    SciTech Connect

    Liu, Bing

    2004-08-09

    On July 8, 2004, L&S Engineering, Inc. submitted a technical assistance request to Pacific Northwest National Laboratory (PNNL) to help estimate the potential energy savings and cost effectiveness of the solar energy and daylighting design alternatives for Richland High School Renovation Project in Richland, WA. L&S Engineering expected PNNL to evaluate the potential energy savings and energy cost savings, the probable installation costs, incentives or grants to reduce the installed costs and simple payback for the following alternative measures: (1) Daylighting in New Gym; (2) Solar Photovoltaics; (3) Solar Domestic Hot Water Pre-Heat; and (4) Solar Outside Air Pre-Heat Following are the findings of the energy savings and cost-effectiveness analysis of above alternative energy saving technologies.

  17. PERSONAL COMPUTER MONITORS: A SCREENING EVALUATION OF VOLATILE ORGANIC EMISSIONS FROM EXISTING PRINTED CIRCUIT BOARD LAMINATES AND POTENTIAL POLLUTION PREVENTION ALTERNATIVES

    EPA Science Inventory

    The report gives results of a screening evaluation of volatile organic emissions from printed circuit board laminates and potential pollution prevention alternatives. In the evaluation, printed circuit board laminates, without circuitry, commonly found in personal computer (PC) m...

  18. Energy potential and alternative usages of biogas and sludge from UASB reactors: case study of the Laboreaux wastewater treatment plant.

    PubMed

    Rosa, A P; Conesa, J A; Fullana, A; Melo, G C B; Borges, J M; Chernicharo, C A L

    2016-01-01

    This work assessed the energy potential and alternative usages of biogas and sludge generated in upflow anaerobic sludge blanket reactors at the Laboreaux sewage treatment plant (STP), Brazil. Two scenarios were considered: (i) priority use of biogas for the thermal drying of dehydrated sludge and the use of the excess biogas for electricity generation in an ICE (internal combustion engine); and (ii) priority use of biogas for electricity generation and the use of the heat of the engine exhaust gases for the thermal drying of the sludge. Scenario 1 showed that the electricity generated is able to supply 22.2% of the STP power demand, but the thermal drying process enables a greater reduction or even elimination of the final volume of sludge to be disposed. In Scenario 2, the electricity generated is able to supply 57.6% of the STP power demand; however, the heat in the exhaust gases is not enough to dry the total amount of dehydrated sludge.

  19. Cost-effectiveness of Chagas disease interventions in latin america and the Caribbean: Markov models.

    PubMed

    Wilson, Leslie S; Strosberg, Arthur M; Barrio, Kimberly

    2005-11-01

    Chagas disease is a parasitic disease in Latin America. Despite vector control programs that have reduced incidence by 70%, there are at least 12-14 million prevalent cases. We used a Markov model to examine strategies for control and treatment of Chagas disease that compared annual costs, life expectancies, and cost-effectiveness of three vector control and drug treatment strategies. Vector control programs alone and vector control plus drug treatment are dominant over no vector control (i.e., less costly and save more lives), and vector control plus drug is highly cost-effective compared with vector control alone. We demonstrated expected changes in deaths over time resulting from various prevention approaches. Vector control affects primarily incidence, not decreasing deaths and prevalence for 30 years, while drug treatment affects prevalence and deaths immediately. The best strategy to combat Chagas disease is combinations of vector control and a potential new drug.

  20. A Cost-Effective Virtual Environment for Simulating and Training Powered Wheelchairs Manoeuvres.

    PubMed

    Headleand, Christopher J; Day, Thomas; Pop, Serban R; Ritsos, Panagiotis D; John, Nigel W

    2016-01-01

    Control of a powered wheelchair is often not intuitive, making training of new users a challenging and sometimes hazardous task. Collisions, due to a lack of experience can result in injury for the user and other individuals. By conducting training activities in virtual reality (VR), we can potentially improve driving skills whilst avoiding the risks inherent to the real world. However, until recently VR technology has been expensive and limited the commercial feasibility of a general training solution. We describe Wheelchair-Rift, a cost effective prototype simulator that makes use of the Oculus Rift head mounted display and the Leap Motion hand tracking device. It has been assessed for face validity by a panel of experts from a local Posture and Mobility Service. Initial results augur well for our cost-effective training solution. PMID:27046566

  1. Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina

    PubMed Central

    Vazquez-Prokopec, Gonzalo M.; Spillmann, Cynthia; Zaidenberg, Mario; Kitron, Uriel; Gürtler, Ricardo E.

    2009-01-01

    Background Control and prevention of Chagas disease rely mostly on residual spraying of insecticides. In Argentina, vector control shifted from a vertical to a fully horizontal strategy based on community participation between 1992 and 2004. The effects of such strategy on Triatoma infestans, the main domestic vector, and on disease transmission have not been assessed. Methods and Findings Based on retrospective (1993–2004) records from the Argentinean Ministry of Health for the Moreno Department, Northwestern Argentina, we performed a cost-effectiveness (CE) analysis and compared the observed CE of the fully horizontal vector control strategy with the expected CE for a vertical or a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy. Total direct costs (in 2004 US$) of the horizontal and mixed strategies were, respectively, 3.3 and 1.7 times lower than the costs of the vertical strategy, due to reductions in personnel costs. The estimated CE ratios for the vertical, mixed and horizontal strategies were US$132, US$82 and US$45 per averted human case, respectively. When per diems were excluded from the costs (i.e., simulating the decentralization of control activities), the CE of vertical, mixed and horizontal strategies was reduced to US$60, US$42 and US$32 per averted case, respectively. Conclusions and Significance The mixed strategy would have averted between 1.6 and 4.0 times more human cases than the fully horizontal strategy, and would have been the most cost-effective option to interrupt parasite transmission in the Department. In rural and dispersed areas where waning vertical vector programs cannot accomplish full insecticide coverage, alternative strategies need to be developed. If properly implemented, community participation represents not only the most appealing but also the most cost-effective alternative to accomplish such objectives. PMID:19156190

  2. Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness

    PubMed Central

    Regenbogen, Scott E; Greenberg, Caprice C; Resch, Stephen C; Kollengode, Anantha; Cima, Robert R; Zinner, Michael J; Gawande, Atul A

    2009-01-01

    Background New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost-effectiveness are unknown. We developed an empirically-calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective X-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. Methods Key model parameters were obtained from field observations during a randomized-controlled BCS trial (N=298), an observational study of RSS (N=191,168), and clinical experience with BCS (N~60,000). Since no comparable data exist for RF, we modeled its performance under two alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision-maker’s perspective. Results Standard counting detects 82% of RSS. Bar-coding prevents at least 97.5% for an additional $95,000 per RSS averted. If RF is as effective as bar-coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal X-ray and selective X-ray for high-risk operations are more costly, but less effective than BCS—$1.1–1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost. Conclusions Using currently available data, this analysis provides a useful model for comparing the relative cost-effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution will depend on its priorities: ease-of-use, cost-reduction or ensuring RSS are truly “never-events”. Given medical and liability costs exceeding $200,000 per incident, novel technologies can substantially reduce the incidence of RSS, at acceptable cost. PMID:19375612

  3. Biogeologic Carbon Sequestration - a Cost-Effective Proposal

    NASA Astrophysics Data System (ADS)

    Shaw, G. H.; Kuhns, R.

    2009-05-01

    Carbon sequestration has been proposed as a strategy for reducing the impact of carbon dioxide emissions from burning of fossil fuels. There are two main routes: 1) capture CO2 emissions from power plants or other large point sources followed by some form of "burial/sequestration", and 2) extraction of CO2 from the ambient atmosphere (involving substantial concentration relative to atmospheric levels) also followed by burial/sequestration. In either case the goal is to achieve significant long-term isolation of CO2 at an economically sustainable price, perhaps measured by some "market price" for CO2, such as the European carbon futures market, where the price is now (2/3/09) about 14-15/tonne of CO2. The second approach, removal of CO2 from the atmosphere, has the potential benefit of reversing the previous buildup of atmospheric CO2, and perhaps even providing a means to "adjust" terrestrial climate by regulating atmospheric CO2 concentrations. For the present, ideas of planetary "geo-engineering" are not as popular as reducing the impact of continued CO2 emissions. In fact, the energy and capital costs of extraction from a dilute atmosphere appear to make this approach uneconomical. Proposals to fertilize the open ocean suffer from concerns about long term ecosystem effects, to say nothing of a lack of verifiability. There is, however, an approach using biological systems that can not only extract significant amounts of CO2, but can do so cost-effectively. Lakes are known in which primary productivity approaches or exceeds 1gm C/cm2-yr. This equates to removal of 35,000 tonnes of CO2 per km2 per year, with a "market value" of about 500,000/yr. Such productivity only occurs under highly eutrophic conditions, and presumably requires significant nutrient additions. As such it would be unthinkable to pursue this technique on a large scale in extant lakes. If, however, it is possible to produce one or more large artificial lakes under acceptable conditions it is

  4. Palm oil: a healthful and cost-effective dietary component.

    PubMed

    Ong, A S H; Goh, S H

    2002-03-01

    Palm oil is an excellent choice for food manufacturers because of its nutritional benefits and versatility. The oil is highly structured to contain predominantly oleic acid at the sn2-position in the major triacylglycerols to account for the beneficial effects described in numerous nutritional studies. Oil quality and nutritional benefits have been assured for the variety of foods that can be manufactured from the oil directly or from blends with other oils while remaining trans-free. The oxidative stability coupled with the cost-effectiveness is unparalleled among cholesterol-free oils, and these values can be extended to blends of polyunsaturated oils to provide long shelf-life. Presently the supply of genetic-modification-free palm oil is assured at economic prices, since the oil palm is a perennial crop with unparalleled productivity. Numerous studies have confirmed the nutritional value of palm oil as a result of the high monounsaturation at the crucial 2-position of the oil's triacylglycerols, making the oil as healthful as olive oil. It is now recognized that the contribution of dietary fats to blood lipids and cholesterol modulation is a consequence of the digestion, absorption, and metabolism of the fats. Lipolytic hydrolysis of palm oil glycerides containing predominantly oleic acid at the 2 position and palmitic and stearic acids at the 1 and 3 positions allows for the ready absorption of the 2-monoacrylglycerols while the saturated free fatty acids remain poorly absorbed. Dietary palm oil in balanced diets generally reduced blood cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides while raising the high-density lipoprotein (HDL) cholesterol. Improved lipoprotein(a) and apo-A1 levels were also demonstrated from palm oil diets; an important benefits also comes from the lowering of blood triglycerides (or reduced fat storage) as compared with those from polyunsaturated fat diets. Virgin palm oil also provides carotenes apart from

  5. Examining the cost-effectiveness of cancer screening promotion.

    PubMed

    Andersen, M Robyn; Urban, Nicole; Ramsey, Scott; Briss, Peter A

    2004-09-01

    Cost-effectiveness analyses (CEAs) can help to quantify the contribution of the promotion of a screening program to increased participation in screening. The cost-effectiveness (C/E) of screening promotion depends in large part on the endpoints of interest. At the most fundamental level, the C/E of a strategy for promoting screening would focus on the attendance rate, or cost per person screened, and the C/E would be influenced by the costs of promotion, as well as by the size and responsiveness of the target population. In addition, the costs of screening promotion (measured as the cost per additional participant in screening) can be included in a CEA estimate of the screening technology. In this case, depending on the efficacy of the screening test and the costs and influence of the promotion, the C/E of screening may improve or become poorer. In the current study, the authors reviewed the literature on the C/E of cancer screening promotion. The following lessons were learned regarding the C/E of screening and its promotion: 1) high-quality information on the C/E of screening is increasingly available; 2) cost-effective promotion of screening is dependent on cost-effective screening strategies; 3) quality-of-life effects may be important in assessing the overall C/E of screening programs; 4) research efforts aimed at identifying cost-effective approaches to screening promotion are useful but sparse; 5) C/E studies should be better incorporated into well designed effectiveness research efforts; 6) variations in C/E according to intervention characteristics, population characteristics, and context should be evaluated in greater depth; 7) the long-term effects of screening promotion are critical to assessing C/E; 8) the effects of promotion on costs of screening must be better understood; and 9) CEA must be interpreted in light of other information. The authors showed that CEA can be a valuable tool for understanding the merits of health promotion interventions and

  6. Film-free efficiency systems: a new cost-effective approach.

    PubMed

    Reicher, M A

    1998-01-01

    Pressure is on healthcare providers to make their services more affordable. Streamlining operations to improve efficiency is one means of achieving that goal. PACS has been touted as the technology to improve radiologic services. Sold as a way to eliminate lost records and lower operations costs, in reality, PACS has raised costs and slowed work flow in many cases. Perhaps PACS that raise operations costs are more properly named digital overhead generating systems (DOGS). There is an alternative solution--film-free efficiency systems (FFES), defined as the technological tools required to lower radiologic costs and improve services. A new type of image and information management technology and distinct from traditional PACS in a number of ways, film-free efficiency systems are immediately cost effective. They improve personnel efficiency, reduce costs per RVU, provide an alternative to film and exclude the use of any technology that is not cost effective. Implementation of these systems must begin with a clearly stated mission, a leadership statement and financial accountability. To guarantee an immediate financial gain in your department, you'll want to finance the system through material cost savings. Implementation should start with the digital modalities. The next step is to retrain staff and reengineer the workplace, followed by creating the necessary infrastructure of PCs in referring physicians' offices. Lastly, implement CR or digital radiography as prices drop and technologies improve in speed. PMID:10186419

  7. Film-free efficiency systems: a new cost-effective approach.

    PubMed

    Reicher, M A

    1998-01-01

    Pressure is on healthcare providers to make their services more affordable. Streamlining operations to improve efficiency is one means of achieving that goal. PACS has been touted as the technology to improve radiologic services. Sold as a way to eliminate lost records and lower operations costs, in reality, PACS has raised costs and slowed work flow in many cases. Perhaps PACS that raise operations costs are more properly named digital overhead generating systems (DOGS). There is an alternative solution--film-free efficiency systems (FFES), defined as the technological tools required to lower radiologic costs and improve services. A new type of image and information management technology and distinct from traditional PACS in a number of ways, film-free efficiency systems are immediately cost effective. They improve personnel efficiency, reduce costs per RVU, provide an alternative to film and exclude the use of any technology that is not cost effective. Implementation of these systems must begin with a clearly stated mission, a leadership statement and financial accountability. To guarantee an immediate financial gain in your department, you'll want to finance the system through material cost savings. Implementation should start with the digital modalities. The next step is to retrain staff and reengineer the workplace, followed by creating the necessary infrastructure of PCs in referring physicians' offices. Lastly, implement CR or digital radiography as prices drop and technologies improve in speed.

  8. An fMRI study on sunk cost effect.

    PubMed

    Zeng, Jianmin; Zhang, Qinglin; Chen, Changming; Yu, Rongjun; Gong, Qiyong

    2013-06-26

    Sunk cost effect (also called escalation of commitment, etc) is a pervasive, interesting and famous decision bias, which has been intensively discussed in psychology, economics, management, political science, zoology, etc. To date, little has been known about the neural basis of this phenomenon. We investigated it by using functional magnetic resonance imaging (fMRI) to monitor healthy subjects' brain activities when they made decisions in a task wherein sunk cost and incremental cost were systematically manipulated. Higher sunk cost only increased activity of some brain areas (mainly lateral frontal and parietal cortices, which are involved in risk-taking), whereas lower incremental cost mainly increased activity of some brain areas (including striatum and medial prefrontal cortex, which are sensitive to rewards). No overlapping brain areas were found to respond to both sunk cost and incremental cost. These results favor certainty effect over self-justification or diminishing sensitivity as account of sunk cost effect.

  9. Cost-Effective TiAl based Materials

    NASA Technical Reports Server (NTRS)

    Moxson, V. S.; Sun, Fusheng; Draper, Susan L.; Froes, F. H.; Duz, V.

    2003-01-01

    Because of their inherent low ductility, TiAl-based materials are difficult to fabricate, especially thin gage titanium gamma aluminide (TiAl) sheet and foil. In this paper, an innovative powder metallurgy approach for producing cost-effective thin gage TiAl sheets (with 356 mm long and 235 mm wide, and a thickness of 0.74, 1.09, 1.55, and 2.34 mm, respectively) is presented. The microstructures and tensile properties at room and elevated temperatures of the thin gage TiAl are studied. Results show that these TiAl sheets have a relatively homogenous chemistry, uniform microstructure, and acceptable mechanical properties. This work demonstrates a cost-effective method for producing both flat products (sheet/foil) and complex chunky parts of TiAl for various advanced applications including aerospace and automotive industries.

  10. Cost-effectiveness analysis of risk-reduction measures to reach water safety targets.

    PubMed

    Lindhe, Andreas; Rosén, Lars; Norberg, Tommy; Bergstedt, Olof; Pettersson, Thomas J R

    2011-01-01

    Identifying the most suitable risk-reduction measures in drinking water systems requires a thorough analysis of possible alternatives. In addition to the effects on the risk level, also the economic aspects of the risk-reduction alternatives are commonly considered important. Drinking water supplies are complex systems and to avoid sub-optimisation of risk-reduction measures, the entire system from source to tap needs to be considered. There is a lack of methods for quantification of water supply risk reduction in an economic context for entire drinking water systems. The aim of this paper is to present a novel approach for risk assessment in combination with economic analysis to evaluate risk-reduction measures based on a source-to-tap approach. The approach combines a probabilistic and dynamic fault tree method with cost-effectiveness analysis (CEA). The developed approach comprises the following main parts: (1) quantification of risk reduction of alternatives using a probabilistic fault tree model of the entire system; (2) combination of the modelling results with CEA; and (3) evaluation of the alternatives with respect to the risk reduction, the probability of not reaching water safety targets and the cost-effectiveness. The fault tree method and CEA enable comparison of risk-reduction measures in the same quantitative unit and consider costs and uncertainties. The approach provides a structured and thorough analysis of risk-reduction measures that facilitates transparency and long-term planning of drinking water systems in order to avoid sub-optimisation of available resources for risk reduction.

  11. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa

    PubMed Central

    Hamza, Muhammad; Idris, Maryam A.; Maiyaki, Musa B.; Lamorde, Mohammed; Chippaux, Jean-Philippe; Warrell, David A.; Kuznik, Andreas; Habib, Abdulrazaq G.

    2016-01-01

    Background Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition

  12. The cost-effectiveness of bevacizumab for the treatment of advanced ovarian cancer in Canada

    PubMed Central

    Duong, M.; Wright, E.; Yin, L.; Martin-Nunez, I.; Ghatage, P.; Fung-Kee-Fung, M.

    2016-01-01

    Background The overall survival (os) analysis of the icon7 trial demonstrated that frontline ovarian cancer patients with a high risk of progression (stage iii suboptimally debulked, and stage iii or iv with unresectable disease) benefited from the addition of bevacizumab to standard chemotherapy compared with standard chemotherapy alone. The objective of the present study was to investigate the cost-effectiveness, from a Canadian publicly funded perspective, of adding bevacizumab to frontline treatment of ovarian cancer at high risk of progression. Methods An area-under-the-curve, Markov-structured model was used to estimate the cost-effectiveness of the treatments. Long-term progression-free survival (pfs) and os were extracted from the icon7 trial (subgroup at high risk of relapse) and extrapolated by parametric time-to-event functions over a time horizon of 10 years. Canadian pfs health state utility values were obtained from the EQ-5D (EuroQoL Group, Rotterdam, Netherlands) questionnaires in the icon7 high-risk patient population. Canadian post-progression utility values were consistent with those for other gynecologic cancers. Cost inputs were informed by public sources. An annual 5% efficacy and cost discount rate was applied. A probabilistic sensitivity analysis and one-way sensitivity analyses were conducted. Results Ovarian cancer patients at high risk of progression receiving bevacizumab plus standard chemotherapy experienced a mean incremental quality-adjusted life year (qaly) gain of 0.374 years. At an additional cost of $35,901.54, the incremental cost-effectiveness ratio (icer) for the addition of bevacizumab to standard chemotherapy, relative to standard chemotherapy alone, was $95,942 per qaly. Conclusions No formal health technology assessment willingness-to-pay threshold exists in Canada. However, at a threshold of $100,000 per qaly, bevacizumab in addition to chemotherapy is a cost-effective alternative for ovarian cancer patients who are at

  13. The Cost-Effectiveness of Biologics for the Treatment of Rheumatoid Arthritis: A Systematic Review

    PubMed Central

    Joensuu, Jaana T.; Huoponen, Saara; Aaltonen, Kalle J.; Konttinen, Yrjö T.; Nordström, Dan; Blom, Marja

    2015-01-01

    Background and Objectives Economic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA) are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically. Methods A literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs) of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro. Results Of the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor inhibitors (TNFi) ranged from 39,000 to 1 273,000 €/quality adjusted life year (QALY) gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs) in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi. Conclusions When 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments

  14. A cost-effectiveness worksheet for patient-education programs.

    PubMed

    Welch, Janet L; Fisher, Mary L; Dayhoff, Nancy E

    2002-07-01

    This article describes the development, implementation, and evaluation of a worksheet used by nursing faculty in a graduate clinical nurse specialist course to assist students in learning to estimate the cost-effectiveness of patient-education programs.1 The worksheet was found to be a satisfactory method of facilitating student learning and could also be used in the service arena to evaluate the cost aspects of patient-education programs.

  15. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

  16. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    PubMed Central

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status. PMID:27678365

  17. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    PubMed Central

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status.

  18. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    PubMed

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

  19. The cost effectiveness of rotavirus vaccination in Iran

    PubMed Central

    Mousavi Jarrahi, Yasaman; Zahraei, Seyed Mohsen; Sadigh, Nader; Esmaeelpoor Langeroudy, Keyhan; Khodadost, Mahmoud; Ranjbaran, Mehdi; Sanjari Moghaddam, Ali; Besharat, Mehdi; Mosavi Jarrahi, Alireza

    2016-01-01

    ABSTRACT Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran. PMID:26360331

  20. Invisible Cost Effective Mechanics for Anterior Space Closure.

    PubMed

    Jumle, Aatish Vinod; Bagrecha, Saurabh; Gharat, Ninad; Misal, Abhijit; Toshniwal, N G

    2015-01-01

    The shifting paradigm towards invisible orthodontic treatment and also awareness in patients has allured their focus towards the most esthetic treatment approach. Also the lingual treatment is proved successful and is very well accepted by the patients. The problem that persist is its high expenses, which is not affordable by all patients. This article is a effort to treat a simple Class I malocclusion with anterior spacing using a simple, esthetic, Cost effective approach with acceptable results when esthetics plays a priority role.

  1. Tuning Chemical Potential Difference across Alternately Doped Graphene p-n Junctions for High-Efficiency Photodetection.

    PubMed

    Lin, Li; Xu, Xiang; Yin, Jianbo; Sun, Jingyu; Tan, Zhenjun; Koh, Ai Leen; Wang, Huan; Peng, Hailin; Chen, Yulin; Liu, Zhongfan

    2016-07-13

    Being atomically thin, graphene-based p-n junctions hold great promise for applications in ultrasmall high-efficiency photodetectors. It is well-known that the efficiency of such photodetectors can be improved by optimizing the chemical potential difference of the graphene p-n junction. However, to date, such tuning has been limited to a few hundred millielectronvolts. To improve this critical parameter, here we report that using a temperature-controlled chemical vapor deposition process, we successfully achieved modulation-doped growth of an alternately nitrogen- and boron-doped graphene p-n junction with a tunable chemical potential difference up to 1 eV. Furthermore, such p-n junction structure can be prepared on a large scale with stable, uniform, and substitutional doping and exhibits a single-crystalline nature. This work provides a feasible method for synthesizing low-cost, large-scale, high efficiency graphene p-n junctions, thus facilitating their applications in optoelectronic and energy conversion devices.

  2. Mitochondrial Ca2+ and membrane potential, an alternative pathway for Interleukin 6 to regulate CD4 cell effector function

    PubMed Central

    Yang, Rui; Lirussi, Dario; Thornton, Tina M; Jelley-Gibbs, Dawn M; Diehl, Sean A; Case, Laure K; Madesh, Muniswamy; Taatjes, Douglas J; Teuscher, Cory; Haynes, Laura; Rincón, Mercedes

    2015-01-01

    IL-6 plays an important role in determining the fate of effector CD4 cells and the cytokines that these cells produce. Here we identify a novel molecular mechanism by which IL-6 regulates CD4 cell effector function. We show that IL-6-dependent signal facilitates the formation of mitochondrial respiratory chain supercomplexes to sustain high mitochondrial membrane potential late during activation of CD4 cells. Mitochondrial hyperpolarization caused by IL-6 is uncoupled from the production of ATP by oxidative phosphorylation. However, it is a mechanism to raise the levels of mitochondrial Ca2+ late during activation of CD4 cells. Increased levels of mitochondrial Ca2+ in the presence of IL-6 are used to prolong Il4 and Il21 expression in effector CD4 cells. Thus, the effect of IL-6 on mitochondrial membrane potential and mitochondrial Ca2+ is an alternative pathway by which IL-6 regulates effector function of CD4 cells and it could contribute to the pathogenesis of inflammatory diseases. DOI: http://dx.doi.org/10.7554/eLife.06376.001 PMID:25974216

  3. Tuning Chemical Potential Difference across Alternately Doped Graphene p-n Junctions for High-Efficiency Photodetection.

    PubMed

    Lin, Li; Xu, Xiang; Yin, Jianbo; Sun, Jingyu; Tan, Zhenjun; Koh, Ai Leen; Wang, Huan; Peng, Hailin; Chen, Yulin; Liu, Zhongfan

    2016-07-13

    Being atomically thin, graphene-based p-n junctions hold great promise for applications in ultrasmall high-efficiency photodetectors. It is well-known that the efficiency of such photodetectors can be improved by optimizing the chemical potential difference of the graphene p-n junction. However, to date, such tuning has been limited to a few hundred millielectronvolts. To improve this critical parameter, here we report that using a temperature-controlled chemical vapor deposition process, we successfully achieved modulation-doped growth of an alternately nitrogen- and boron-doped graphene p-n junction with a tunable chemical potential difference up to 1 eV. Furthermore, such p-n junction structure can be prepared on a large scale with stable, uniform, and substitutional doping and exhibits a single-crystalline nature. This work provides a feasible method for synthesizing low-cost, large-scale, high efficiency graphene p-n junctions, thus facilitating their applications in optoelectronic and energy conversion devices. PMID:27351273

  4. Chemical Ecology of the Colorado Potato Beetle, Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae), and Potential for Alternative Control Methods

    PubMed Central

    Sablon, Ludovic; Dickens, Joseph C.; Haubruge, Éric; Verheggen, François J.

    2012-01-01

    The Colorado potato beetle (CPB) has been a major insect pest to potato farming for over 150 years and various control methods have been established to reduce its impact on potato fields. Crop rotation and pesticide use are currently the most widely used approaches, although alternative methods are being developed. Here we review the role of various volatile and nonvolatile chemicals involved in behavior changes of CPB that may have potential for their control. First, we describe all volatile and nonvolatile chemicals involved in host plant localization and acceptance by CPB beetles, including glycoalcaloids and host plant volatiles used as kairomones. In the second section, we present the chemical signals used by CPB in intraspecific communication, including sex and aggregation pheromones. Some of these chemicals are used by natural enemies of CPBs to locate their prey and are presented in the third section. The last section of this review is devoted a discussion of the potential of some natural chemicals in biological control of CPB and to approaches that already reached efficient field applications. PMID:26466794

  5. Implications of weak Donnan potential in ion-exchange reactions. An alternate strategy for modeling sorption processes

    SciTech Connect

    Bhandari, V.M.

    1998-09-01

    Donnan potential generated during an ion-exchange process is conventionally believed to play an important role in partitioning co-ions in the resin and solution phases; most earlier studies implied near total exclusion of co-ions from the resin pores. The present work attempts to investigate implications of weak Donnan potential with specific reference to the sorption of acids on weak base resins. An alternate mathematical treatment has been proposed to describe the sorption behavior of any type of acid by assuming diffusion and sorption of single species, the composite acid molecule, in the resin pores. Fick`s law is then used to characterize the diffusion process. The proposed model is validated using data reported in the literature for the sorption of a strong monobasic acid (HCl) and also for a weak monobasic acid (HCOOH). The fit of the model is excellent, and the regressed values of the effective diffusion coefficient are shown to be reasonable and correct to the order of magnitude. The model is expected to offer a simpler and unified approach for modeling sorption behavior of different types of acids and will be more useful in problems of acid separation from mixtures.

  6. Chemical Ecology of the Colorado Potato Beetle, Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae), and Potential for Alternative Control Methods.

    PubMed

    Sablon, Ludovic; Dickens, Joseph C; Haubruge, Éric; Verheggen, François J

    2012-12-20

    The Colorado potato beetle (CPB) has been a major insect pest to potato farming for over 150 years and various control methods have been established to reduce its impact on potato fields. Crop rotation and pesticide use are currently the most widely used approaches, although alternative methods are being developed. Here we review the role of various volatile and nonvolatile chemicals involved in behavior changes of CPB that may have potential for their control. First, we describe all volatile and nonvolatile chemicals involved in host plant localization and acceptance by CPB beetles, including glycoalcaloids and host plant volatiles used as kairomones. In the second section, we present the chemical signals used by CPB in intraspecific communication, including sex and aggregation pheromones. Some of these chemicals are used by natural enemies of CPBs to locate their prey and are presented in the third section. The last section of this review is devoted a discussion of the potential of some natural chemicals in biological control of CPB and to approaches that already reached efficient field applications.

  7. Effect of dense plasmas on exchange-energy shifts in highly charged ions: An alternative approach for arbitrary perturbation potentials

    SciTech Connect

    Rosmej, F.; Bennadji, K.; Lisitsa, V. S.

    2011-09-15

    An alternative method of calculation of dense plasma effects on exchange-energy shifts {Delta}E{sub x} of highly charged ions is proposed which results in closed expressions for any plasma or perturbation potential. The method is based on a perturbation theory expansion for the inner atomic potential produced by charged plasma particles employing the Coulomb Green function method. This approach allows us to obtain analytic expressions and scaling laws with respect to the electron temperature T, density n{sub e}, and nuclear charge Z. To demonstrate the power of the present method, two specific models were considered in detail: the ion sphere model (ISM) and the Debye screening model (DSM). We demonstrate that analytical expressions can be obtained even for the finite temperature ISM. Calculations have been carried out for the singlet 1s2p{sup 1} P{sub 1} and triplet 1s2p{sup 3} P{sub 1} configurations of He-like ions with charge Z that can be observed in dense plasmas via the He-like resonance and intercombination lines. Finally we discuss recently available purely numerical calculations and experimental data.

  8. Cost-effectiveness analysis for health communication programs.

    PubMed

    Guilkey, David K; Hutchinson, Paul; Lance, Peter

    2006-01-01

    This article describes methods for analyzing the cost-effectiveness of health communication programs, focusing in particular on estimating program effectiveness with econometric methods that address experimental and quasi-experimental designs (and their absence), national or subnational program coverage, and endogenously targeting of programs. Experimental designs provide a gold standard for assessing effectiveness but are seldom feasible for large-scale health communication programs. Even in the absence of such designs, however, fairly simple methods can be used to examine intermediate objectives, such as program reach, which in turn can be linked to program costs to estimate cost effectiveness. When moving beyond program reach to behavioral or other outcome measures, such as contraceptive use or fertility, or when faced with full-coverage national programs, more elaborate data and methods are required. We discuss data requirements and assumptions necessary in each case, focusing on single-equation multiple regression models, structural equations models, and fixed effects estimators for use with longitudinal data, and then describing how cost information can be incorporated into econometric models so as to get measures of the cost-effectiveness of communication interventions.

  9. Cost-effectiveness in Clostridium difficile treatment decision-making

    PubMed Central

    Nuijten, Mark JC; Keller, Josbert J; Visser, Caroline E; Redekop, Ken; Claassen, Eric; Speelman, Peter; Pronk, Marja H

    2015-01-01

    AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI). METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines. RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI. PMID:26601096

  10. Cost-effectiveness of antiretroviral therapy expansion strategies in Vietnam.

    PubMed

    Tran, Dam Anh; Wilson, David P; Shakeshaft, Anthony; Ngo, Anh Duc; Reyes, Josephine; Doran, Christopher; Zhang, Lei

    2014-07-01

    This study determines an optimal strategy for scaling up ART in Vietnam by examining three initiation thresholds [350 cells/mm(3), 500 cells/mm(3), and treat all people living with HIV (PLHIV) regardless of CD4 cell counts] and treatment commencement rates among treatment-eligible PLHIV ranging from 5% to 100% within 12 months of diagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated using a Markov model, based on data from a cohort of 3449 patients who initiated ART between January 1, 2005 and December 31, 2009 in 13 outpatient clinics across six provinces in Vietnam. Our analyses indicated that raising treatment eligibility criteria, in line with WHO guidelines (CD4 ≤500 cells/mm(3)) or removing CD4-based criteria would both be cost-effective in Vietnam. However, the cost-effective strategy from an economic viewpoint is first to increase coverage substantially among those with lowest CD4 levels, and only when coverage increases towards saturation should initiation criteria be lifted. Universal coverage under current guidelines would cost an additional $85 million and $96 million per year if the treatment threshold was 500 cells/mm(3). These scenarios would avert 15,000 and 22,000 HIV-related deaths in 2010-2019, with ICERs of $500-$660 per QALY gained. It is imperative to increase treatment coverage for newly diagnosed PLHIV in Vietnam according to the current guidelines prior to increasing the CD4 threshold for ART initiation.

  11. Cost-effectiveness of assisted conception for male subfertility.

    PubMed

    Moolenaar, Lobke M; Cissen, Maarje; de Bruin, Jan Peter; Hompes, Peter G A; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J

    2015-06-01

    Intrauterine insemination (IUI), with or without ovarian stimulation, IVF and intracytoplasmatic sperm injection (ICSI) are frequently used treatments for couples with male subfertility. No consensus has been reached on specific cut-off values for semen parameters, at which IVF would be advocated over IUI and ICSI over IVF. The aim of this study was to evaluate the cost-effectiveness of interventions for male subfertility according to total motile sperm count (TMSC). A computer-simulated cohort of subfertile women aged 30 years with a partner was analysed with a pre-wash TMSC of 0 to 10 million. Three treatments were evaluated: IUI with and without controlled ovarian stimulation; IVF; and ICSI. Main outcome was expected live birth; secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. The choice of IVF over IUI with ovarian stimulation and ICSI over IVF depends on the willingness to pay for an extra live birth. If only cost per live birth is considered for each treatment, above a pre-wash TMSC of 3 million, IUI is less costly than IVF and, below a pre-wash, TMSC of 3 million ICSI is less costly. Effectiveness needs to be confirmed in a large randomized controlled trial.

  12. Cost-effectiveness of assisted conception for male subfertility.

    PubMed

    Moolenaar, Lobke M; Cissen, Maarje; de Bruin, Jan Peter; Hompes, Peter G A; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J

    2015-06-01

    Intrauterine insemination (IUI), with or without ovarian stimulation, IVF and intracytoplasmatic sperm injection (ICSI) are frequently used treatments for couples with male subfertility. No consensus has been reached on specific cut-off values for semen parameters, at which IVF would be advocated over IUI and ICSI over IVF. The aim of this study was to evaluate the cost-effectiveness of interventions for male subfertility according to total motile sperm count (TMSC). A computer-simulated cohort of subfertile women aged 30 years with a partner was analysed with a pre-wash TMSC of 0 to 10 million. Three treatments were evaluated: IUI with and without controlled ovarian stimulation; IVF; and ICSI. Main outcome was expected live birth; secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. The choice of IVF over IUI with ovarian stimulation and ICSI over IVF depends on the willingness to pay for an extra live birth. If only cost per live birth is considered for each treatment, above a pre-wash TMSC of 3 million, IUI is less costly than IVF and, below a pre-wash, TMSC of 3 million ICSI is less costly. Effectiveness needs to be confirmed in a large randomized controlled trial. PMID:25900905

  13. Cost-effectiveness of primary tetanus vaccination among elderly Canadians.

    PubMed

    Hutchison, B G; Stoddart, G L

    1988-12-15

    Although tetanus is now rare, vaccination is currently recommended for the entire population. Most elderly North Americans have never received tetanus vaccination. We evaluated the expected cost-effectiveness of using mailed reminders from family physicians to increase primary tetanus vaccination coverage among elderly Canadians. We estimated that over 10 years the program would prevent five cases of tetanus and one death from tetanus, resulting in a gain of 13 life-years. There would be 16,700 adverse reactions to tetanus toxoid, 17% in people already immune to tetanus. The net cost of the program (in 1984 Canadian dollars) would be $1.9 million per case of tetanus prevented, $7.1 million per death prevented and $810,000 per life-year gained. These high cost-effectiveness ratios are largely attributable to the very low risk of tetanus, even among nonimmune elderly people. Tetanus toxoid and physicians' services for vaccination would account for 86% of the program costs. Because the mailed reminders would be responsible for only 13% of the program costs, other possible programs to increase primary tetanus vaccination coverage could not be expected to have substantially lower cost-effectiveness ratios. We conclude that efforts to increase primary tetanus vaccination coverage among elderly Canadians would be a questionable use of health care resources.

  14. Cost-effectiveness of voluntary HIV screening in Russia.

    PubMed

    Tole, S P; Sanders, G D; Bayoumi, A M; Galvin, C M; Vinichenko, T N; Brandeau, M L; Owens, D K

    2009-01-01

    Russia has one of the world's fastest growing HIV epidemics, and HIV screening has been widespread. Whether such screening is an effective use of resources is unclear. We used epidemiologic and economic data from Russia to develop a Markov model to estimate costs, quality of life and survival associated with a voluntary HIV screening programme compared with no screening in Russia. We measured discounted lifetime health-care costs and quality-adjusted life years (QALYs) gained. We varied our inputs in sensitivity analysis. Early identification of HIV through screening provided a substantial benefit to persons with HIV, increasing life expectancy by 2.1 years and 1.7 QALYs. At a base-case prevalence of 1.2%, once-per-lifetime screening cost $13,396 per QALY gained, exclusive of benefit from reduced transmission. Cost-effectiveness of screening remained favourable until prevalence dropped below 0.04%. When HIV-transmission-related costs and benefits were included, once-per-lifetime screening cost $6910 per QALY gained and screening every two years cost $27,696 per QALY gained. An important determinant of the cost-effectiveness of screening was effectiveness of counselling about risk reduction. Early identification of HIV infection through screening in Russia is effective and cost-effective in all but the lowest prevalence groups.

  15. Analytical tools for planning cost-effective surveillance in Gambiense sleeping sickness.

    PubMed

    Shaw, A P; Cattand, P

    2001-01-01

    The re-emergence of sleeping sickness as a major health problem in parts of Africa, combined with the new sources of financial support and provision of drugs means that an investigation of the cost-effectiveness of the different approaches is timely. There has been very little work done on the economics of controlling either form of sleeping sickness. This paper builds on work done for WHO by the authors on developing a framework for analysing the cost-effectiveness of different methods for surveillance in gambiense sleeping sickness. The framework has been used to build a spreadsheet which makes it possible to simulate the effects of controlling the disease at different prevalences, for example using mobile teams or various forms of fixed post surveillance and screening different proportions of the population in a year. Prices, control strategies, prevalence, sensitivity and specificity of tests are all variables which can be altered to suit different situations or investigate how different approaches perform. As new research is beginning to produce calculations of the burden of sleeping sickness, in terms of disability-adjusted life years (DALY) potentially averted by controlling the disease, it is possible to combine these DALY estimates with the analyses of cost-effectiveness undertaken in these exercises to look at the cost-utility of the work, both to compare different approaches and demonstrate that controlling sleeping sickness represents good value for money as an investment in health.

  16. The role of cognition in cost-effectiveness analyses of behavioral interventions

    PubMed Central

    2012-01-01

    Background Behavioral interventions typically focus on objective behavioral endpoints like weight loss and smoking cessation. In reality, though, achieving full behavior change is a complex process in which several steps towards success are taken. Any progress in this process may also be considered as a beneficial outcome of the intervention, assuming that this increases the likelihood to achieve successful behavior change eventually. Until recently, there has been little consideration about whether partial behavior change at follow-up should be incorporated in cost-effectiveness analyses (CEAs). The aim of this explorative review is to identify CEAs of behavioral interventions in which cognitive outcome measures of behavior change are analyzed. Methods Data sources were searched for publications before May 2011. Results Twelve studies were found eligible for inclusion. Two different approaches were found: three studies calculated separate incremental cost-effectiveness ratios for cognitive outcome measures, and one study modeled partial behavior change into the final outcome. Both approaches rely on the assumption, be it implicitly or explicitly, that changes in cognitive outcome measures are predictive of future behavior change and may affect CEA outcomes. Conclusion Potential value of cognitive states in CEA, as a way to account for partial behavior change, is to some extent recognized but not (yet) integrated in the field. In conclusion, CEAs should consider, and where appropriate incorporate measures of partial behavior change when reporting effectiveness and hence cost-effectiveness. PMID:22380627

  17. Recruitment of mental health survey participants using Internet advertising: content, characteristics and cost effectiveness.

    PubMed

    Batterham, Philip J

    2014-06-01

    Postal and telephone survey research is threatened by declining response rates and high cost. Online recruitment is becoming more popular, although there is little empirical evidence about its cost-effectiveness or the representativeness of online samples. There is also limited research on optimal strategies for developing advertising content for online recruitment. The present study aimed to assess these aspects of online recruitment. Two mental health surveys used advertisements within a social network website (Facebook) to recruit adult Australian participants. The initial survey used advertisements linking directly to an external survey website, and recruited 1283 participants at $9.82 per completed survey. A subsequent survey used advertisements linking to a Facebook page that featured links to the external survey, recruiting 610 participants at $1.51 per completion. Both surveys were more cost-effective than similar postal surveys conducted previously, which averaged $19.10 per completion. Online and postal surveys both had somewhat unrepresentative samples. However, online surveys tended to be more successful in recruiting hard-to-reach populations. Advertising using "problem" terminology was more effective than "positive" terminology, while there was no significant effect of altruistic versus self-gain terminology. Online recruitment is efficient, flexible and cost-effective, suggesting that online recruitment has considerable potential for specific research designs. PMID:24615785

  18. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    PubMed

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  19. Recruitment of mental health survey participants using Internet advertising: content, characteristics and cost effectiveness.

    PubMed

    Batterham, Philip J

    2014-06-01

    Postal and telephone survey research is threatened by declining response rates and high cost. Online recruitment is becoming more popular, although there is little empirical evidence about its cost-effectiveness or the representativeness of online samples. There is also limited research on optimal strategies for developing advertising content for online recruitment. The present study aimed to assess these aspects of online recruitment. Two mental health surveys used advertisements within a social network website (Facebook) to recruit adult Australian participants. The initial survey used advertisements linking directly to an external survey website, and recruited 1283 participants at $9.82 per completed survey. A subsequent survey used advertisements linking to a Facebook page that featured links to the external survey, recruiting 610 participants at $1.51 per completion. Both surveys were more cost-effective than similar postal surveys conducted previously, which averaged $19.10 per completion. Online and postal surveys both had somewhat unrepresentative samples. However, online surveys tended to be more successful in recruiting hard-to-reach populations. Advertising using "problem" terminology was more effective than "positive" terminology, while there was no significant effect of altruistic versus self-gain terminology. Online recruitment is efficient, flexible and cost-effective, suggesting that online recruitment has considerable potential for specific research designs.

  20. Cost-effectiveness of ocriplasmin for the treatment of vitreomacular traction and macular hole

    PubMed Central

    Bennison, Craig; Stephens, Stephanie; Lescrauwaet, Benedicte; Van Hout, Ben; Jackson, Timothy L.

    2016-01-01

    Background If left untreated, vitreomacular traction (VMT) will infrequently improve through spontaneous resolution of vitreomacular adhesion (VMA), and patients remain at risk of further deterioration in vision. The mainstay of treatment for VMT is vitrectomy, an invasive procedure that carries the risk of rare but serious complications and further vision loss. As such, a ‘watch and wait’ approach is often adopted before this surgical intervention is performed. Ocriplasmin (microplasmin) is a potential alternative treatment for patients with symptomatic VMA/VMT that may remove the requirement for vitrectomy. Objective The purpose of this study was to evaluate the cost-effectiveness of ocriplasmin for the treatment of VMT in comparison to standard of care. Study design A cohort-based computer simulation model was developed, capturing three mutually exclusive subgroups: 1) VMT without epiretinal membrane (ERM) or full thickness macular hole (FTMH), 2) VMT with ERM but no FTMH, and 3) VMT with FTMH. Transition probabilities between health states, utilities, and resource utilisation were estimated based on clinical trial results, the literature, and expert opinion. The cost per quality-adjusted life year (QALY) gained was estimated over a lifetime, using UK unit costs and utilities associated with visual acuity, adverse events, metamorphopsia, and surgical interventions. Setting Analyses were conducted from a UK payer perspective. Population Transition probabilities for the model were primarily estimated from patient-level data from the combined Phase 3 MIVI-TRUST trials in patients with symptomatic VMA/VMT, including when associated with a FTMH ≤400 µm. Intervention Ocriplasmin (microplasmin) is a one-time intravitreal injection designed specifically to release the abnormal traction between the macula and the vitreous and thereby treat VMT, as well as macular hole with persistent vitreous attachment. Main outcome measure The main outcome measure of the

  1. Cost-Effectiveness of an Electronic Medical Record Based Clinical Decision Support System

    PubMed Central

    Gilmer, Todd P; O'Connor, Patrick J; Sperl-Hillen, JoAnn M; Rush, William A; Johnson, Paul E; Amundson, Gerald H; Asche, Stephen E; Ekstrom, Heidi L

    2012-01-01

    Background and Objective Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The United Kingdom Prospective Diabetes Study Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality-adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (0.26 percent, p = .014) relative to patients in the control arm. Intervention costs were $120 (SE = 45) per patient in the first year and $76 (SE = 45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE = 0.01) and increased lifetime costs by $112 (SE = 660), resulting in an incremental cost-effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two-way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system. PMID:22578085

  2. Cost effectiveness analysis of early zidovudine treatment of HIV infected patients.

    PubMed

    Oddone, E Z; Cowper, P; Hamilton, J D; Matchar, D B; Hartigan, P; Samsa, G; Simberkoff, M; Feussner, J R

    1993-11-20

    OBJECTIVE--To compare cost effectiveness of early and later treatment with zidovudine for patients infected with HIV. DESIGN--Markov chain analysis of cost effectiveness based on results of use of health care and efficacy from a trial of zidovudine treatment. SETTING--Seven Veterans Affairs medical centres in the United States. SUBJECTS--338 patients with symptomatic HIV infection and a lymphocyte count of 200 x 10(6) to 500 x 10(6) CD4 cells/l. INTERVENTIONS--Zidovudine 1500 mg/day started either at recruitment to the trial or when CD4 cell count fell below 200 x 10(6)/l. MAIN OUTCOME MEASURES--Health care costs and rates of disease progression between six clinical states of HIV infection. RESULTS--Patients given early treatment with zidovudine remained without AIDS for an extra two months at a cost of $10,750 for each extra month without AIDS (at 1991 costs). Cost effectiveness ratio was most sensitive to the cost of zidovudine and to the quality of life of patients receiving early treatment. At treatment of 500 mg/day the cost effectiveness ratio for early treatment was $5432 for each extra month without AIDS. Patients given early treatment experienced more side effects, and if their quality of life was devalued by 8% compared with patients treated later the two treatments were equivalent in terms of quality adjusted months of life without AIDS. CONCLUSIONS--Early treatment with zidovudine is expensive and is very sensitive to the cost of zidovudine and to potential reductions in quality of life of patients who experience side effects. Doctors should reconsider early treatment with zidovudine for patients who experience side effects that substantially compromise their quality of life. PMID:8257887

  3. Cost-effectiveness of provider-based HIV partner notification in urban Malawi

    PubMed Central

    Rutstein, Sarah E; Brown, Lillian B; Biddle, Andrea K; Wheeler, Stephanie B; Kamanga, Gift; Mmodzi, Pearson; Nyirenda, Naomi; Mofolo, Innocent; Rosenberg, Nora E; Hoffman, Irving F; Miller, William C

    2014-01-01

    -based notification strategies are potentially cost-effective for identifying new cases of HIV. These strategies offer a simple, effective and easily implementable opportunity to control HIV transmission. PMID:23325584

  4. Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries.

    PubMed

    Knight, Gwenan M; Griffiths, Ulla K; Sumner, Tom; Laurence, Yoko V; Gheorghe, Adrian; Vassall, Anna; Glaziou, Philippe; White, Richard G

    2014-10-28

    To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40-80% efficacy, and to be targeted at "infants" or "adolescents/adults." Vaccine prices were tiered by income group (US $1.50-$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024-2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11-24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42-1.58) million TB cases could be prevented at $1,692 ($634-$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle-, and upper-middle-income countries, respectively. Increased investments in adult-targeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies.

  5. Cost-effectiveness of methadone maintenance treatment for HIV-positive drug users in Vietnam.

    PubMed

    Tran, Bach Xuan; Ohinmaa, Arto; Duong, Anh Thuy; Do, Nhan Thi; Nguyen, Long Thanh; Mills, Steve; Houston, Stan; Jacobs, Philip

    2012-01-01

    Methadone maintenance treatment (MMT) is efficacious in reducing drug use that may improve HIV/AIDS care and treatment outcomes. This study evaluated the incremental cost-effectiveness of MMT for HIV-positive drug users from the perspective of health service providers. A sample of 370 HIV-positive drug users (age: mean ± SD: 29.5 ± 5.9 years; 95.7% male) taking MMT in multi-sites was assessed at baseline, three, six and nine months. Costs of MMT services were analyzed and converted to the year 2009. Quality-adjusted life years (QALYs) were modeled from changes in health-related quality of life of patients using the modified World Health Organization Quality of Life - Brief Version (WHOQOL-BREF). Inverse probability-of-treatment weights, constructed using propensity score of non-responses, were applied to adjust for potential confounding. Over nine months, MMT substantially improved QALYs of HIV/AIDS patients (0.076 QALY [0.066-0.084]). The increments in QALY were large and stabilized in those patients taking antiretroviral treatment and abstinent to drug use. For one QALY gained, the MMT program would cost US$3745.3, approximately 3.2 times Vietnam GDP per capita in 2009. The cost-effectiveness of MMT intervention was robust against HIV advanced status or co-morbidity, e.g., TB treatment, but it might not be cost-effective for those patients who continued to use drug. Findings of this study indicate that providing MMT for HIV-positive drug users is a cost-effective intervention in Vietnam. Integrating MMT to HIV/AIDS care and treatment services would be beneficial in injection-driven HIV epidemics.

  6. Cost-Effectiveness of Rotavirus Vaccination in Bolivia from the State Perspective

    PubMed Central

    Smith, Emily R.; Rowlinson, Emily E.; Iniguez, Volga; Etienne, Kizee A.; Rivera, Rosario; Mamani, Nataniel; Rheingans, Rick; Patzi, Maritza; Halkyer, Percy; Leon, Juan S.

    2011-01-01

    BACKGROUND In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state’s policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. METHODS To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6,751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. RESULTS Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. DISCUSSION Our data will guide Bolivia’s funding allocation for RV as international subsidies change. PMID:21624421

  7. Home-based viewing (el velorio) after death: a cost-effective alternative for some families.

    PubMed

    Gonzalez, Faustino; Hereira, Mildreys

    2008-01-01

    After the death of a loved one, giving an opportunity to view the body helps bring families and friends together to celebrate the life and mourn the passing of a person. This gathering, known as a Wake or a Viewing, precedes the burial and usually lasts from 1 to several days. In the United States, the viewing now takes place in funeral parlors, away from the decedent's home. However, there are still several countries and people who keep the body at home where the family and friends are invited to say their goodbyes. We present here 2 cases for which our Hospice assisted the families with a home viewing. These were indigent people who could not afford embalming or the additional cost of a viewing in a parlor and who, without this opportunity, would have not had time to get together and mourn and celebrate life as friends, family, and community.

  8. Build Your Own Board: Brightboards Offer a Cost-Effective Alternative to Interactive Whiteboards

    ERIC Educational Resources Information Center

    Vallis, Keith; Williamson, Peter

    2009-01-01

    Interactive whiteboards are all the rage in classrooms across the world these days, and for good reason. Like most technology, they hold students' attention much better than a traditional lecture-and-blackboard lesson ever could. They also solve the problem of having only one classroom computer for 30 students by projecting the screen at the front…

  9. Basic Education and Agricultural Extension. Costs, Effects, and Alternatives. World Bank Staff Working Papers Number 564.

    ERIC Educational Resources Information Center

    Perraton, Hilary; And Others

    The five papers in this volume examine the methods, costs, and effects of traditional agricultural extension services and basic education and about the use of mass media for extension and education. The first paper, a literature review regarding the effectiveness of agricultural extension, reports that extension agents' studies of internal…

  10. Michigan State Code Adoption Analysis: Cost-Effectiveness of Lighting Requirements - ASHRAE/IESNA 90.1-2004

    SciTech Connect

    Richman, Eric E.

    2006-09-29

    This report documents PNNL's analysis of the potential energy effect and cost-effectiveness of the lighting requirements in ASHRAE/IESNA 90.1-2004 if this energy code is adopted in the state of Michigan, instead of the current standard.

  11. Is Taurolidine-citrate an effective and cost-effective hemodialysis catheter lock solution? A systematic review and cost- effectiveness analysis

    PubMed Central

    Kavosi, Zahra; Sarikhani Khorrami, Maryam; Keshavarz, Khosro; Jafari, Abdosaleh; Hashemi Meshkini, Amir; Safaei, Hamid Reza; Nikfar, Shekoufeh

    2016-01-01

    Background: Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran. Methods: To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases. The outcomes of interest for cost-effectiveness analysis were as follows: "Catheter-related bacteremia episodes"; "catheter-related bacteremia-free survival"; "catheter thrombosis rate" for efficacy evaluation and "reduction of catheter-related infection". For evidence synthesis, a meta-analysis was conducted on the extracted efficacy data. To evaluate the cost of treatments, direct medical costs were included, and the incremental cost-effectiveness ratio was calculated for each comparison. The payers’ (patients and insurance companies) perspectives were used for cost analysis. Results: After carrying out the systematic process, three articles were included in the analysis. Considering 95% confidence interval, the relative difference was -0.16 (-0.25 to -0.07) for catheterrelated bacteremia episode, indicating that the rate of catheter-related infections in hemodialysis patients who used taurolidine-citrate was 16% less than in those hemodialysis patients who received heparin. Considering 95% confidence interval, the relative difference was 0.13 (-0.06 0.32) for catheter thrombosis, showing that the rate of catheter-related thrombosis in hemodialysis patients who used taurolidine-citrate was 13% more than in hemodialysis patients who received heparin. The results of this analysis indicated that taurolidine-citrate, compared to heparin, was more effective in preventing catheter-related infection; therefore, it could be

  12. Finding Alternatives to the Dogma of Power Based Sample Size Calculation: Is a Fixed Sample Size Prospective Meta-Experiment a Potential Alternative?

    PubMed Central

    Tavernier, Elsa; Trinquart, Ludovic; Giraudeau, Bruno

    2016-01-01

    Sample sizes for randomized controlled trials are typically based on power calculations. They require us to specify values for parameters such as the treatment effect, which is often difficult because we lack sufficient prior information. The objective of this paper is to provide an alternative design which circumvents the need for sample size calculation. In a simulation study, we compared a meta-experiment approach to the classical approach to assess treatment efficacy. The meta-experiment approach involves use of meta-analyzed results from 3 randomized trials of fixed sample size, 100 subjects. The classical approach involves a single randomized trial with the sample size calculated on the basis of an a priori-formulated hypothesis. For the sample size calculation in the classical approach, we used observed articles to characterize errors made on the formulated hypothesis. A prospective meta-analysis of data from trials of fixed sample size provided the same precision, power and type I error rate, on average, as the classical approach. The meta-experiment approach may provide an alternative design which does not require a sample size calculation and addresses the essential need for study replication; results may have greater external validity. PMID:27362939

  13. Energy potential and alternative usages of biogas and sludge from UASB reactors: case study of the Laboreaux wastewater treatment plant.

    PubMed

    Rosa, A P; Conesa, J A; Fullana, A; Melo, G C B; Borges, J M; Chernicharo, C A L

    2016-01-01

    This work assessed the energy potential and alternative usages of biogas and sludge generated in upflow anaerobic sludge blanket reactors at the Laboreaux sewage treatment plant (STP), Brazil. Two scenarios were considered: (i) priority use of biogas for the thermal drying of dehydrated sludge and the use of the excess biogas for electricity generation in an ICE (internal combustion engine); and (ii) priority use of biogas for electricity generation and the use of the heat of the engine exhaust gases for the thermal drying of the sludge. Scenario 1 showed that the electricity generated is able to supply 22.2% of the STP power demand, but the thermal drying process enables a greater reduction or even elimination of the final volume of sludge to be disposed. In Scenario 2, the electricity generated is able to supply 57.6% of the STP power demand; however, the heat in the exhaust gases is not enough to dry the total amount of dehydrated sludge. PMID:27054741

  14. An assessment of potential degradation products in the gas-phase reactions of alternative fluorocarbons in the troposphere

    NASA Technical Reports Server (NTRS)

    Niki, Hiromi

    1990-01-01

    Tropospheric chemical transformations of alternative hydrofluorocarbons (HCF's) and hydrochlorofluorocarbons (HCFC's) are governed by hydroxyl radical initiated oxidation processes, which are likely to be analogous to those known for alkanes and chloroalkanes. A schematic diagram is used to illustrate plausible reaction mechanisms for their atmospheric degradation, where R, R', and R'' denote the F- and/or Cl-substituted alkyl groups derived from HCF's and HCFC's subsequent th the initial H atom abstraction by HO radicals. At present, virtually no kinetic data exist for the majority of these reactions, particularly for those involving RO. Potential degradation intermediates and final products include a large variety of fluorine- and/or chlorine-containing carbonyls, acids, peroxy acids, alcohols, hydrogen peroxides, nitrates and peroxy nitrates, as summarized in the attached table. Probably atmospheric lifetimes of these compounds were also estimated. For some carbonyl and nitrate products shown in this table, there seem to be no significant gas-phase removal mechanisms. Further chemical kinetics and photochemical data are needed to quantitatively assess the atmospheric fate of HCF's and HCFC's, and of the degradation products postulated in this report.

  15. Potential contribution of ENVISAT ASAR alternating polarisation and Wide-Swath modes images for crop discrimination at the regional scale

    NASA Astrophysics Data System (ADS)

    Blaes, X.; Holeck, F.; Defourny, P.

    2002-01-01

    This experimental study was carried out in the framework of the DUP project "Dedicated Remote Sensing Product Generation for the Agro-Industry: Cereal Case" leaded by Synoptics b.v. (NL). The main objective is to investigate the potential contribution of the ENVISAT images for the discrimination of the main crops at a regional scale. ASAR Alternating Polarisation (AP and Wide Swath (WS) modes have been simulated from 15 ERS images over Belgium. A quantitative approach was completed using 791 parcels corresponding to the following crops: winter wheat, winter barley, spring wheat, spring barley, grasses, sugar beet, maize and potato. The impact of the spatial resolution of the ASAR sensor is assessed through the comparison of the results obtained for the AP (30m) and WS (150m) modes with regards to the field size. Both pixel-based and parcel-based unsupervised classification approaches have been applied. Dedicated interpretation schemes were developed for specific crop discrimination. The promising results obtained from the 150-m ASAR signal are expected to be further enhanced by the very high acquisition rate of the WS mode, i.e. an acquisition every 3 to 5 days.

  16. PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series

    PubMed Central

    Walter, Jan; Kuhn, Susanne Antje; Reichart, Rupert; Kalff, Rolf

    2010-01-01

    The surgical management of cervical spondylodiscitis consists of the resection of the affected disc, the decompression of the cervical spinal cord, followed by the stabilization using an autologous bone graft or a titanium implant combined with a ventral plate fixation. Until now, there were no studies about the practicability and putative safety of PEEK cages in cervical spine infection. Now, we present the history of five patients suffering from neurological deficits and septicemia caused by mono- or bisegmental pyogenic cervical discitis and intraspinal abscess without severe bone destruction. Patients were treated surgically by discectomy, decompression, and ventral spondylodesis. The disc was replaced by a PEEK cage without additional fixation. Progressive bony fusion and complete regression of the inflammatory changes was demonstrated 7–8 months later by a computer assisted tomography and contrast enhanced magnetic resonance imaging, respectively. The vertebral alignment changed minimally; the cages developed only a slight average subsidence. The clinical symptoms improved in all patients significantly. Neck pain or instability was never observed. Nevertheless, prospective investigations of a larger patient series are mandatory. We suppose that the use of PEEK cages represents a potential and safe alternative in the treatment of cervical spondylodiscitis in selected patients. PMID:20069319

  17. Establishment of alternative potency test for botulinum toxin type A using compound muscle action potential (CMAP) in rats.

    PubMed

    Torii, Yasushi; Goto, Yoshitaka; Nakahira, Shinji; Ginnaga, Akihiro

    2014-11-01

    The biological activity of botulinum toxin type A has been evaluated using the mouse intraperitoneal (ip) LD50 test. This method requires a large number of mice to precisely determine toxin activity, and, as such, poses problems with regard to animal welfare. We previously developed a compound muscle action potential (CMAP) assay using rats as an alternative method to the mouse ip LD50 test. In this study, to evaluate this quantitative method of measuring toxin activity using CMAP, we assessed the parameters necessary for quantitative tests according to ICH Q2 (R1). This assay could be used to evaluate the activity of the toxin, even when inactive toxin was mixed with the sample. To reduce the number of animals needed, this assay was set to measure two samples per animal. Linearity was detected over a range of 0.1-12.8 U/mL, and the measurement range was set at 0.4-6.4 U/mL. The results for accuracy and precision showed low variability. The body weight was selected as a variable factor, but it showed no effect on the CMAP amplitude. In this study, potency tests using the rat CMAP assay of botulinum toxin type A demonstrated that it met the criteria for a quantitative analysis method.

  18. Cost-effectiveness of digital mammography screening before the age of 50 in The Netherlands.

    PubMed

    Sankatsing, Valérie D V; Heijnsdijk, Eveline A M; van Luijt, Paula A; van Ravesteyn, Nicolien T; Fracheboud, Jacques; de Koning, Harry J

    2015-10-15

    In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost €3,376/LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at €5,329 (biennial 48-74 vs. current strategy), €7,628 (biennial 45-74 vs. biennial 48-74), €10,826 (biennial 40-74 vs. biennial 45-74) and €18,759 (annual 40-49 + biennial 50-74 vs. biennial 40-74). Other strategies (49 + biennial 50-74 and annual 45-49 + biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.

  19. [Threshold values for cost-effectiveness ratio and public funding of medical technologies].

    PubMed

    Rabinovich, Mordechai; Greenberg, Dan; Shemer, Joshua

    2007-06-01

    Rising healthcare costs, together with the rapid emergence of new and expensive medical technologies, have facilitated the use of economic analyses for making coverage decisions. The use of cost-effectiveness studies requires an external criterion (threshold value) for the cost-effectiveness ratio, below which funding would be recommended. Although such a threshold reflects the societal value of a full-quality life-year, currently accepted thresholds have been determined arbitrarily. Studies that screened hundreds of cost-effectiveness analyses have found that the most commonly used threshold is $US 50,000 for an additional QALY (Quality Adjusted Life-Year). This figure reflects the estimated cost per QALY to the US Medicare plan for funding a dialysis treatment for patients with chronic renal failure. While healthcare systems throughout the world, as in Israel, have not explicitly declared using a specific threshold for coverage decisions, some countries use an implicit threshold, above which the decision would usually be negative. In the UK and Australia, for instance, the implicit threshold is $US 50,000 to $US 60,000 per QALY. There are several suggestions to set a differential threshold value between countries, associated with their relative wealth, or between diverse disease and treatment characteristics, e.g. higher thresholds for life-saving treatments. Advantages of setting an explicit threshold include improved transparency and consistency of decisions, improved social equity and enhanced public credibility. Draw-backs might be the creation of an excessively mechanical decision-making process, without consideration of other relevant variables, such as severity of disease, existence of alternatives, or the economic burden to the patient. Adoption of a "flexible threshold" approach, in which the threshold is not the exclusive criterion for decision-making, might resolve these weaknesses. Utilization of the threshold concept is likely to expand in the coming

  20. Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

    PubMed Central

    Miravitlles, Marc; Gáldiz, Juan B; Huerta, Alicia; Villacampa, Alba; Carcedo, David; Garcia-Rio, Francisco

    2016-01-01

    Purpose Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective. Methods A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed. Results UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY. Conclusion UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective. PMID:26848262